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Keith P. West - One of the best experts on this subject based on the ideXlab platform.
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the use and interpretation of serum retinol distributions in evaluating the public health impact of vitamin a programmes
Public Health Nutrition, 2012Co-Authors: Amanda C Palmer, Keith P. West, Nita Dalmiya, Werner SchultinkAbstract:OBJECTIVE Developing countries have adopted universal, high-potency vitamin A (VA) supplementation and food fortification as major strategies to control deficiency, prevent nutritional blindness and reduce child mortality. Yet questions persist regarding how best to measure impact and when to phase out supplementation. The present paper provides guidance on the use and interpretation of serum retinol (SROL) distributions as indicators of both programme impact and adequate VA intake in a population. DESIGN We reviewed extant data on SROL's response to high-potency VA supplementation and VA-fortified foods in children. RESULTS Supplementation virtually eliminates Xerophthalmia and reduces child mortality; however, it shifts the SROL distribution only transiently (<2 months). Regular consumption of VA-fortified foods prevents Xerophthalmia, lowers mortality and sustainably improves SROL distributions, from which both compliance and public health impact can be inferred. CONCLUSIONS Given SROL's limited responsiveness to high-potency VA supplementation, target population coverage remains the preferred performance indicator. However, periodic SROL surveys do reflect underlying dietary risk and can guide programming: low or marginal SROL distributions in areas with high supplementation coverage do not signify programme failure, but rather suggest the need to continue supplementation while working to effectively raise dietary VA intakes. We propose that a sustained rise in the SROL distribution, defined as ≤5 % prevalence of SROL < 0·70 μmol/l among vulnerable population groups in at least two consecutive surveys (≥1 year apart), be used as an indicator of stable and adequate dietary VA intake and status in a population, at which point programmes may re-evaluate the need for continued universal supplementation.
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vitamin a deficiency and Xerophthalmia among school aged children in southeastern asia
European Journal of Clinical Nutrition, 2004Co-Authors: Veena Singh, Keith P. WestAbstract:Objective: To determine provisional estimates of the extent of vitamin A (VA) deficiency and Xerophthalmia among school-aged children. Design: Literature search of published, unpublished and website-based population survey and study reports, with country-specific imputation of prevalence rates and numbers of children affected by: (1) VA deficiency based on measured or imputed distributions of serum retinol concentration <0.70 μmol/l (equivalent to <20 μg/dl) and (2) Xerophthalmia, by country. Setting: Countries within the WHO South-East Asian Region. Subjects: The target group for estimation was children 5–15 y of age. Interventions: None. Results: The estimated prevalence of VA deficiency is 23.4%, suggesting that there are ∼83 million VA-deficient school-aged children in the region, of whom 10.9% (9 million, at an overall prevalence of 2.6%) have mild Xerophthalmia (night blindness or Bitot's spot). Potentially blinding corneal Xerophthalmia appears to be negligible at this age. Conclusions: VA deficiency, including mild Xerophthalmia, appears to affect large numbers of school-aged children in South-East Asia. However, nationally representative data on the prevalence, risk factors and health consequences of VA deficiency among school-aged children are lacking within the region and globally, representing a future public health research priority.
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extent of vitamin a deficiency among preschool children and women of reproductive age
Journal of Nutrition, 2002Co-Authors: Keith P. WestAbstract:Knowledge of the extent of vitamin A (VA) deficiency (D) is critical for identifying high-risk populations and mobilizing resources for prevention. Yet, all estimates are necessarily imperfect, often based on assumptions in the absence of data. In 1995, the World Health Organization estimated 254 million children to be VA-deficient and 2.8 million to have Xerophthalmia. Subsequently, estimates were changed to 75-140 million and 3.3 million, respectively. Although both sets are consistent with a problem of enormous magnitude, the discrepancies also created uncertainty. The present analysis indicates there are approximately 127 million and 4.4 million preschool children with VAD (serum retinol 6 million women develop night blindness (XN) during pregnancy annually. Roughly 45% of VA-deficient and xerophthalmic children and pregnant women with low-to-deficient VA status live in South and Southeast Asia. These regions harbor >60% of all cases of maternal XN, three fourths of whom seem to live in India. Africa accounts for 25-35% of the global cases of child and maternal VAD; about 10% of all deficient persons live in the eastern Mediterranean region, 5-15% live in the Western Pacific and approximately 5% live in the Region of the Americas. VA prophylaxis seems to be preventing the number of deficient preschool children from increasing while probably reducing rates of blindness and mortality. Greater effort is needed to assess and prevent VAD and its disorders, particularly among pregnant and lactating women.
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Hyporetinolemia and acute phase proteins in children with and without Xerophthalmia
The American journal of clinical nutrition, 2000Co-Authors: Richard D Semba, Keith P. West, Gantira Natadisastra, Muhilal, Ward Eisinger, Yin Lan, Alfred SommerAbstract:BACKGROUND The relations among hyporetinolemia, acute phase proteins, and vitamin A status in children are unclear. OBJECTIVE The objective was to examine the relations between acute phase proteins and plasma retinol concentrations in children with and without clinical vitamin A deficiency (Bitot spots and night blindness). DESIGN The study was a nonconcurrent analysis of acute phase protein concentrations and other data from a previous clinical trial. Preschool children, 3-6 y of age, with (n = 118) and without (n = 118) Xerophthalmia were assigned to receive oral vitamin A (60 mg retinol equivalent) or placebo and were seen at 5 wk. All children received oral vitamin A (60 mg retinol equivalent) at 5 wk. RESULTS At baseline, alpha(1)-acid glycoprotein (AGP) was elevated in 42.9% and 23.5% (P < 0.003) and C-reactive protein (CRP) was elevated in 17.7% and 13.7% (NS) of children with and without Xerophthalmia, respectively. Hyporetinolemia (retinol < 0.7 micromol/L) occurred in 61.0% and 47.4% (P < 0.04) of children with and without Xerophthalmia, respectively. A history of fever, a history of cough, and nasal discharge noted on examination were each associated with elevated acute phase proteins. Vitamin A supplementation increased plasma retinol at 5 wk but had no significant effect on concentrations of acute phase proteins. CONCLUSIONS Elevated acute phase protein concentrations and infectious disease morbidity are closely associated during vitamin A deficiency.
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child feeding and care behaviors are associated with Xerophthalmia in rural nepalese households
Social Science & Medicine, 1998Co-Authors: Joel Gittelsohn, Keith P. West, Anita V Shankar, Faisal Faruque, Tara Gnywali, Elizabeth K PradhanAbstract:The study examined caregiver-child interactions, intrahousehold food allocation and general child care behaviors and their effect on children's Xerophthalmia status in the rural Terai region of Nepal. Seventy-eight households with a child having a history of Xerophthalmia (cases) were matched with 78 households with a child of the same age having no history of Xerophthalmia (controls). Seven day-long continuous monitoring observations were performed in each household (over 15 months) by trained Nepali observers, focusing on feeding and care of a focus child and his/her younger sibling. Nineteen different behavioral variables were operationalized, including serving method, second helpings, serving refusals, encouragement to eat, request intensity, meal serving order, food channeling, food sharing, positive social behaviors, negative social behaviors, and positive health behaviors. Automatic serving and request intensity were strongly negatively correlated, especially among younger siblings. Children who serve themselves receive less encouragement to eat. Those children who are refused in their requests for food tend to ask for food more frequently, for a longer time, and be less likely to self-serve. Children who eat from a shared plate are less likely to interact with a food server and more likely to self-serve. Negative social behavior towards children is associated with the child having to request food more frequently and a greater likelihood of being refused food. Children who receive positive health care from their caregivers are also more frequently asked if they would like food by the server and are encouraged to eat. Several caregiver child feeding behaviors were related to a child's risk of having past vitamin A deficiency. Controls were much more likely to be served food automatically. Cases were more likely to serve themselves food and have multiple servings of food. Cases were nearly two times more likely than controls to be treated with neglect or harshly, and much less likely than controls to have their health needs receive attention. Examining intrahousehold behavior is critical for understanding the causes of vitamin A deficiency in rural Nepalese children, and has great potential for identifying and improving interventions to improve children's diets and care.
Alfred Sommer - One of the best experts on this subject based on the ideXlab platform.
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Original Research Communications-surveys Dietary practices and Xerophthalmia among Indonesian children13
2016Co-Authors: Ignatius Tarwotfo, Alfred Sommer, Tito Soegiharto, Djoko Susanto, Ph. DAbstract:ABSTRACT The stated frequency with which 30 Indonesian children with corneal xeroph-thalmia and age/sex/neighborhood matched controls ordinarily consumed vitamin- and provitamin A-rich foods was compared. Controls were more frequent consumers of eggs (p < 0.05), fish (p < 0.05), dark green leafy vegetables (p < 0.05), carrots (p < 0.01), and carotene-containing fruits (p < 0. 1). Similar data were collected on 358 children with Bitot’s spots and on normal preschool age children in a countrywide survey. Breast-feeding was more common among normals than among cases (p < 0.00 1). Normals were also more frequent consumers of mango and papaya during the 2nd and 3rd yr of life (p < 0.05); and of dark green leafy vegetables and eggs during the 3rd through 6th yr of life (p < 0.01). In two separate studies, differences in carotene consumption by normals and abnormals were confirmed by differences in their serum carotene levels. Approxi-mately 80 % of Indonesian families, with and without xerophthalmic children, consumed dark-green leafy vegetables at least once a day, and 99 % at least once a week. Diet therefore appears to be an important factor in the genesis of Xerophthalmia in Indonesia despite the availability of suitable provitamin A-rich foods. Am J Clin Nutr 1982; 35:574-581. KEY WORDS Xerophthalmia, diet, vitamin A, caroten
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Am J C/in Nutr 1987;45:977-80. Printed in USA. © 1987 American Society for Clinical Nutrition 977 Increased
2016Co-Authors: Alfred Sommer, Ignatius Tarwotjo, Joanne KatzAbstract:risk of Xerophthalmia following diarrhea and respiratory disease
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vitamin a deficiency and clinical disease an historical overview
Journal of Nutrition, 2008Co-Authors: Alfred SommerAbstract:Vitamin A deficiency has a plethora of clinical manifestations, ranging from Xerophthalmia (practically pathognomonic) to disturbances in growth and susceptibility to severe infection (far more protean). Like other classical vitamin deficiency states (scurvy, rickets), some of the signs and symptoms of Xerophthalmia were recognized long ago. Reports related to vitamin A and/or manifestations of deficiency might conveniently be divided into "ancient" accounts; eighteenth to nineteenth century clinical descriptions (and their purported etiologic associations); early twentieth century laboratory animal experiments and clinical and epidemiologic observations that identified the existence of this unique nutrient and manifestations of its deficiency; and, most recently, a flowering of carefully conducted clinical studies and field-based randomized trials that documented the full extent and impact of deficiency among the poor of low- and middle-income countries, which in turn changed global health policy.
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assessment and control of vitamin a deficiency the annecy accords
Journal of Nutrition, 2002Co-Authors: Alfred Sommer, Frances R DavidsonAbstract:Comprehensive recommendations for the assessment and control of vitamin A deficiency (VAD) were rigorously reviewed and revised by a working group and presented for discussion at the XX International Vitamin A Consultative Group meeting in Hanoi, Vietnam. These recommendations include standardized definitions of VAD and VAD disorders. VAD is defined as liver stores below 20 μg (0.07 μmol) of retinol per gram. VAD disorders are defined as any health and physiologic consequences attributable to VAD, whether clinically evident (Xerophthalmia, anemia, growth retardation, increased infectious morbidity and mortality) or not (impaired iron mobilization, disturbed cellular differentiation and depressed immune response). An estimated 140 million preschool-aged children and at least 7.2 million pregnant women are vitamin A deficient, of whom >10 million suffer clinical complications, principally Xerophthalmia but also increased mortality, each year. A maternal history of night blindness during a recent pregnancy was added to the clinical criteria for assessing vitamin A status of a population, and the serum retinol criterion for a public health problem was revised to 15% or more of children sampled having levels of <20 μg/dL (0.7 μmol/L). Clinical trials and kinetic models indicate that young children in developing countries cannot achieve normal vitamin A status from plant diets alone. Fortification, supplementation, or other means of increasing vitamin A intake are needed to correct widespread deficiency. To improve the status of young infants, the vitamin A supplements provided to mothers during their first 6 wk postpartum and to young infants during their first 6 mo of life should be doubled.
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acute sixth nerve palsy in vitamin a treatment of Xerophthalmia
British Journal of Ophthalmology, 2000Co-Authors: Eugene W M Ng, Nathan Congdon, Alfred SommerAbstract:Editor,—Vitamin A deficiency remains a leading cause of blindness worldwide with Xerophthalmia affecting 5–10 million children, resulting in 250 000–500 000 new cases of blindness each year. In the developed world, vitamin A deficiency is rare and usually occurs in the setting of malabsorptive states (such as cystic fibrosis and small bowel disease), liver disease, or malnutrition. Xerophthalmia is a medical emergency carrying a high risk of blindness, infection and death. Immediate administration of massive doses of vitamin A is required. Such rapid restoration of vitamin status is felt to be extremely safe at recommended doses. Appropriate dosing regimens in infants have been less clear than in older children and adults.1 Reports of side effects are limited, and therefore we report a case of acute sixth nerve palsy in an infant receiving intramuscular vitamin A for Xerophthalmia secondary to cystic fibrosis. ### CASE REPORT A 5 month old male infant with a …
Joanne Katz - One of the best experts on this subject based on the ideXlab platform.
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Am J C/in Nutr 1987;45:977-80. Printed in USA. © 1987 American Society for Clinical Nutrition 977 Increased
2016Co-Authors: Alfred Sommer, Ignatius Tarwotjo, Joanne KatzAbstract:risk of Xerophthalmia following diarrhea and respiratory disease
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sampling designs for Xerophthalmia prevalence surveys
International Journal of Epidemiology, 1997Co-Authors: Joanne Katz, Steven S Yoon, Karl Brendel, Keith P. WestAbstract:Background. The purpose of this study was to estimate the bias and design effects associated with the Expanded Program on Immunization's (EPI) sampling design when estimating Xerophthalmia prevalence, and to estimate the savings associated with EPI in terms of distance travelled within selected clusters. Methods. Computer simulation of the EPI sampling strategy was done using maps from a Xerophthalmia survey of 40 wards in Sarlahi district, Nepal. Samples of fixed cluster sizes of 7, 10, 15, 20 and 25 were compared. The estimated prevalence using the EPI design was compared with the true prevalence in the 40 wards to estimate the bias. The design effect was estimated by taking the ratio of the variance under EPI sampling to that of stratified random sampling (SRS) with fixed cluster sizes. The EPI was also modified by increasing the distance between selected houses from nearest neighbour to skipping 1-4 houses between selected ones. The difference between the distance travelled within clusters using SRS compared with EPI was weighed against the bias and increased variance. Results. The prevalence of Xerophthalmia was 2.8%. The EPI design overestimated Xerophthalmia prevalence by between 0.27% and 1.16%. The design effects of EPI cluster sampling within wards varied between 0.73 and 1.35. Neither the bias nor the design effect was related to distance between households or cluster size. Distance travelled within wards was always less for EPI designs with cluster sizes of 7 or 10. There was no saving in terms of distance travelled for designs with cluster sizes from 15 to 25 if there were two or more houses between selected ones. For fixed cluster sizes of 15 or fewer, the EPI sampling design using nearest or next nearest neighbours is a better choice than SRS in terms of minimizing the distance travelled and the mean square error. Conclusions. The choice of an optimum method would need to account for the density of clusters and difficulty of travel between clusters, as well as the costs of travel within clusters. Based on certain assumptions, EPI with 15 children per cluster would be favoured over examining all children in selected wards unless the travel time between wards was more than 2 days.
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epidemiology of Xerophthalmia in nepal a pattern of household poverty childhood illness and mortality
Archives of Ophthalmology, 1995Co-Authors: S. K. Khatry, Keith P. West, Joanne Katz, S. C. Leclerq, Elizabeth K Pradhan, Makar Dhoj Thapa, Ram Prasad PokhrelAbstract:A case-control study of Xerophthalmia (120 cases, two with corneal disease; 3377 children without Xerophthalmia, 12 to 60 months of age) was conducted in the rural plains of Nepal. Relative household wealth (ownership of animals and goods, house quality) and social standing (parental education, nondaily laboring, more affluent castes) were inversely related to risk of Xerophthalmia. Mothers of cases were more likely to have had children die than mothers of controls (odds ratio, 1.85; 95% confidence interval, 1.22 to 2.78); case households were more likely to have had a young child die in the past year (odds ratio, 2.85; 95% confidence interval, 1.43 to 5.67). Children with Xerophthalmia were more wasted and stunted than controls, although these associations largely disappeared after adjusting for socioeconomic influences. Frequency of breast-feeding was highly protective against Xerophthalmia in a dose-response manner (odds ratio, 0.32 for 1 to 10 times a day, 0.12 for >10 times a day) after adjusting for age and other factors. The risk of Xerophthalmia rose directly with reported duration of dysentery in the previous week (odds ratio, 2.13 and 5.81 for durations of 1 to 6 days and ≥7 days, respectively, vs none). Mild Xerophthalmia is reflective of a lower, local standard of living within which child health, nutrition, and survival are compromised.
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Impact of Vitamin A Supplementation on Prevalence and Incidence of Xerophthalmia in Nepal
Investigative ophthalmology & visual science, 1995Co-Authors: Joanne Katz, Keith P. West, S. K. Khatry, M. D. Thapa, S. C. Leclerq, E. K. Pradhan, R. P. Pokhrel, Alfred SommerAbstract:Results. Before the intervention, 4318 children were examined for Xerophthalmia. The prevalence was 2.3% in the vitamin A group and 3.3% in the placebo group. All children with Xerophthalmia were treated with vitamin A at the time of the examination. Of those examined at baseline, 38 in the vitamin A group and 48 in the placebo group died in the 16 months after intervention. There were 1871 (84%) surviving children in the vitamin A group and 1711 (85%) in the placebo group examined at follow-up. After adjustment for the baseline prevalence of Xerophthalmia, vitamin A reduced the prevalence at follow-up by 63% (95% confidence interval, 21% to 83%). The apparent incidence was 3.2/1000 per year in the vitamin A group and 9.2/1000 per year in the placebo group, an adjusted reduction of 62% (95% confidence interval, 0% to 86%).
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clustering of Xerophthalmia within households and villages
International Journal of Epidemiology, 1993Co-Authors: Joanne Katz, Keith P. West, James M Tielsch, Scott L Zeger, Alfred SommerAbstract:The clustering of Xerophthalmia within households and villages was estimated among preschool age children using data from studies conducted in Malawi, Zambia, Indonesia and Nepal over the past decade. Pairwise odds ratios (OR) were used to measure the magnitude of clustering. This OR measures the risk of Xerophthalmia for a preschool child given that another randomly chosen preschool child from the same household (or same village but different household) had Xerophthalmia, relative to the risk if that randomly chosen preschool child did not have Xerophthalmia. Village pairwise OR ranged from 1.2 in Malawi to 2.2 in Nepal. Household pairwise OR ranged from 4.4 in Malawi to 9.7 in Indonesia, indicating that Xerophthalmia clustering was much greater within households than villages. The magnitude of this clustering was as large, or larger than, infectious outcomes such as diarrhoea, fever and cough. Although Xerophthalmia was associated with a weekly history of infectious morbidity, the clustering of diarrhoea, fever and cough explained very little of the Xerophthalmia clustering observed in each of these studies, Hence, other household factors such as food availability and dietary practices should be examined for their role in the clustering of Xerophthalmia within certain households.
Ignatius Tarwotjo - One of the best experts on this subject based on the ideXlab platform.
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Am J C/in Nutr 1987;45:977-80. Printed in USA. © 1987 American Society for Clinical Nutrition 977 Increased
2016Co-Authors: Alfred Sommer, Ignatius Tarwotjo, Joanne KatzAbstract:risk of Xerophthalmia following diarrhea and respiratory disease
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changing prevalence of Xerophthalmia in indonesia 1977 1992
European Journal of Clinical Nutrition, 1994Co-Authors: Ignatius Tarwotjo, B Kodyat, Susilowati Herman, Dewi Permaesih, D Karyadi, S Wilbur, James M TielschAbstract:OBJECTIVE The primary objective of this analysis was to determine if the prevalence of Xerophthalmia in Indonesia has changed over the period 1977-78 to 1992. DESIGN The design was two cross-sectional prevalence surveys conducted in the same rural sample locations 14 years apart. SETTING The studies were conducted in 15 provinces of Indonesia using a stratified random selection of villages. SUBJECTS All persons in selected villages < 6 years of age were eligible for participation. Children were recruited during a door-to-door census of villages and invited to present for an eye examination at a central point in the village. A total of 19,032 subjects were included in the 1977-78 and 18,508 children in the 1992 survey. RESULTS Overall, the prevalence of active Xerophthalmia among preschool children declined by 75% (1.33% in 1977-78 to 0.34% in 1992). Active corneal disease declined by 95% (1/1000 in 1977-78 to 0.05/1000 in 1992). While the overall declines were dramatic and highly significant (P < 0.0001), selected provinces continued to show rates higher than the WHO criteria for a problem of public health significance. CONCLUSIONS The prevalence of Xerophthalmia has declined significantly over the past 14 years in Indonesia. The specific reasons for this decline cannot be ascribed to any particular intervention due to the multitude of health and social changes that have occurred during this period.
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Xerophthalmia and growth in preschool indonesian children
The American Journal of Clinical Nutrition, 1992Co-Authors: Ignatius Tarwotjo, Joanne Katz, Keith P. West, James M Tielsch, Alfred SommerAbstract:Approximately 4000 preschool children in West Java, Indonesia, were examined for Xerophthalmia and weighed and measured at 3-mo intervals from March 1977 to December 1978. Children recovering from Xerophthalmia over a 3-mo interval gained an average of 124 g (95% CI 42-206) more over 3 mo than normal children. Their height gain was similar to normal children's. Children who developed Xerophthalmia during a 3-mo period gained 199 g (95% CI 114-313) less and grew 0.28 cm (95% CI 0.12, 0.44) less than their normal peers. Children with chronic Xerophthalmia gained 120 g (95% CI 49-191) less and grew 0.21 cm (95% CI 0.05-0.37) less than normal children. These data suggest that linear and ponderal growth is adversely affected by chronic and incident Xerophthalmia, but that catch-up ponderal growth is experienced by children recovering from Xerophthalmia.
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nutritional and household risk factors for Xerophthalmia in aceh indonesia a case control study the aceh study group
The American Journal of Clinical Nutrition, 1991Co-Authors: L Mele, Keith P. West, A Pandji, H Nendrawati, Robert Tilden, Ignatius TarwotjoAbstract:Risk factors for Xerophthalmia were assessed in 466 subjects [38% with night blindness (XN), 60% with Bitot's spots (X1B), 2% with corneal Xerophthalmia (X2 or X3)] under age 6 y and their village-age-sex-matched control subjects during a community trial. Socioeconomic status and hygiene standards were lowest for households of xerophthalmic children and highest for nonstudy households in the trial population, with values for control households lying in between (P less than 0.001 by linear trend). Risk of Xerophthalmia increased with less frequent consumption of dark green leaves, yellow fruits, or egg during weaning, adjusted for current intake and present age [odds ratio (OR) = approximately 3.5]. Exclusion of these same foods from the current diet (except for mango and papaya in older children) was associated with a two- to ninefold excess risk of Xerophthalmia, adjusted for weaning influences. Xerophthalmic children aged less than 3 y were generally at higher risk of dietary imbalance than were older children. Xerophthalmia is associated with a chronic, infrequent consumption of key vitamin A foods from weaning through early childhood.
Renzhi Wang - One of the best experts on this subject based on the ideXlab platform.
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sodium hyaluronate s effect on Xerophthalmia a meta analysis of randomized controlled trials
Current Medical Research and Opinion, 2016Co-Authors: Xiangyi Kong, Chengrui Yan, Bing Xing, Yi Yang, Renzhi WangAbstract:AbstractBackground and aims:Several studies in the past have attempted to demonstrate the efficacy of sodium hyaluronate in the treatment of Xerophthalmia. However, results have been conflicting and a definite conclusion has not yet been reached. In order to provide integrated evidence for the effectiveness of sodium hyaluronate and to judge the methodological value of relevant randomized controlled trials (RCTs) in nearly thirty years, we conducted this meta-analysis.Methods:A range of electronic databases were searched: MEDLINE, the Cochrane Library Database, EMBASE, CINAHL, Web of Science and the Chinese Biomedical Database (CBM) without language restrictions. Two independent reviewers assessed trials for eligibility and quality, and meta-analysis was performed using the STATA 12.0 software. An integrated odds ratio (OR) with its corresponding 95% confidence interval (95% CI) was calculated.Results:Six RCTs were included with a total of 839 Xerophthalmia patients. The meta-analysis results revealed tha...
