Vitamin A deficiency and prevention

Xerophthalmia and its prevention and treatment, and community health care based.

1. OCULAR MANIFESTATION OF VITAMIN A DEFICIENCY. BY S.PERSIS BENETTA M.OPTOM 2 ND YEAR

2. Introduction Ocular manifestation of Vitamin A deficiency are referred to has.. “XEROPHTHALMIA”

3. What is Xerophthalmia? The term is used for all the changes in the structures in the eye, including, Conjunctiva Cornea Retina Rods cones

4. Etiology Dietary deficiency of vitamin A Defective absorption from the gut Protein energy malnutrition (PEM) infections

5. WHO classification. Xerophthalmia classification Ocular signs XN Night blindness X1A Conjunctival xerosis X1B Bitot’s spot X2 Corneal xerosis X3A Keratomalacia <1/3 corneal surface X3B Keratomalacia >1/3 corneal surface XS Corneal scar XF Xerophthalmic fundus

6. Clinical features Earliest symptom of Xerophthalmia XN

7. One or more patches of dry, lusterless, non wettable conjunctiva Patches seen in interpalpebral of the nasal and temporal quadrants In advanced cases it involves the whole conjunctiva resulting in conjunctival thickening, wrinkling. X1A

8. Bitot’s spot is raised white, foamy, triangular patch of keratinized epithelium situated in the bulbar conjunctiva. Bilateral Temporal X1B

9. Punctate keratopathy Nasally Granular pebby dryness Cornea lacks lustre X2

10. Stromal defects Due to liquefactive necrosis Small ulcers in peripheral Large ulcers involve centrally or entire cornea These might result in blindness X3A & X3B

11. Healing of stromal defects results in corneal scar of different densities and size XS

12. Seed like, raised white lesions scattered uniformly over the fundus XFC

13. Treatment. Local ocular therapy – artificial tears, instilled every 3-4 ( hrs ) Vitamin A therapy – treatment applies to all the stages Treatment of underlying conditions AGE DOSAGE >1 year 200,000 IU of Vit A oral or 100,000 IU by intramuscular inj <1year 50,000 IU of Vit A Women / pregnant woman XN 10,000 IU VIT A X1A 10,000 IU VIT A X1B 10,000 IU VIT A Corneal Xerophthalmia 200,000 IU VIT A

14. CONTROL AND PREVENTION o f VIT A DEFICIENCY.

15. Short term approach. Patients Treatment Infants 6-12 months / weight <8kgs 100,000 IU Vit A, orally every 3-6 months Children >1 yr / <6yrs 200,000 IU Vit A, orally every 6 months Lactating mothers 20,000 IU Vit A orally Infants < 6 months (not being breast fed) 50,000 IU Vit A orally

16. Vit A supplements – Child Survival and Safe Motherhood (CSSM) DOSAGE AGE First dose (1lakh IU) 9 month along with measles vaccine Second dose (2lakh IU) 18 month along with DPT/OPV Third dose (2lakh IU) 2 years

17. Medium term approach. Food fortification with vitamin A

18. Long term approach. Vitamin A rich foods. Nutritional health education.

19. RESEARCH PAPER TALKS Cure was associated with certain foods—in early times with topical application or ingestion of animal and fish liver, and in later years with ingestion of plant foods containing green and yellow pigments (Wolf, 1996 ). Steenbock (1919) postulated, and later confirmed, that carotenoid from yellow maize (corn) could support growth and prevent ocular lesions. Since Isler et al. (1947) discovered a cost-effective way to synthesize vitamin A, cure and prevention are also possible through commercially produced, synthetic vitamin A.

20. Breast-fed infants do not usually show clinical deficiency for at least 4 to 6 months after birth. They may be at a marginally adequate point however , if breast-fed by a malnourished, vitamin A-depleted mother (Underwood, 1994a ). At the same time, if breast-fed, even from a malnourished mother whose breast milk vitamin A has been improved through direct maternal supplementation (200,000 IU of vitamin A given within 2 months postpartum [WHO/UNICEF/IVACG, in press]), adequate infant vitamin A status may be prolonged beyond 6 months ( Stoltzfus et al., 1993).

21. Vitamin A requirements , therefore, are greatest during periods of rapid growth—infancy and early childhood, adolescence, and pregnancy—and when the vitamin is lost from the body through normal physiologic processes, such as lactation, or through nonphysiological losses brought about by frequent disease, such as malabsorption, diarrhea, and febrile infections (FAO/WHO, 1988).

22. The bioavailability of the provitamin A carotenoids from plants is greatly influenced by the nature of the embedding matrix (i.e., fibrous, dark green leafy vegetables [DGLV] or soft-fleshed yellow/orange vegetables and fruits) and the composition of the accompanying meal.

23. Populations with subclinical deficiency—tissue concentrations of vitamin A low enough to have adverse health consequences, even in the absence of xerophthalmia , WHO's current definition of VAD (WHO, 1996a ).

24. Approaches To The Prevention Or Correction Of Vad . Vitamin A intervention approaches are commonly grouped into two main control strategies: (1) direct increase in vitamin A intake through dietary modification with natural or fortified foods and supplements and (2) indirect public health measures to control disease frequency. Information, education, and communication (IEC), including social marketing and specific vitamin A-oriented nutrition education, may or may not accompany each of the above interventions.

25. VAD-endemic areas require special attention to micronutrient supplementation . Vitamin A plays a central role in the body’s ability to fight off infectious diseases, deficiency can have far-reaching health consequences. People with a Vitamin A deficiency are more susceptible to measles, diarrhoea , respiratory infections and HIV/AIDS .

26. Improving the vitamin A status of deficient children aged 6 months to 6 years dramatically increases their chances of survival . Good vitamin A status is associated with reduction in the rate of hospital admissions and reduced need for out-patient services at clinics and therefore lowers overall cost of health services . Recent studies suggest that preventing vitamin A deficiency of women during and before pregnancy greatly reduces their risk of mortality and morbidity around the time of childbirth, probably through increasing resistance to infection and lowering levels of anaemia

27. Many International organizations like UNICEF and WHO have made the strategies for the prevention and elimination of vitamin A deficiency disease and they provide these strategies to the affected countries in the form of action plan, literature It isthe responsibility of the governments and the health departments of the affected countries to implement these strategies for the betterment of the future of common people and children.

28. References Prevention of Vitamin A Deficiency Barbara A. Underwood, Ph.D. National Eye Institute https://www.ncbi.nlm.nih.gov/books/NBK230106 / Strategies for the prevention and elimination Of Vitamin A Deficiency . Submitted as a part of a SUMMATIVE ESSAY OF INTERNATIONAL NUTRITION IN MSC IN PUBLIC HEALTH https:// www.researchgate.net/publication/324719932_Strategies_for_the_prevention_and_elimination_Of_Vitamin_A_Deficiency_Module_Title_INTERNATIONAL_NUTRITION

29. Thank You!