Year : 1981 | Volume
: 29 | Issue : 4 | Page : 473--475
Incidence of xerophthalmia in Assam
LC Dutta, SK Das, D Baishya, Bujarborua
Dept. of Ophthalmology, Medical College, Gauhati, India
L C Dutta
Dept. of Ophthalmology, Medical College, Gauhati
|How to cite this article:|
Dutta L C, Das S K, Baishya D, Bujarborua. Incidence of xerophthalmia in Assam.Indian J Ophthalmol 1981;29:473-475
|How to cite this URL:|
Dutta L C, Das S K, Baishya D, Bujarborua. Incidence of xerophthalmia in Assam. Indian J Ophthalmol [serial online] 1981 [cited 2020 Feb 19 ];29:473-475
Available from: http://www.ijo.in/text.asp?1981/29/4/473/30957
The State of Assam measuring about 74000 sq. miles consists of 10 districts and inhabitates about 1.5 crores of people; children constitute about 40% of the total population. Due to the change of the topography after the great earthquake of 1950, the State is frequently affected by flood of the river Brahmaputra and Barak during the monsoons. Various degrees of xerophthalmia are found amongst the children population after the floods. In a study of pattern of Eye diseases amongst of children attending the eye dept. It was revealed that vitamin-A deficiency manifestations are present in 11.41% of the children attending the eye O.P.D. In a hospital based study it was found that xerophthalmia occurs in families having six or more family members and in families with poor- economic status. Male children are affected more often (71.81%) than the famales. 78.1% of the children with Keratomalacia were found to have intestinal helminthiasis and 87.5% had gastro-intestinal disorder prior to d°velopment of keratomalacia. About 50% of the inmates of the blind school of the State are found to have some anterior segment healed lesions which are supposed to be due to xerophthalmia. In this study an attempt was made to survey the incidence of xerophthalmia in some districts of the State.
MATERIAL AND METHODS
20 sample sites of 4 districts were taken up in this study.
1. Rural areas - - 13 samples.
2. Urban areas - - 5 „
3. Tea Garden labourers
colonies -- - 5 „
Moreover the study included the children attending the
(a) Paediatric and
(b) Eye O.P.D. of Gauhati Medical College.
Along with the ocular examination assessment of the nutritional status and the socioeconomic status of the children under the age of 12 years were done. History of night blindness and prophylactic vitamin-A therapy was particularly noted. Anterior segment of the eye was examined with the help of a hand light using magnification, whenever, necessary. The findings were recorded according to the following classification:
XO - Night blindness only
XI - Conjunctival Xerosis, (including Bitot's spots).
X2 - Corneal xerosis
Y3A - Corneal ulceration with xerosis X3B - Keratomalacia
X4 - Corneal scars like nebulae, leucoma, staphylomata, phthisis bulbi etc.
In a group of 15 cases of keratomalacia, admitted into the hospital, serum vitamin-A concentration and total serum protein with albumin-globulin ratio were studied. The concentration of serum vitamin-A and protein was again estimated after treatment prior to discharge of the patient from hospital. Serum vitamin-A and serum protein of B normal children were studied as control.
A total of 5039 children between the ages of 1 to 12 years were examined in 20 sample sites, in rural, urban and tea-garden labourers population. Out of these, 1455 were below the age of 5 years. The number of male and female cases examined were approximately the same. The incidence of xerophthalmia was 11.27% (568 cases) and the ratio of male female= 1.9:1 i.e. the male children have been found to have affected more than the female children. The breakdown of the xerophthalmia cases were as follows:[Table 1]
The incidence of xerophthalmia in the rural population was found to be 9.5% but the incidence in children below the age of 5 years was 7.4%.
The survey of the children of the urban areas was done mainly in and around Gauhati city. A total of 1100 children (636 male, 464 female) were examined. The number of xerophthalmia cases of various degrees was 91 (8.27%) in the following grades. [Table 2]
The survey of the children of the rural population revealed that out of 2871 cases 272 had various degrees of xerophthalmia as shown below:[Table 3]
Most of the cases were found in XI group (76.8%)
In the tea-garden labourers colonies 1068 cases were examined and 205 cases (19.2%) had various grades of xerophthalmia. The detailed incidence of these 205 cases are:-[Table 4]
In incidence of xerophthalmia in children below the age of 5 years was approximately 13%. Out of 739 children attending the Paediatrics, O.P.O. only 52 cases (7.03%) found to have signs of xerophthalmia, whereas the incidence of xerophthalmia in children attending the Eye O.P.D. was 34.24%.
The serum vitamin-A concentration in normal children was found to vary from 50 to 60 microgram percent with a mean of 54.7 microgram percent and the total serum protein was in the range of 7.20 to 7.80 gm. percent with a mean of 7.31 gm.% In 15 cases of X3B grade of xerophthalmia (keratomalacia) the serum vitamin A concentration was as low as 10 microgram%, only in 3 cases it was more than 40 microgram % (the mean value was-25.53 microgram%) and the serum protein concentration in these cases was also low (Mean 5.56 gm. %). After treatment with vitamin "A" and 1.5 gm. protein per kg. body wt. for i5 days there was improvement of the clinical condition with concomitant rise of serum vitamin A concentration and total serum protein (mean value, 51.27 microgram % and 7.44 gm. % respectively) with almost normal albumin-globulin ratio.
According to the report of the Ministry of Health, Govt. of India the prevalance of vitamin-A deficiency is about 3.8% in the preschool children and 10.15% in the school children. In our study the incidence of xerophthalmia in the pre-school children is 8.5%. The incidence in rural and urban areas was almost the same but in the tea-garden labourers colonies the overall incidence of xerophthalmia was quite high (19.2%) and the incidence in children above the age of 5 years is 12.7%.
It has been notified that even after intermittant high dose vitamin-A therapy programme all over the country, the incidence of xerophthalmia is not decreasing. It may be due to the fact that the metabolism and storage of vitamin-A depends upon the availability of dietary protein. The vitamin-A in the form of retinylester is stored in the liver. During its mobilization from the liver, the retinylester is hydrolysed to retinyl which associates with a specific type of protein known as Retinol binding protein (R.B.P.). This RBP is synthesized in the liver and released into the plasma as retinyl and RBP-complex. The RBP synthesis is reduced in protein/deficiency and therefore even after massive dose of vitamin-A alone the child cannot be protected against xerophthalmia. Therefore it is recommended that in the preventive programme of xerophthalmia protein supplement also should be given.