|LETTER TO EDITOR
|Year : 2003 | Volume
| Issue : 4 | Page : 361-363
Vitamin A intervention in the thar desert
S Desai, R Desai, Navin Chandra Desai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Desai S, Desai R, Desai NC. Vitamin A intervention in the thar desert. Indian J Ophthalmol 2003;51:361-3
Xerophthalmia due to Vitamin-A deficiency is prevalent in the desert region of Western Rajasthan. Xerophthalmia is multi-factorial in origin, and the causes include poor environmental conditions, poor socioeconomic status and poor nutrition. Earlier studies have found the prevalence of xerophthalmia at 14.6% and it is of major public health importance in this region, and there is not much difference between rural (16.2%) and urban (13.7%) populations. For a long time in India there had been no specific vitamin-A intervention programmes, although cataract surgery camps have been very popular in India since the early 1900s. These camps can provide an opportunity to interact with large rural populations and institute a one-time vitamin-A intervention programme at no additional cost. With this realisation we successfully integrated an activity called "Xerophthalmia Clinic" in our rural eye camps since 1983.
Essentially, these eye camp based xerophthalmia clinics are meant to institute Vitamin-A megadoses to the under 10 population that visits our rural cataract surgery camps either accompanying their relations or out of curiosity If time permits, we also visit the local school or Anganwadi (day care centre for children under five) to feed megadoses of vitamin A. Details of this activity are described elsewhere., Briefly, it involves gathering all the children who have accompanied their parents to the camp, examining them for xerophthalmia and giving them a megadose of vitamin-A either as prophylaxis or if xerophthalmia is manifest, as a therapeutic dose. Recently we have also been asking volunteers to take us to slum areas and nearby villages for Vitamin A intervention. Usually the clinic is accompanied by a talk to parents and children on!•he prevention of nutritional blindness. This camp-based activity is very simple and easy to organise and often it is the only means to check xerophthalmia in rural areas. An ophthalmic assistant or trained health worker can also organise and implement this activity with ease. Vitamin-A can be sourced free or at low cost through the government or other agencies. Thousands of eye camps are organised every year in India and this gives an unprecedented opportunity to eye care professionals to come in contact with children and implement a cost-effective prophylaxis against xerophthalmia and vitamin-A deficiency.
Western Rajasthan has the largest arid zone in India (62%) and nearly half of this area is a desert with little or no rainfall. It is subject to constant and recurrent droughts. We have observed a positive correlation between drought and xerophthalmia and seen that during drought and famine the prevalence of the xerophthalmia increases. The most recent example is the current drought situation in the western Rajasthan.
From November 2002 to March 2003, we organised vitamin-A intervention programmes in conjunction with our eye camps at 17 locations in Jodhpur, Barmer and Jaisalmer districts. A total of 3605 children were given prophylactic or therapeutic doses of vitamin-A and 268 (7.4%) children were detected to have xerophthalmia due to vitamin-A deficiency [Table - 1].
The people of this region apply a cosmetic called "kajal" on the lid margins. Both children and adults favour the use of "kajal". It is a formulation of lamp black mixed with oil. It is applied in the hope of an warding off an evil eye and also as an ocular cosmetic. Kajal stains the xerotic areas in the eye black which makes XIA and XIB lesions stand out. This aids in quick flash/daylight detection of these lesions with ease. In Barmer district special efforts were made to trace women who had recently delivered (8 weeks post partum) to feed them one capsule of vitamin-A (200,000 IU) to protect them as well as to increase breast milk vitamin-A titres to help protect the breastfed infant. Thirteen such women were either called to the site or fed vitamin A at home, and none of them had signs of xerophthalmia.
We have earlier reported that the prevalence of xerophthalmia is high and it is similar in urban and rural areas in the desert of Rajasthan. In recent years, we have observed that xerophthalmia has decreased in the urban population to a level below the public health significance, though it is not shown a similar trend in rural areas. One of the reasons for this is the fact that rural populations still do not consume foods rich in vitamin-A. There are several food sources in the desert region of western Rajasthan which are excellent sources of β carotene though their availability is seasonal and they tend not to be very popular food items. During Xerophthalmia clinics we recommend that housewives should increase the dietary intake of these locally grown food stuffs in their family. The message becomes more effective when a child with Bitot spot or Night Blindness is detected and the lesion is demonstrated to the other children and people gathered there (usually, the lesions are Kajal-stained and have a startling appearance, impressive to the lay person).
| Acknowledgement|| |
We would like to thank the Task Force Sight for Life, a humanitarian initiative by F.Hofmann LaRoche Ltd., Switzerland, who provided us free supplies of vitamin A capsules (200,000 IU). We are grateful to the members of the National Society for the Prevention of Blindness (Jodhpur District Branch) who volunteered their time and organisational skills in the venture.
| References|| |
Desai NC. The Xerophthalmic profile in desert regions. Afro-Asian J Ophthalmol
Desai NC, Bhargava G. The xerophthalmia clinic - An essential appendage to the rural eye camp. Raj J Ophthalmol
Desai NC, Desai S, Desai R. Xerophthlamia clinics in rural eye camps. Intl Ophthalmol
Desai S, Desai R, Desai NC. Compendium of Dietry Sources of Vitamin A in the Thar Desert. Indian J Ophthalmol
[Table - 1]