Child blindness due to lack of vitamin A

The accusing eye The tragedy strikes the very young: mostly toddlers and infants. Playing, they begin to bump into things. They knock over things-and they seem to be more careless and clumsy after sunset. They are scolded. They cry, they rub their eyes; they seem to become clumsier as the days pass. Then, the rubbing and crying becomes a habit. The mother peers at the child's face. The whites of the eyes are thick, soft and dry. Crying becomes painful - the eyes have stopped producing tears. After a while, sores appear on the vital glassy covering, the cornea, that protects the iris. And it begins to liquefy, turning into a jelly-like mass.Thus, quietly, insidiously, tens of thousands of children of the developing world go blind. Needlessly blind. The reason: lack of a tiny but vital amount of Vitamin A in their daily diet. This deficiency is the leading cause of child blindness in the Third World today.The toll is awesome. In 1972, at least 150,000 children in Bangladesh fell prey to Vitamin A deficiency blindness. By 1973, a conservative estimate of the number of infants and toddlers at risk in Asia, Africa and Latin America was put forward: at least 11 million. Most of them were believed to be in southern and southeast Asia. Most of them were known to be from families where poverty augmented all other problems.What about us? "Vitamin A deficiency disease" ranks high on the list of common childhood ailments provided to government child care centres in south India. Surveys conducted in southern states by the Indian Council of Medical Research have revealed that nearly 10 per cent of all children of preschool age have clinical signs of the deficiency. The overall estimate for India is that about 12,000 children go irreversibly blind every year.Is there no answer to this deprivation?There are two, and one is already being tried out in four of the worst-affected countries: Bangladesh, India, Indonesia and the Philippines. This is the spaced, heavy dosage of Vitamin A concentrate for children of the 0-5 age group. One of the first serious nationwide campaigns began in Bangladesh in March 1973, when the government deployed 6,500 malaria field workers to administer Vitamin A capsules, supplied by UNICEF, to over eight million infants and children. With an airlift of 15 million capsules from the U.N. child care agency, a second round of vitamin dosage was carried out after six months, and the government took a policy decision to sustain the programme for at least another two years. In Indonesia, despite the abundance of good sources of Vitamin A, a 1973 estimate of blind children added up to 500,000 cases. Again, what about us? Harking back four years, 12 states were considered "blindness-endemic areas," and it was estimated that about 20 million children were in need of protective or curative Vitamin A therapy. A preventive programme had been launched in 1970, to give children of southern and eastern states a high-potency dose of 200,000 International Units (IU) of the vitamin every six months. In 1973, its target coverage was reported to be 13 million children by the end of the year. Current data indicates that this target was not achieved: an official press bulletin issued in May this year reports that the programme now covers "more than four million children," according to figures provided by the states. This is no mean achievement, but it is obvious that the programme needs a massive input of energy.Children of the shadowsThere are indications that it may get this needed shot in the arm: the government proposes to extend the Vitamin A distribution drive to all states and union territories during the current 1976-77 period.This sounds like an emergency solution, and it is. The real remedy lies in an improved daily diet. But diet habits are resistant to change, even when the components of the needed change are ready at hand. Recent data from the ICMR shows that most of the 250,000 listed blind children are the victims of nutritional deficiencies. Not just lack of vitamins-lack of food. Medical papers have begun to refer to the condition as "malnutrition blindness".Ironically, this affliction is in a way the by-product of developing nations' efforts to improve the general health of their citizens. Children who might otherwise have died of virus epidemics, bacterial infections or other classic causes of child mortality now manage to inch past these hazards. But they are not equipped to withstand Vitamin A deficiency. Of course, it does not kill them-but it effectively cripples their future.Vitamin therapy for the child at risk is a vital and necessary provision. But it does provide the whole answer to the risk. When the ICMR speaks of "inadequate dietary intake" as the leading cause of this kind of blindness, it means not only underfed children, but also their malnourished mothers. The normal food of pregnant and lactating women of poorer classes is low in Vitamin A. Their babies are born with predictably low concentration of the vitamin in their lives. Colostrum, the early secretion of the mother's breast, is rich in Vitamin A, but is usually not fed to the baby; prejudices see to that. The later milk of a malnourished woman-the baby's sole source of food supply-has little of the vitamin. Dosing a nursing mother with Vitamin A makes no difference; she has to receive the supplementation much earlier, in the last three months of pregnancy. Then only does it tide her and the child through the vulnerable first months.Another grim facet of the continuing tragedy has recently come to light. Some studies indicate that general malnutrition impairs a child's capacity to absorb Vitamin A medication. Clinical data shows that average absorption of the massive six-monthly dose is between 58 and 75 per cent of the 200,000 IU administered, and long-term retention is about 47 per cent. The approved dose ensures that the child retains around 100,000 IU - but only if its general nutritional condition is good enough. If a child is malnourished or suffering from the intestinal and respiratory infections so widespread as to be "normal", absorption falls, and retention is around 30 per cent. In many cases, this is not enough to stave off blindness.But the race to save India's toddlers from this prospect cannot await the change of diet habits, the slow eradication of prejudices and taboos. It is a race against time. A one-year-old suffering acute deficiency symptoms can go blind in a week. In the final twilight stage, there are only a few hours when permanent blindness may still be averted. And this miracle must still depend on the little amber capsule that can bribe fate to give the child another chance until his elders learn.Published By: AtMigration Published On: Apr 11, 2015 10:38 IST--- ENDS ---

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Child blindness due to lack of vitamin A

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