Determinants of vitamin a deficiency in children between 6 months and 2 years of age in Guinea-Bissau

The World Health Organization (WHO) classifies Guinea-Bissau as having severe vitamin A deficiency (VAD). To date, no national survey has been conducted. We assessed vitamin A status among children in rural Guinea-Bissau to assess status and identify risk factors for VAD. In a vitamin A supplementat...

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Published in:BMC public health 2013-02, Vol.13 (1), p.172-172, Article 172
Main Authors: Danneskiold-Samsøe, Niels, Fisker, Ane Bærent, Jørgensen, Mathias Jul, Ravn, Henrik, Andersen, Andreas, Balde, Ibraima Djogo, Leo-Hansen, Christian, Rodrigues, Amabelia, Aaby, Peter, Benn, Christine Stabell
Format: Article
Language:English
Subjects:
Age
Analysis
C-reactive protein
Child, Preschool
Children
Children & youth
Enzyme-linked immunosorbent assay
Ethnic groups
Ethnicity - statistics & numerical data
Female
Guinea-Bissau - epidemiology
Health aspects
Humans
Immunization
Infant
Infection
Male
Medical research
Medicine, Experimental
Physiological aspects
Prevalence studies (Epidemiology)
Protein binding
Proteins
Public health
Risk Factors
Rural areas
Rural Health - statistics & numerical data
Seasons
Surveys
Vaccination
Vaccination - statistics & numerical data
Vaccines
Vitamin A
Vitamin A deficiency
Vitamin A Deficiency - epidemiology
Vitamin A Deficiency - ethnology
Vitamins
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Summary:The World Health Organization (WHO) classifies Guinea-Bissau as having severe vitamin A deficiency (VAD). To date, no national survey has been conducted. We assessed vitamin A status among children in rural Guinea-Bissau to assess status and identify risk factors for VAD. In a vitamin A supplementation trial in rural Guinea-Bissau, children aged 6 months to 2 years who were missing one or more vaccines were enrolled, vaccinated and randomized to vitamin A or placebo. Provided consent, a dried blood spot (DBS) sample was obtained from a subgroup of participants prior to supplementation. Vitamin A status and current infection was assessed by an ELISA measuring retinol-binding protein (RBP) and C-reactive protein (CRP). VAD was defined as RBP concentrations equivalent to plasma retinol 5 ml/L. In Poisson regression models providing prevalence ratios (PR), we investigated putative risk factors for VAD including sex, age, child factors, maternal factors, season (rainy: June-November; dry: December-May), geography, and use of health services. Based on DBS from 1102 children, the VAD prevalence was 65.7% (95% confidence interval 62.9-68.5), 11% higher than the WHO estimate of 54.7% (9.9-93.0). If children with infection were excluded, the prevalence was 60.2% (56.7-63.7). In the age group 9-11 months, there was no difference in prevalence of VAD among children who had received previous vaccines in a timely fashion and those who had not. Controlled for infection and other determinants of VAD, the prevalence of VAD was 1.64 (1.49-1.81) times higher in the rainy season compared to the dry, and varied up to 2-fold between ethnic groups and regions. Compared with having an inactivated vaccine as the most recent vaccine, having a live vaccine as the most recent vaccination was associated with lower prevalence of VAD (PR=0.84 (0.74-0.96)). The prevalence of VAD was high in rural Guinea-Bissau. VAD varied significantly with season, ethnicity, region, and vaccination status. Clinicaltrials.gov NCT00514891.
ISSN:1471-2458
1471-2458
DOI:10.1186/1471-2458-13-172