A Pilot Survey to Assess the Vitamin A Status of Children Aged 6-72 months in the Ramu Region of Papua New Guinea

Abstract

Papua New Guinea has been classified by the World Health Organisation as an area where clinical vitamin A deficiency (VAD) exists. This is at variance with the experience of the local physicians who do not encounter classical VAD in clinical practice. This pilot study was carried out to resolve this contradiction, since many suggestions have been made to fortify foods with Vitamin A. If done in the absence of concrete data to back up this classification, it could take the focus away from the real problem as well as potentially create problems of Vitamin A toxicity. Therefore, answers from this study could have far reaching implications in a country such as PNG, which has high childhood mortality and limited financial and manpower resources. The objective of this study was to determine the vitamin A status and identify risk factors of VAD in children aged 6 months to 6 years in a rural area of Papua New Guinea. The survey was carried out in the Ramu region of Madang province. Households and children were randomly selected and standard questionnaires were used to collect information about diet, previous illnesses and night blindness. The weight and height of all children was recorded and an ocular and physical examination carried out by trained personnel. In addition, haemoglobin estimation and examination of blood films for malaria parasites was carried out in all the children. In a randomly selected number of children, estimations of serum retinol and other micronutrient levels were carried out. Results: A total of 609 children were enrolled in the study. Biochemical parameters were studied in 106 of them .The mean age of the children was 35 months. Possible night blindness was reported in 4 children. No xerophthalmia was seen. The prevalence of serum retinol levels ( 0.7 (mol/L (WHO suggested cut off values for subclinical VAD) was 10.3%. Anthropometric indicators indicated a high proportion of the children had stunting and wasting or both. Analysis of dietary patterns, maternal literacy, food availability and other surrogate indicators indicated that the population is at mild-moderate risk of developing VAD. In conclusion, no evidence of clinical vitamin A deficiency was found. Subclinical vitamin A deficiency seemed to occur in this population at a level of mild-moderate public health importance. Further studies need to be carried out to assess the situation in different areas in PNG before policy decisions can be made with regards to mass vitamin A supplementation.