Increased risk of xerophthalmia following diarrhea and respiratory disease

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Abstract
Preschool-age rural Indonesian children were reexamined every 3 mo for 18 mo. An average of 3228 were free of xerophthalmia at the examination initiating each of the six, 3-mo follow-up intervals. Children with respiratory disease and/or a recent history of diarrhea at the start of an interval developed xerophthalmia by the end of the interval at more than twice the rate of their healthier peers (p less than 0.05) independent of anthropometric status. It appears that vitamin A deficiency and infections, especially diarrhea and respiratory disease, can establish a vicious cycle that induces and perpetuates ocular and systemic disease. Vitamin A deficiency and xerophthalmia are major public health problems throughout much of the developing world. Perhaps 5 million or more children develop xerophthalmia every year of whom 1/4 million go blind. Children with mild xerophthalmia die at 4-16 times the rate of their nonxerophthalmic peers. Vitamin A supplementation of children at large may reduce mortality by at least 1/3. Given the size and significance of the problem of vitamin A deficiency and the limited resources presently available to combat it, recognition of contributory factors or conditions that identify children at increased risk would allow targeting of intervention activities for greater efficiency and effectiveness. In this study, preschool-age rural Indonesian children were reexamined every 3 months for 18 months. An average of 3228 were free of xerophthalmia at the examination initiating each of the 6, 3 month follow-up intervals. Children with respiratory disease and/or a recent history of diarrhea at the start of an interval developed xerophthalmia by the end of the interval at more than twice the rate of their healthier peers (p0.05) independent of anthropometric status. It appears that vitamin A deficiency and infections, especially diarrhea and respiratory disease, can establish a vicious cycle that induces and perpetuates ocular and systemic disease.