Ignatius Tarwotjo

IMPACT OF VITAMIN A SUPPLEMENTATION ON CHILDHOOD MORTALITY. A Randomised Controlled Community Trial

450 villages in northern Sumatra were randomly assigned to either participate in a vitamin A supplementation scheme (n = 229) or serve for 1 year as a control (n = 221). 25 939 preschool children were examined at baseline and again 11 to 13 months later. Capsules containing 200 000 IU vitamin A were distributed to preschool children aged over 1 year by local volunteers 1 to 3 months after baseline enumeration and again 6 months later. Among children aged 12-71 months at baseline, mortality in control villages (75/10 231, 7.3 per 1000) was 49% greater than in those where supplements were given (53/10 919, 4.9 per 1000) (p less than 0.05). The impact of vitamin A supplementation seemed to be greater in boys than in girls. These results support earlier observations linking mild vitamin A deficiency to increased mortality and suggest that supplements given to vitamin A deficient populations may decrease mortality by as much as 34%.

Increased mortality in children with mild vitamin A deficiency.

An average of 3481 preschool-age rural Indonesian children were re-examined every 3 months for 18 months. The mortality rate among children with mild xerophthalmia (night blindness and/or Bitots spots) was on average 4 times the rate, and in some age groups 8 to 12 times the rate, among children without xerophthalmia. Mortality increased, almost linearly, with the severity of mild xerophthalmia (night blindness, Bitots spots, and the two combined). These relations persisted after stratification for respiratory disease, wasting, gastroenteritis, pedal oedema, and childhood exanthems. Mild vitamin A deficiency was directly associated with at least 16% of all deaths in children aged from 1 to 6 years. These results suggest that mild xerophthalmia justifies vigorous community-wide intervention, as much to reduce childhood mortality as to prevent blindness, and that night blindness and Bitots spots are as important as anthropometric indices in screening children to determine which of them need medical and nutritional attention.

INCIDENCE, PREVALENCE, AND SCALE OF BLINDING MALNUTRITION

4595 pre-school-age children in six villages of West Java were examined every 3 months. The incidence of active corneal xerophthalmia was 5 per 1000 per year (95% confidence limits, 2.6-7.5), and the average prevalence during each round of examinations was 12 per 10000. In a randomised, multistage cluster survey of 27084 rural children throughout Indonesia the population-weighted prevalence of active corneal disease among pre-school-age children was 6.4 per 10000 (95% confidence limits 3.2-9.6), 53% of that in the longitudinal study areas. At an adjusted incidence rate of 2.7 per 1000 per year, over 60000 Indonesian children become xerophthalmic every year. By extrapolation of these findings about 500000 new cases of xerophthalmia, half of which lead to blindness, occur each year in India, Bangladesh, the Philippines, and Indonesia combined.

PREVALENSI KKP ANAK BALITA DI WILAYAH INDONESIA BAGIAN TIMUR

Telah dianalisis data berat badan (BB) dan tinggi badan (TB) anak Balita yang dikumpulkan pada waktu pelaksanaan Studi Prevalensi Defisiensi Vitamin A dan Zat-zat Gizi Lainnya di Wilayah Indonesia Timur pada tahun 1990/1991. Tujuan analisis ini terutama untuk mengetahui prevalensi Kurang Kalori Protein (KKP) di empat propinsi Wilayah Indonesia Bagian Timur (IBT) dan perbandingan antara prevalensi KKP menurut perhitungan berdasarkan median baku Harvard dengan Z-skor berdasarkan baku WHO-NCHS. Hasil analisis menunjukkan bahwa prevalensi gizi buruk dan sedang (KKP) di wilayah IBT masing-masing 17% menurut indeks BB/U berdasarkan median baku Harvard dan 44% menurut indeks BB/U berdasarkan -2 SB baku WHO-NCHS. Prevalensi KKP menurut TB/U berdasarkan Z-skor WHO-NCHS hampir sama dengan prevalensi menurut indeks BB/U berdasarkan median bahan baku Harvard. Untuk mendapatkan prevalensi KKP yang hampir sama antara kedua indikator tersebut, batas ambang penentuan status KKP (gizi baik dan gizi kurang) menurut indeks BB/U berdasarkan baku WHO-NCHS adalah antara -2.6 SB dan -2.8 SB, atau rata-rata -2.75 SB.