Skip to main content
main-content

01.12.2013 | Research article | Ausgabe 1/2013 Open Access

BMC Public Health 1/2013

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

Zeitschrift:
BMC Public Health > Ausgabe 1/2013
Autoren:
Niels Danneskiold-Samsøe, Ane Bærent Fisker, Mathias Jul Jørgensen, Henrik Ravn, Andreas Andersen, Ibraima Djogo Balde, Christian Leo-Hansen, Amabelia Rodrigues, Peter Aaby, Christine Stabell Benn
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2458-13-172) contains supplementary material, which is available to authorized users.

Competing interests

No competing interests exist. This manuscript has not been published before or submitted elsewhere for publication.

Authors’ contributions

NDS: laboratory work, data analysis and the draft of the manuscript; ABF: conception of the research idea, study design, data collection and analysis, interpreted the data and review of manuscript; MJJ: conception of the research idea, study design, data collection, part of laboratory work; HR, AA: data analysis and reviewed manuscript; IDB: data collection and analysis; CLH: laboratory work and review of manuscript, AR: conception of the research idea, study design, data collection; PA, CB: conception of the research idea, study design, interpreted the data and review of manuscript. All authors have read and approved the final version of the manuscript.

Abstract

Background

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.

Methods

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 <0.7 μmol/L; infection was defined as CRP >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.

Results

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)).

Conclusions

The prevalence of VAD was high in rural Guinea-Bissau. VAD varied significantly with season, ethnicity, region, and vaccination status.

Trial registration

Clinicaltrials.gov NCT00514891
Zusatzmaterial
Additional file 1: Table S1: Overview of missing data in included variables. Supplementary Table S2 Effect of receiving VAS within 2 or 4 months prior to inclusion if included in the simple and large model respectively. Supplementary Table S3 Risk of VAD in timely vaccinated children if included in the simple and large model compared to other children within the same age group. Supplementary Table S4 Risk factors for vitamin A deficiency in rural Guinea-Bissau for children without infection. Supplementary Table S5 Risk factors for vitamin A deficiency in rural Guinea-Bissau retaining only the most deficient children by setting the cut-off for VAD 10% lower than 0.83. Supplementary table S6 Risk factors for vitamin A deficiency in rural Guinea-Bissau retaining both the most and marginally deficient children by setting the cut-off for VAD 10% higher than 0.83. (DOCX 96 KB)
12889_2012_5072_MOESM1_ESM.docx
Authors’ original file for figure 1
12889_2012_5072_MOESM2_ESM.tiff
Authors’ original file for figure 2
12889_2012_5072_MOESM3_ESM.jpeg
Authors’ original file for figure 3
12889_2012_5072_MOESM4_ESM.jpeg
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2013

BMC Public Health 1/2013 Zur Ausgabe