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Indian Journal of Community Medicine

Vitamin-A Deficiency and Goitre in Antenatal Mothers in a City Hospital

Author(s): R.J. Yadav and P. Singh

Vol. 29, No. 3 (2004-07 - 2004-09)

Abstract

Objectives: 1) To find out the magnitude of the problem of Vitamin A deficiency and goitre in pregnant women. 2) To find out the consumption of green leafy vegetable (GLV) by pregnant women. 3) To find out the level of iodised salt consumed by the pregnant women's family.

Study Design: Cross-sectional.

Setting: Indoor and O.P.D. of Medical College, Calcutta.

Participants: 503 pregnant women.

Statistical analysis: Proportions and Chi-square test.

Results: 3.28 % suffered from night blindness, 1.39% from conjunctival xerosis and only 0.4% had Bitot's spot. 13.51% and 5% were suffering from Grade-I and Grade-II type of goitre respectively among the 503 pregnant women. 173 salt samples out of 238 studied, contained iodine level of more than 15 ppm. 3.2% of the participants paid no importance at all to consume green leafy vegetables GLV regularly during pregnancy.

Conclusion: An attempt to include GLV in the pregnant women's diet should be advocated. IEC for sustenance of utilization of iodized salt should be emphasized.

Key words: Vitamin A deficiency, Goitre, GLV, IEC, Antenatal mothers, Iodine testing kit, RDA, IDD.

Introduction:

Vitamin A deficiency is a major public health problem of our country mainly affecting the children. Night blindness is reported more commonly in pre-school children and pregnant mothers1. Origin of childhood Vitamin A deficiency can be traced to poor Vitamin A status of the mother during pregnancy and lactation as well as poor intake of foods rich in either preformed Vitamin A or carotenoids at the stage of introduction of complementary foods or thereafter2.

Further some estimate showed that 4% of the reproductive age group women suffered from Vitamin A deficiency which may further increase during pregnancy and leads to deficient state in the children of those women3.

Iodine deficiency disorder (IDD) is another public health problem affecting all vulnerable groups of population. However, universal access to iodized salt and its daily consumption prevents iodine deficiency disorder. So, monitoring the consumption of iodized salt through detection of level of salt iodization at household level by iodine testing kit will ensure protection to the population and also to this vulnerable group of population i.e. pregnant women4,5,6. So the present study was undertaken with the following objectives to find out the magnitude of the problem of Vitamin A deficiency and goitre in pregnant women and to find out the level of green leafy vegetable consumption by pregnant women and level of salt iodization in their family.

Material and Methods:

The present study was a hospital-based study carried out in the antenatal O.P.D. and indoor of Gynecology and Obstetrics Department of Medical College, Calcutta during the period from February to March 1997. The sample size of 500 pregnant women to be examined was selected on the basis of feasibility. Data were collected in a predesigned and pretested proforma by the interviewers who were trained about different stages of ocular manifestations of Vitamin A deficiency and different grades of goitre based on the WHO publication of Sommer on Vitamin A deficiency and Hetzel's book on goitre respectively4,5. The level of salt iodization was detected with the help of iodine testing kit. All clinical findings were confirmed by the faculty members of the Department of Community Medicine, Medical College, Calcutta.

The pregnant women or their family members were asked to bring the common salt from their houses on the next day or during the next visit in a closed container or in a sealed plastic packet. Many pregnant women did not turn up during the next visit. Some of those who came in the next visit forgot to bring the salt.

Therefore, it was not possible to assess the level of iodization of salt in all the cases interviewed during the study.

Result and Discussion:

During the study 503 antenatal mothers were covered, majority of them (43.9%) belonged to 20-24 years of age group followed by 25-29 years (26.2%). Among the pregnant women attending the O.P.D. 37.2% had secondary level of education, 25.2% had primary level of education and only 14.1% were illiterate. Majority of the pregnant women were Hindu by religion (95.4%). Prevalance of Vit A deficiency and its distribution in age groups of pregnant women is shown in Table 1.

The data obtained from the study was not strictly comparable but there was some existence of Vitamin A deficiency (3.2%), which is more than 1% in the study population. Out of total vitamin A deficiency cases, 56.2% belonged to lower socio-economic status group followed by upper lower group (31.2%), 6.25% in case of both lower middle and upper middle group and none was from upper socioeconomic status. However it was observed that prevalence of night blindness increased with the age up to 30 years and thereafter it declined (Table-1). It was highest in pregnant mothers who had graduate level of education (9.7%) while in other groups it was around 2-3%. This could be due to the consumption of less green leafy vegetables or other Vitamin A rich food and preference of fashionable diet containing less Vitamin A by the higher educated group.

Only 4.6% of the total pregnant women were Muslim by religion. Among them 8.7% suffered from night blindness and 4.4% each with conjunctival xerosis and Bitot's spot. The difference between two religious groups in respect of occurrence of Vitamin A deficiency is statistically significant (x2=7.62, P<.01, df-1). It was found that vitamin A deficiency was detected among 4.8% Para (P)2, 3% P1 mothers followed by 1.1% P0 mothers. Both Vitamin A and Goitre was found in 0.8% primi mothers and 5% P1 mothers. Relationship between vitamin A deficiency status and parity of the mother was found to be highly significant. Only goitre was present in 16.6% of P0 mother, 12.9% P1 mother and 47.6% P2 mothers, which is significantly high. Para2 mothers were mostly illiterate Muslim and lack of awareness of consumption of iodized salt among them may be the cause of this deficiency state. Occurrence of Night blindness was 4.8% in case of pregnancy under 12 weeks of gestation, while above 20 weeks it was 3.5%. But between 12-20 weeks it was only 1%.

Green leafy vegetables (GLV) consumption was studied with three days recall. It was observed that 56.7% of pregnant women consumed GLV for three days or more, 33.2% for two days, 9.9% for a day and only 3.2% did not consume GLV at all. GLV consumption in West Bengal was observed to be more than the RDA3. GLV consumption should be strongly recommended during pregnancy and lactational period to bring down the night blindness prevalence to a negligible level. A strong IEC for pregnant women is needed as because, so long, emphasis was given on children only. Prevalance and age distribution of goitre among pregnant women is shown in table 2. Study revealed that the goitre was almost equally distributed amongst different religion and literacy groups. The present status of goitre is an indication of strong IEC activities. Level of salt iodization of pregnant women's family was studied by iodine testing kit supplied by UNICEF. Out of 503 families 238 families (47.31%) brought common salt in a covered container during the study period. Rest of them either forgot to bring the common salt or showed reluctance to bring the salt for testing. Among 238 samples, 45 samples (18.9%) contained iodine level of less than 15 ppm. While in 173 out of 238 samples (72.7%) the level was 15-30 PPM and 20 samples had a level above 30 PPM (8.40%). This finding corroborates with the findings of S. Kumar that also showed 71.2% salt samples were found to contain >15 ppm of iodine at house hold level in different districts of West Bengal6. The level of iodized salt consumption appeared to better in the present study which could be due to involvement of AWW at grass root level training and joint training program.

Table-1 Age wise distribution of Antenatal Mothers with Vitamin A dificiency and Goitre

Age group
in years
N No deficiency Night
Blindness
Conjunctival xerosis Bitot's spot Goitre
Grade - 0 Grade-1 Grade-II
No. % No. % No. % No. % No. % No. % No. %
< 20 55 54 (98.18) 1 (1.82) - - - - 48 (87.27) 5 (9.09) 2 (3.64)
20-24 221 213 (96.38) 8 (3.62) 5 (2.26) 1 (0.45) 193 (87.33) 20 (11.05) 8 (3.62)
25-29 132 126 (95.45) 6 (4.55) 2 (1.51) 1 (0.75) 81 (61.36) 37 (28.03) 14 (10.61)
30-34 51 50 (98.04) 1 (1.96) - - - - 46 (90.20) 4 (7.84) 1 (1.96)
35-39 41 41 (100) - - - - - - 39 (95.12) 2 (4.88) - -
40 and above - - - - -> 3 3 (100) - - - - - - 3 (100) - - - -
Total 503 487 (96.82) 16 (3.18) 7 (1.39) 2 (0.40) 410 (81.55) 68 (13.52) 25 (4.97)
N.B. - Some pregnant women had more than one signs / symptoms of Vitamin A dificiency.

References:

  1. Passi SJ, Khanna K, Puri S. Dietary Promotion of Vitamin A Rich Foods through Agriculture, Horticulture and Social / Farm Forestry - A report prepared by Institute of Home Economics University of Delhi; 1994;34
  2. UNICEF. Reducing Malnutrition - A call for urgent action, Vitamin A deficiency, 1995;1-3
  3. WHO/UNICEF/IVACG Task Force. Vitamin A supplements - A guide to their use in the treatment and prevention of Vitamin A deficiency and xerophthalmin. 1998;9-14.
  4. Sommer Alfred. Vitamin A dificiency and its consequences - A field guide to detection and control, 3rd edition, WHO, Geneva. 1995; 38
  5. Hetzel BS and Pandav CS. S.O.S. for a billion. Delhi Oxford University press, 1995;1-25 & 220-23.
  6. Kumar S. Indicators to monitor progress of NIDDCP and some other observations, Indian Journal of Public Health, Special Issue on I.D.D. 1995; 39:141-147.
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