Tribal Odisha Eye Disease Study Report \# 6. Opportunistic screening of vitamin A deficiency through School Sight Program in tribal Odisha (India)

Our plain-English summary of Tribal Odisha Eye Disease Study Report # 6. Opportunistic screening of vitamin A deficiency through School Sight Program in tribal Odisha (India), by L. Panda, S. Nayak, T. Das (Indian Journal of Ophthalmology, 2020).

The study

• Authors: L. Panda, S. Nayak, T. Das
• Journal: Indian Journal of Ophthalmology
• Published: 2020;68(2):351-355
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: To explore the possibility of vitamin A deficiency (VAD) detection through School Sight Program (SSP) in a tribal district of Odisha, India.

Methods: In a cross-sectional observational study, we tracked school children with ocular signs/symptoms of VAD to their villages. The ophthalmologist examined their under-5 siblings and other under-5 children in the village. Information pertaining to family belief and practices of food, water, sanitation, and the socioeconomic status of the family were collected.

Results: The ocular features of VAD were detected in 207 of 4801 (4.3%) examined children. This included 70 children (mean age 11 ± 2.6 years) detected in the school, 22 siblings (mean age 3.2 ± 1.2 years) of these children detected at their home, and 115 children (mean age 3 ± 1.5 years) detected in their habitat. The average family size was 5.8 ± 2.02 and the birth order of the child with VAD was 2.3 ± 1.25. Most parents were farmer, living in asbestos-roofed house, depended on public underground water, and practiced open-air defecation. The distribution of VAD in 207 children was conjunctival xerosis (X1A = 207; 100% of VAD and 4.3% of all children), Bitot's spot (X1B = 169; 81.6% of VAD and 3.5% of all children), corneal scar (XS = 3; 1.4% of VAD and 0.06% of all children), and night blindness (XN = 35; 16.9% of VAD and 0.72% of all children).

Conclusion: An opportunistic screening for detection of VAD through a SSP could be cost-effective and complement the existing strategy.

In plain English

This cross-sectional study in Rayagada district, Odisha, India, tested whether a school eye-screening program could lead to children with vitamin A deficiency (VAD) outside school. The program screened 153,107 children in 2124 schools. Teachers suspected VAD in 300 children, and an ophthalmologist confirmed it in 70. A team then visited the homes of 65 of these children. It examined 32 under-5 siblings and 250 other under-5 children in the same villages. Eye signs of VAD were found in 22 siblings and 115 village children. In total, 207 of 4801 children examined (4.3%) had VAD. All 207 had conjunctival xerosis, a dryness of the eye surface. Of the 4801 children, 169 (3.5%) had Bitot's spot, 35 had night blindness and 3 had corneal scars. Most parents were farmers, and 81% of the children with VAD were recorded as practicing open-air defecation. The authors wrote that most of these children lived in asbestos-roofed houses. The study did not measure or analyze asbestos. The authors concluded that such screening could be cost-effective and complement the existing strategy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional observational study: opportunistic screening that followed children found in a school sight program back to their homes and villages
• Who was studied: School children screened in the Rayagada School Sight Program (153,107 children in 2124 schools in a tribal district of Odisha, India), plus under-5 siblings and other under-5 children in their villages; 4801 children examined in total
• Exposure: The study was about vitamin A deficiency, not asbestos. Asbestos appears only as a description of housing: the authors report that the majority of the children with VAD lived in asbestos-roofed houses. No asbestos exposure was measured or analyzed. Diet, water, sanitation and occupation were also recorded.
• Main results:
  • In all school and village groups combined, 207 of 4801 examined children had ocular signs of vitamin A deficiency (4.3%)
  • In schools, teachers suspected VAD in 300 children. Optometrists confirmed it in 73, and the ophthalmologist confirmed it in 70.
  • At home and in villages, 22 siblings of the school children with VAD had signs of VAD. So did 115 of 250 other under-5 children in the same habitats.
  • Bitot's spot was found in 169 children: 81.6% of the children with VAD and 3.5% of all 4801 examined. The authors noted this exceeded the 0.5% cut-off used to define VAD as a public health problem.
  • Corneal scar was found in 3 children (1.4% of those with VAD, 0.06% of all children). Night blindness was found in 35 (16.9% of those with VAD, 0.72% of all children).
  • Among the 207 children with VAD, only 5% consumed cow milk or other dairy products, and between 12% and 38% had regular nonvegetarian food. Open-air defecation was recorded for 81% of these children (168 of 207 in Table 3), and 90% of parents were farmers (187, 90.5%, in Table 3). These figures are counted per child, not per family.
  • There were no documented records of vaccination or vitamin A supplementation, and parents' answers about them were vague
• The authors' conclusion: The authors concluded that opportunistic screening for VAD through a school sight program could be cost-effective and complement the existing strategy. They also stated that VAD is a public health problem in Rayagada.
• Limitations the authors state:
  • The school sight program was not designed to detect vitamin A deficiency; the VAD screening was opportunistic
  • Not all children in the tribal community may attend school, so some habitats were probably missed
  • The program was not designed to identify risk factors for VAD. The authors also note there was no case-control study.

Related studies

• A global clinical view on vitamin A and carotenoids — A. Sommer, K.S. Vyas (2012)
• Asbestos-related disease in public school custodians — L.C. Oliver, N.L. Sprince, et al. (1991)
• Experiences of a state-sponsored notification and screening program for asbestos workers — A.P. Bender, A.N. Williams, et al. (1993)
• Asbestos-related disease in custodial and building maintenance workers from a large municipal school district — J.R. Balmes, A. Daponte, et al. (1991)
• A radiographic survey of public school building maintenance and custodial employees — H.A. Anderson, L.P. Hanrahan, et al. (1992)
• Asbestos in Vermont schools: findings of a statewide on-site investigation — L.F. Novick, C. Rice, et al. (1981)

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