Validity of Bitot's spots in evaluation of impact of Vitamin A supplementation Programmes in children between 1 and 5 years of age

INTRODUCTION:   The prevalence of Bitot’s spots (BS) is often used to quantify vitamin A deficiency burden in India, both before and after mega-dose vitamin A supplementation (MVAS) programmes. However, the proportion of BS cured following this intervention is unclear in contemporary times. The current study evaluated the responsiveness of BS over   1 year to MVAS administered as per the national programme in rural India.

METHODS:  Design: Prospective, community-based, 1-year follow-up of a cohort.

Setting: Rural Uttar Pradesh, India. : Two hundred and sixty-two children with BS,

aged between 1 and 5 years, administered 60 mg (retinol equivalent) of vitamin A on diagnosis and after 1 month. Cure or resolution was defined if there was no discernible BS in either eye.

RESULTS:   During 1 year, only three children were lost to follow-up. At 6 months of

follow-up (MVAS at baseline and 1 month later), 51.1 (95% CI 45.3, 57.3) % were

classified as cured. The corresponding figure at 1 year (additional MVAS at

6 months) was 59.9 (95% CI 54.1, 65.9) %. Among those cured at 6 months, about

half and three-quarters had resolved at 2 and 3 months, respectively. Apart from

male gender, there were no significant socio-demographic or clinical predictors of

response.

CONCLUSIONS: Substantial non-response to MVAS at 6 months (49%) and 1 year

(40%) of follow-up suggests that presently in the Indian subcontinent, BS

is a relatively crude indicator of severe current vitamin A deficiency. For

programmatic decisions and evaluation, the public health burden of vitamin A

deficiency should not be assessed solely through BS.