Resolution of Bitot's Spots Following Mega-Dose Vitamin a Supplementation in Children between 1 and 5 Years of Age

Abstract

Objectives: To evaluate the responsiveness of BS over one year to MVAS administered as per national program in rural India. Methods: Prospective community based follow-up of a cohort of 262 children with BS, aged between 1 and 5 years. Resolution or cure was defined if there was no discernible BS in either eye. Results: During one year, only three children were lost to follow-up. At six months of follow-up (MVAS at baseline and 1 month later), 51.1% (95% CI 45.3% to 57.3%) were classified as cured. The corresponding figures at one year (additional MVAS at 6 months) were 59.9% (95% CI 54.1% to 65.9%). Amongst those cured at six months, about half and three-fourths had resolved at two and three months, respectively. There were no significant socio-demographic or clinical predictors of response. Conclusions: Substantial non-response to MVAS at six months (49%) and one year (40%) of follow-up suggests that presently in the Indian subcontinent, Bitot's spot is a relatively crude indicator of severe current vitamin A deficiency. Thus for programmatic decisions and evaluation, public health burden of VAD should not be solely assessed through BS.