Epidemiology of xerophthalmia in Nepal. A pattern of household poverty, childhood illness, and mortality. The Sarlahi Study Group
S. K. Khatry, K. P. West Jr, J. Katz, S. C. LeClerq, E. K. Pradhan, L. S. Wu, M. D. Thapa and R. P. Pokhrel
National Society for the Prevention of Blindness, Kathmandu, Nepal.
A case-control study of xerophthalmia (120 cases, two with corneal disease;
3377 children without xerophthalmia, 12 to 60 months of age) was conducted
in the rural plains of Nepal. Relative household wealth (ownership of
animals and goods, house quality) and social standing (parental education,
nondaily laboring, more affluent castes) were inversely related to risk of
xerophthalmia. Mothers of cases were more likely to have had children die
than mothers of controls (odds ratio, 1.85; 95% confidence interval, 1.22
to 2.78); case households were more likely to have had a young child die in
the past year (odds ratio, 2.85; 95% confidence interval, 1.43 to 5.67).
Children with xerophthalmia were more wasted and stunted than controls,
although these associations largely disappeared after adjusting for
socioeconomic influences. Frequency of breast-feeding was highly protective
against xerophthalmia in a dose-response manner (odds ratio, 0.32 for 1 to
10 times a day, 0.12 for > 10 times a day) after adjusting for age and
other factors. The risk of xerophthalmia rose directly with reported
duration of dysentery in the previous week (odds ratio, 2.13 and 5.81 for
durations of 1 to 6 days and > or = 7 days, respectively, vs none). Mild
xerophthalmia is reflective of a lower, local standard of living within
which child health, nutrition, and survival are compromised.
