Vitamin A deficiency among rural women
Source: Flickr, World Bank

Vitamin A deficiency remains a significant public health problem in many developing countries, including India. This micronutrient deficiency, which most commonly affects pregnant women, women of reproductive age (15-48 years of age), and young children, can lead to vision problems and blindness, anemia, decreased ability to fight off infections, increased risk of morbidity and mortality during pregnancy, low birth weight, and increased risk of child mortality. In 2002, India’s National Nutrition Monitoring Bureau reported that dietary intake of vitamin A among rural women was grossly inadequate, with not even 50 percent of recommended vitamin A being consumed women across most age groups. 

A new study from the International Journal of Health Sciences & Research provides an updated examination of vitamin A deficiency levels among India’s rural women, specifically among women of reproductive age. The study analyzed both dietary intake of vitamin A and blood serum retinol levels among 898 women of reproductive age, including pregnant and lactating women, from 30 randomly selected villages in Ahmednagar district in Maharashtra state.

Trained field investigators collected qualitative data on dietary intakes using a 24-hour diet recall surveys conducted at the time of meal preparation (whenever possible). The weight of the food consumed was then calculated, and all of this this food intake data was entered into HarvestPlus’s CS Dietary software in order to calculate intake of vitamin A and β-carotene. β-carotene levels were then converted into serum retinol equivalents. The adequacy of women’s dietary intakes was calculated as a percent of the recommended dietary allowances provided by the Indian Council of Medical Research. The diet recall data was then validated using food weight data for 40 women who were not part of the study but who resided in similar villages and whose diet patterns were similar to those of the participants. In addition, a blood sample was taken from 200 women to test for serum retinol levels. Among the 898 participants, 47.8 percent were not pregnant and not lactating, 45.5 percent were lactating, and 6.7 percent were pregnant at the time of the study.

The results show that among women of reproductive age in these rural areas, the mean adequacy of vitamin A intake ranged from 44.5 percent to 54.8 percent. Vitamin A intakes were lower for women ages 21-39 than for woman above the age of 39; more than half of the women aged 21-39 consumed less than 30 percent of the recommended daily amount of vitamin A, putting them at significant risk of vitamin A deficiency. Overall, only five percent of women consumed close to (90-100 percent) of the daily recommended amount.

Dietary adequacy was higher for non-pregnant, non-lactating women than for either lactating women or pregnant women; overall, the sampled pregnant and lactating women consumed less than 50 percent of the daily recommended amount of vitamin A. In addition, as the length of lactation increased, dietary adequacy continued to fall. According to the authors, this increases the risk of vitamin A deficiency for both lactating mothers and breastfed babies.

Family income appears to be positively associated with both mean dietary intake of vitamin A and mean adequacy of vitamin A consumption. Both indicators rose as household income (in Rupees per month) increased. The authors suggest that this is because as household income increases, so, too, does household purchasing power and the ability to buy higher value, vitamin A-rich foods (such as milk, eggs, green leafy vegetables, and yellow-orange fruits and vegetables). Ownership of livestock, particularly cattle, also appears to play a role in women’s diets. Sixty percent of the sampled women belong to households that do not own livestock/cattle; both dietary intake and dietary adequacy were significantly lower among these women. Mean vitamin A intake for women whose households own cattle was 50 µg/day higher than for women whose households do not own cattle. The authors posit that these results stem from the fact that women with access to cattle in their households are more likely to consume vitamin A-rich milk.

Surprisingly, there was no significant difference found in mean dietary intake  based on women’s education level, access to tap water or electricity, family size, landholdings, or type of house structure.

Women’s low intake of vitamin A was reflected in low serum retinol levels detected through blood samples collected from 200 women during the study. Only one-fifth of the women who consented to blood tests had serum retinol levels within the normal range; more than three-fourths of the sampled women had serum retinol levels that indicated vitamin A deficiency. The authors point out, however, that due to the relatively small number of women who consented to blood tests, it is not possible to determine the specific factors influencing serum retinol levels.

The study highlights the need for continued efforts to increase vitamin A intake among rural women in India. Programs that increase women’s access to vitamin A-rich foods, as well as efforts to improve education regarding the importance of vitamin A intake for women’s and children’s health, are recommended. 

Photo credit:Flickr, World Bank