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April 1995

Epidemiology of Xerophthalmia in NepalA Pattern of Household Poverty, Childhood Illness, and Mortality

Author Affiliations

From the National Society for the Prevention of Blindness, Kathmandu, Nepal (Drs Khatry and Pokhrel and Mr Thapa), and the Center for Human Nutrition and Dana Center for Preventive Ophthalmology, The Johns Hopkins Schools of Public Health and Medicine, Baltimore, Md (Drs West and Katz, Mr LeClerq, and Mss Pradhan and Wu). Members of The Sarlahi Study Group are listed at the end of this article.

Arch Ophthalmol. 1995;113(4):425-429. doi:10.1001/archopht.1995.01100040039024

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 ≥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.