title: Resolution of Bitot's spots following mega-dose vitamin A supplementation in children between 1 and 5 years of age.
abstract: OBJECTIVE
  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
  Prospective, community-based, 1-year follow-up of a cohort.
  
  
  METHODS
  Rural Uttar Pradesh, India.
  
  
  METHODS
  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 sociodemographic 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.
authors.affiliation: 1Department of Human Nutrition,All India Institute of Medical Sciences,Ansari Nagar,New Delhi,India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Kapil
authors.affiliation: 2Department of Community Medicine,MLN Medical College,Allahabad,India.
authors.forename: Shraddha
authors.initials: S
authors.lastname: Dwivedi
authors.affiliation: 3Department of Pediatrics and Clinical Epidemiology,Sitaram Bhartia Institute of Science and Research,B-16,Qutab Institutional Area,New Delhi 110016,India.
authors.forename: Harshpal S
authors.initials: HS
authors.lastname: Sachdev
authors.affiliation: 4Department of Biostatistics,All India Institute of Medical Sciences,Ansari Nagar,New Delhi,India.
authors.forename: S N
authors.initials: SN
authors.lastname: Dwivedi
authors.affiliation: 4Department of Biostatistics,All India Institute of Medical Sciences,Ansari Nagar,New Delhi,India.
authors.forename: R M
authors.initials: RM
authors.lastname: Pandey
authors.affiliation: 1Department of Human Nutrition,All India Institute of Medical Sciences,Ansari Nagar,New Delhi,India.
authors.forename: Harsha
authors.initials: H
authors.lastname: Hirdyani
authors.affiliation: 4Department of Biostatistics,All India Institute of Medical Sciences,Ansari Nagar,New Delhi,India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Upadhyay
mesh_terms: D002675:Child, Preschool; D019587:Dietary Supplements; D005128:Eye Diseases / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012737:Sex Factors; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D014802:Vitamin A Deficiency / Q000150:complications / Q000188:drug therapy*
chemical_list: D014801:Vitamin A