title: Prevalence and associated factors of clinical manifestations of vitamin a deficiency among preschool children in asgede-tsimbla rural district, north Ethiopia, a community based cross sectional study.
abstract: BACKGROUND
  Vitamin A Deficiency is a common form of micronutrient deficiency, globally affecting 33.3 % of preschool-age children. An estimated of 44.4 % of preschool children in Africa were at risk for vitamin A deficiency. In Ethiopia, vitamin A deficiency leads to 80,000 deaths a year and affects 61 % of preschool children. The aim of this study was to investigate the prevalence and associated factors with the night blindness, Bitot's spot and vitamin A intake among preschool children in rural area, Asgede-Tsimbla district, North Ethiopia.
  
  
  METHODS
  Community based cross sectional study was conducted from January 27 to March 7, 2014. A total 1230 preschool children were selected by systematic random sampling from 8 randomly selected kebelles (smallest administrative unit). Structured and pretested questionnaires adapted from relevant studies and WHO/FAO was for data collection. In addition, sex, age, and height were taken and filled to Emergency Nutrition Assessment (ENA) for Standardized Monitoring and Assessment of Relief and Transition (SMART) 2007 software to convert the nutritional data into Z-scores of the indices. The data was then transported to SPSS version 20. Bivariate and Multivariable binary logistic regressions were carried out to investigate the effect of each independent variable on the dependent variable. Statistical significance was set at p-value < 0.05.
  
  
  RESULTS
  The odds of Bitot's spots (1.46 %) and night blindness (1.22 %) were higher than the WHO Cut-off levels used to define a public health problem. The odds of night blindness was 4 times higher among children belonging to family size greater or equal to four [Adjusted Odds Ratio (AOR) = 4.18, 95 % CI = 1.15,15.3] and 6 times higher among children of illiterate mothers [AOR = 5.96 , 95 % CI = 1.33,26.69]. The odds of Bitot's spots was 5.35 times higher among children belonging to family size greater or more four [AOR =5.35; 95 % CI = 1.49, 19.2], 4.75 times higher among children of illiterate mothers [AOR = 4.75, 95 % CI =1.32, 17.18] and 6 times higher in males than females [AOR = 5.8, 95 % CI = 1.65, 20.46].
  
  
  CONCLUSIONS
  The study revealed that night blindness and Bitot's spots are major nutritional problems in the study area. The independent predictors of night blindness were mother illiteracy status and large family size and also for Bitot's spots were mother illiteracy status, male sex of child and large family size. Therefore, the need to increase educational level of mother, use of family planning of women and emphasis on male children and children from large family size by involving the Education sector, Health sector, (Federal Ministry of Health) FMOH and (Tigray Regional Health Bureau) TRHB is crucial.
authors.affiliation: Department of Medicine, Aksum University, Aksum, Ethiopia.
authors.forename: Tesfalem
authors.initials: T
authors.lastname: Abrha
authors.affiliation: Department of Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran ; Center of International Reproductive Health Training (CIRHT), Bahir Dar University, Bahir Dar, Ethiopia.
authors.forename: Yonas
authors.initials: Y
authors.lastname: Girma
authors.affiliation: Department of Public Health, Aksum University, Aksum, Ethiopia.
authors.forename: Kebede
authors.initials: K
authors.lastname: Haile
authors.affiliation: Department of Medicine, Aksum University, Aksum, Ethiopia.
authors.forename: Mezgebe
authors.initials: M
authors.lastname: Hailu
authors.affiliation: Center of International Reproductive Health Training (CIRHT) Program Manager, Addis Ababa, Ethiopia.
authors.forename: Mengistu
authors.initials: M
authors.lastname: Hailemariam
keywords: Bitot‘s spot; Clinical vitamin a status; Night blindness; Vitamin a deficiency