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Caring for kids new to Canada

A guide for health professionals working with immigrant and refugee children and youth

Vitamin A Deficiency

Key points

  • Vitamin A deficiency is common in low-resource countries, especially among refugees.
  • Vitamin A deficiency can affect vision, in a range from reduced night vision to blindness.
  • Causes include dietary insufficiency, malabsorption, or increased utilization or excretion due to common illnesses.
  • Stressors such as diarrhea, measles and pneumonia can decrease vitamin A levels and lead to disease.

Prevalence

Vitamin A deficiency is common in low-resource countries, particularly among refugees. For example, one-third of adolescent refugees in Nepal and up to two-thirds of African refugee children have been reported to have vitamin A deficiency.1,2

Definition

Vitamin A status can be identified by measuring serum retinol concentrations to assess levels. Table 1 helps define degrees of deficiency. With the high prevalence of vitamin A deficiency, however, this testing is not usually done if patients are asymptomatic.

Etiology

Table 1: Vitamin A deficiency using retinol concentration
Serum retinol (micrograms/dL) Serum retinol (micromols/L) WHO definition
<10 <0.35 Severe
10-19.9 0.35-0.69 Moderate
20 or above 0.7 or above None
Source: Adapted from Centers for Disease Control and Prevention, World Food Programme. A Manual: Measuring and interpreting malnutrition and mortality. Rome: WFP, 2005:28.

Vitamin A deficiency can be caused by low dietary intake, malabsorption and increased utilization or excretion associated with common illnesses.3 Despite established policies for supplementing and fortifying foods supplied at refugee camps, high rates of vitamin A deficiency persist. Refugee numbers, pressures on food supply and difficult logistics make implementation a challenge in many regions.

Consequences

While most cases of vitamin A deficiency are not severe enough to have definite, observable symptoms, stressors such as measles, pneumonia or diarrhea can decrease levels further and result in serious disease. Vitamin A deficiency can affect vision, in a range from poor night vision to blindness,4 and there is an increased risk of death after measles, diarrhea or pneumonia.

The prevalence of blindness in children in Sudanese refugee camps has been estimated at 1.4 per 1000 children, with 40% of cases due to corneal opacities attributed mainly to vitamin A deficiency.5 Additional consequences include impaired bone growth, weakened immune response and increased risk of mortality.4

Diagnosis

If a deficiency is suspected, clinicians should have vitamin A levels tested in a newcomer child or youth.

Treatment

Vitamin A deficiency in young newcomers can be treated with supplementation and dietary modifications.

The recommended daily intake of vitamin A for all age groups, including infants, children and adolescents, are available from Health Canada.

Selected resources

References

  1. Seal AJ, Creeke PI, Mirghani Z, et al. Iron and vitamin A deficiency in long-term African refugees. J Nutr 2005;135(4):808-13.
  2. Woodruff BA, Blanck HM, Slutsker L, et al. Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal. Public Health Nutr 2006;9(1):26-34.
  3. WHO. World Health Report 2002 – Reducing risks, promoting healthy life. Geneva, Switzerland: WHO, 2002.
  4. Centers for Disease Control and Prevention. Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination. Bethesda, MD: CDC, 2012.
  5. Zeidan Z, Hashim K, Muhit MA, et al. Prevalence and causes of childhood blindness in camps for displaced persons in Khartoum: Results of a household survey. East Mediterr Health J 2007;13(3):580-5.

Reviewer(s)

  • Anna Banerji, MD
  • Andrea Hunter, MD

Last updated: April, 2013