Vitamin A deficiency among children from low socio-economic status living in different environments in Khartoum State.

Vitamin A deficiency among children from low socio-economic status living in different environments in Khartoum State. Vitamin A deficiency Vitamin A DeficiencyDefinitionVitamin A deficiency exists when the chronic failure to eat sufficient amounts of vitamin A or beta-carotene results in levels of blood-serum vitamin A that are below a defined range. (VAD (Value Added Dealer) Same as VAR. ) is a major public health problem inSudan. The disease was hyper-endemic in the East, but during the lastdecade the country has been passing through difficult times andcontinuous changing situations, where the civil war in the south, theemergency of drought and desertification desertificationSpread of a desert environment into arid or semiarid regions, caused by climatic changes, human influence, or both. Climatic factors include periods of temporary but severe drought and long-term climatic changes toward dryness. , then the rains and floodsended with a food gap which led to the spread of vitamin A deficiencynearly all over the country. This study was a cross-sectional study using motherhood method forcollecting data. The study was conducted among 160 mothers having 295children in the age groups between 6 months--10 years in four groups oflow socio-economic status. Two of thegroups were living in urban slums(Daralsalam and Alsemeir) and the other two groups were living inpockets with populations of low socio-economic status within areas ofhigh socio-economic status (Alryad and Shambat New Extension). The data was collected by interviewing the mothers usingstandardized administrated questionnaires where night blindness night blindness,inability to see normally in subdued light. It is usually a result of vitamin A deficiency. The rod cells, one of two light-sensitive areas of the retina of the eye, are impaired in their capacity to produce a chemical compound called rhodopsin, or andoccular abnormalities were used as the criteria for diagnosing thedisease. Anthropometric measurements anthropometric measurements (anˈ·thrō·p were also used to determine thegeneral nutritional status nutritional status,n the assessment of the state of nourishment of a patient or subject. of the populations. The prevalence of VAD inthe four areas was: 59% at Daralsalam, 38% at Alsemeir, 49% at Alryadand 32% at Shambat based on occular abnormalities. Night blindness was23% at Daralsalam, 6% at Alsemeir, 8% at Shambat and no single case inAlryad. Vitamin A deficiency in children was associated withinsufficient dietary intake and attacks of infectious diseases(diarrhea, measles and respiratory infections). Mother's loweducational status and lack of nutritional education played an importantrole in the spread of the diseases and thus health education was highlyrecommended for the mothers of malnourished mal��nour��ishedadj.Affected by improper nutrition or an insufficient diet. children to avoidconsequences of VA depletion. In this study it was thought pertinentalso to confirm the recommendations of Mohamed, M. and Hassan, S. (2)that VA supplementation programs should continue fill the economiccrisis is solved. Also nation wide surveys are necessary to determinethe exact prevalence of VAD to launch the necessary interventions. The study put in evidence that the residential area is a veryimportant factor in nutritional status; food support from surroundingsdepended on the area of living (p=0.000). Alryad is the area where thesupport is more frequent compared with Shambat (table 5), whilenutritional status of children is significantly different, ([X.sup.2]=29.408), in such a way that 64% of children in shambat were wellnourished compared with the children in the other three areas, 41% fromDaralsalam. 38% from Alsemeir, and 32% from Alryad (table 8). Inspite of support; Alryad area revealed a bad status of nutritionfor children compared to Shambat where the support is less and this maybe due to many factors such as: the supportive food taken only by theelders, or the supportive food is not regular, although the quality ofthe supportive food in Alryad contains vegetables and fruits. ReceivingVA supplement, as well is signifcantly different ([X.sup.2] = 69. 084);in Darasalam 90% compared with the other three areas where 77% were fromAlsemeir, 59% from Shambat, and 32% from Alryad. [TEXT NOT REPRODUCIBLE IN ASCII ASCIIor American Standard Code for Information Interchange,a set of codes used to represent letters, numbers, a few symbols, and control characters. Originally designed for teletype operations, it has found wide application in computers. ] Introduction Vitamin A deficiency (VAD) occurs largely in developing countriesamong undemourished children whose diets are limited in carotene carotene(kâr`ətēn'), long-chained, unsaturated hydrocarbon found as a pigment in many higher plants, particularly carrots, sweet potatoes, and leafy vegetables. containing vegetables, animal products ,and fat. Very often repeatedepisodes of diarrhea and other infections interfere with absorption, andincrease vitamin A vitamin Aalso called retinolFat-soluble alcohol, most abundant in fatty fish and especially in fish-liver oils. It is not found in plants, but many vegetables and fruits contain beta-carotene (see (VA) requirements. Febrile febrile/feb��rile/ (feb��ril) pertaining to or characterized by fever. feb��rileadj.Of, relating to, or characterized by fever; feverish. illness and particularlymeasles may precipitate keratomalacia in subjects with depleted vitaminA stores. In global surveys sponsored by World Health Organization(WHO), it was found that vitamin A deficiency was a cause of blindness,in varying degrees in all the 30 countries in South East Asia East AsiaA region of Asia coextensive with the Far East.East Asian adj. & n. , Africa,and Latin America Latin America,the Spanish-speaking, Portuguese-speaking, and French-speaking countries (except Canada) of North America, South America, Central America, and the West Indies. visited by the team (1) Vitamin A continues to be a leading cause of micronutrient mi��cro��nu��tri��entn.A substance, such as a vitamin or mineral, that is essential in minute amounts for the proper growth and metabolism of a living organism. deficiency, blindness, and eye disorders in the Philippines. In 1992 thestudy done by UNICEF, among children six months to six years of age, theprevalence of night blindness was 0.7% and of Bitot's Spots Bi��tot's spotspl.n.Small grayish foamy triangular deposits on the conjunctiva adjacent to the cornea in the area of the palpebral fissure, associated with vitamin A deficiency. 0.2%.Certain communities (remote rural villages, urban slums) and populationgroups (children from large families, with poorly educated mothers, fromunlanded farms or small fishing households) are considered at higherrisk than others (4). Vitamin A deficiency in Sudan In Sudan, vitamin A is considered as a public health problem. Thesurveys that were conducted in Khartoum and Gezira (1982) indicated thatvitamin A deficiency prevalence was 2% (2). Recent studies conducted inthe urban slums of Khartoum state in 1994, have shown that vitamin Adeficiency in children was 46.3% at Wad Elbashir (3). A more recentstudy (1999) carried in Daralsalam and AlSemeir urban slums aroundKhartoum ill children aged 6 months to 6 years found that, theprevalence of VAD in urban slums was 18% at Daralsalam and 29% atAlsemeir. This serious magnitude of prevalence was considered to be anoutcome of interrelated socio-economic factors that included, low familyincome, low education levels and unawareness of the population,irrespective of irrespective ofprep.Without consideration of; regardless of.irrespective ofpreposition despitewhether health services health servicesManaged care The benefits covered under a health contract were available or not (2) A collaborative study was conducted in 1978 by the WHO andNutrition Department in the Gezira and Khartoum areas. There, 1948 boysand 1972 girls were studied. Of those, 1.9% were having bothBitot's Spots and Xerosis xerosis/xe��ro��sis/ (ze-ro��sis) abnormal dryness, as of the eye, skin, or mouth.xerot��icxerosis generalisa��ta , no Corneal cornealpertaining to the cornea. See also keratitis, keratopathy.corneal anomalyincludes microcornea, coloboma, megalocornea, dermoid, congenital opacity.corneal black bodysee corneal sequestrum (below). Lesions were detected. Soaccording to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. the WHO criteria, Xerophthalmia xerophthalmia/xe��roph��thal��mia/ (zer?of-thal��me-ah) abnormal dryness and thickening of the conjunctiva and cornea due to vitamin A deficiency. xe��roph��thal��mi��an. does not appear to be aproblem of a public health significance in these two provinces. Butthere were indicators that hypovitaminosis A was fairly prevalent whichneed to be confirmed by determining serum vitamin A level (5) In Sudan during 1989 a study was conducted to estimate vitamin Astatus of well-nourished, breast-feeding Sudanese women in Gezira area.Plasma retinol retinol:see Vitamin A under vitamin. and total tocopherol tocopherol:see vitamin. were estimated. It was found thatneither the retinol nor tocopherol values showed a correlation to parityor duration of breast-feeding (6) In 1991, a study was conducted in Sudan in Khartoum TeachingHospital aiming at examining malnourished children for signs ofXerophthalmia. It was found that 29% of the study group (4moths-5years)had varying degrees of Xerophthalmia. These included 56% Bitot'sSpots with Conjuntival Xerosis, 11% with Corneal Ulceration ulceration/ul��cer��a��tion/ (ul?ser-a��shun)1. the formation or development of an ulcer.2. an ulcer.ul��cer��a��tionn.1. Development of an ulcer.2. , 17% withBitot's Spots, 1% with Corneal Xernsis and 3% with Corneal Scars,and 9% were having night blindness (7). In 1997, a study was conducted in six Sudanese states (Kassala,South Darfur Coordinates: South Darfur (Arabic: جنوب دارفور; transliterated: Janob Darfor) is one of the 26 wilayat or , North Kordofan, Red Sea, Gazira and Nahr Elneil). The aimsof the study were to evaluate the nutritional status and micronutrientsdeficiencies including vitamin A of children and mothers. The resultsshowed the overall prevalence of night blindness was 8.5% and was foundto be inversely proportional to age of weaning. In the Red Sea Provincethe study showed that 3.7% of primary school children had Bitot'sSpots and 4.81% were having night blindness. The study also revealedhigh prevalence of vitamin A deficiency particularly in the Eastern partof Sudan (8). In a more recent study in 1999, the major findings of the studyhave shown that vitamin A deficiency in urban slums was 18% atDaralsalam and 29% at Alsemeir (2) The study concluded that thesituation of VAD in urban slums is alarming because of low income offamilies, the level of education of parents and complete absence or poorhealth centers when available. The researchers also made the followingmain recommendations: fortification fortification,system of defense structures for protection from enemy attacks. Fortification developed along two general lines: permanent sites built in peacetime, and emplacements and obstacles hastily constructed in the field in time of war. of sugar or even other diets, withvitamin A supplements as recently advised by a WHO consultant isunrealistic under our present economic situation. Health educationthrough serious health services, improvement of the income situation ofthe Sudanese citizens and immediate VA supplementation interventions areof vital importance (2) Justification Still studies on vitamin A deficiency in young children, in theSudan need further investigations and surveys for authenticdocumentation and suggestions on possible solutions. Again all studiesconducted were restricted to the age group of children between 6 monthsand 5 years. All such investigation were conducted in areas with lowsocio-economic status and poor or lack of health services. So far, noinvestigations were carried out in areas with pockets of populationswith low socioeconomic status riving amongst communities of highsocio-economic status. Objectives: 1) To estimate the prevalence of vitamin deficiency among childrenbetween 6 months and 10 years old riving in urban slums. 2) To study vitamin A deficiency of the same target group of lowsocio-economic status living in residential pockets among populations ofhigh socio-economic status. 3) To assess the perception of mothers towards the problem. 4) To further knowledge on the relationship between dietary factorsand infectious diseases to vitamin A deficiency. 5) To verify whether there is an association of vitamin Adeficiency with educational awareness, and socio-economic status of thestudied target groups. Methodology The study was a cross-sectional study using motherhood method forcollecting data. Population The study was conducted on children between 6 months and 10 yearsof age, The elementary unit of analysis was a child between 6 months and10 years of age. Study areas Four areas were chosen: Daralsalam, one of Omdurman Urban Slums,was chosen randomly from a list of slum areas that were found registeredin the Ministry of Health (MOH See modem on hold. ). Daralslam urban slum is situatedapproximately 25km outside Khartoum State and 14km South Libya Market.Tribes riving in Daralslam Omdurman urban slum were Deinka, Nueir,Shuluk, Nuba and Kordofan Arabs. Alsemeir urban slum, is a newsettlement which is neither registered in the Ministry of Health nor inthe Ministry of Housing Alsemeir urban slum is situated south West Sobaabout 30km from Khartoum centre, and it is divided into two parts: Alsemeir Almahatta and Alsemeir Alhila. The investigation was donein Alsemeir Almahatta. Tribes living in Alsemier were Bargo and Tama(originally from boarders between Sudan and Chad). The other two targetgroups represented populations of low socio-economic status living insubhuman sub��hu��man?adj.1. Below the human race in evolutionary development.2. Regarded as not being fully human.sub��hu residential pockets in Alryad and Shambat New Extension. Thelatter are two areas populated with citizens of very high socio-economicstatus. Sample size According-to the literature and statistical method for calculatingsample size the equation: N = [2.sup.2]Pq/[d.sup.2] was adopted, where 2is normal standard quartile QuartileA statistical term describing a division of observations into four defined intervals based upon the values of the data and how they compare to the entire set of observations.Notes:Each quartile contains 25% of the total observations. at level of 5%, P is prevalence of vitamin Adeficiency; q is 1-P and d is the precision of the study. The suggested sample was 160 mothers with children whose age variedbetween 6 months to 10 years. Definition of variables The dependent variable is vitamin A deficiency and independentvariable is the child between 6 months and 10 years of age in thestudied area. Data collection and materials 1) Standardized administered questionnaires and personal interviewswere used for mothers 2) Books, journals, reports, etc. Determination of VAD was based on dietary assessment and examiningocular abnormalities. Criteria of exclusion Mother without children. Data analysis Qualitative statistical analysis was used. Computer facilities andStatistical Package of Social Science (SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. ) was used. The criteria for determining malnutrition were based onmeasurements of the body to see if growth has been adequate(anthropometry anthropometry(ănthrəpŏm`ətrē), technique of measuring the human body in terms of dimensions, proportions, and ratios such as those provided by the cephalic index. ). 1. Height for age is an indicator of chronic malnutrition. A childexposed to inadequate nutrition inadequate nutritionMalnutrition, see there for along period of lime will have areduced growth and therefore a lower height compared to other childrenof the same age (stunting). 2. Weight for age is a composite indicator of both long-termmalnutrition (deficit in height/"stunting"). 3. Weight for Height is an indicator of acute malnutrition thattells us if a child is too thin for a given height (wasting). 4. MUAC is another anthropometric an��thro��pom��e��try?n.The study of human body measurement for use in anthropological classification and comparison.an indicator. MUAC is simple, fastand is a good predictor of immediate risk of death, and can be used tomeasure acute malnutrition from 6 months to 59 months. The degree of malnutrition was evaluated according to the weightfor height methods. Results Table 1 shows that the daily income of 61% of the studiedpopulation was less than 3000 L.S, 33% were in the range 3000-5999, 4%were in the range 6000-8999, while only 2% of the selected sample haddaily income that exceeded 9000 L.S. Table 2 reveals that malaria is the disease that mostly occured(23%), diarrhea came in the second place (22%), respiratory diseaseswere 15% and measles were 5%. Regarding the combination of diseases,D&M were 16% D&Me were 1% D&R were 6%, M&Me were 2.7%,M&R were 5% and Me&R were 0.3%. However, out of all coach-acteddiseases malaria (47%) and diarrhea (45%) were of great prevalence. Table 3 shows that in Alsemeir 78% of mothers started to give theirchildren weaning food after the 4th months. Whereas the frequency ofchildren whose mothers provided them with weaning food after 4th monthswas 97% at Shambat, 96% at Alryad and 94% at Daralslam. Those who weanedafter more than 9 months ranged from 0-8%, while those who weaned before4 months ranged from 0-14%. Table 4 shows that the majority (33 %) of the mothers gave theirchildren SF, 25.5% gave LV + SF, 1.5% gave M&MP, 1.5% gave M &MP + LV, 1.5% gave L+ LV and 0.5% gave L, 0.5% gave LV, 8% gave M &MP+L, 7% gave M& MP +SF, 4% gave L+SF. While 17% gave all types ofthese food. Table 5 shows that getting food from surrounding communities wasmore frequent in Alryad (90%), while Shambat (12%) where the supportfrom surrounding communities was poor (p=0.000). Table 6 shows that the majority (80%) of food items obtained fromsurrounding families were mulah and only 20 % obtained mulah + breadfrom surrounding families. None got meat, vegetables or fruits. Table 7 shows that 55.5% of food items obtained from surroundingfamilies were mulah, 25 % obtained vegetables & fruits, while 19.5%obtained mulah +bread and none got meat. Table 8 Shows that there is a relation between residence and childnutritional state (p= 0.000), in such way that Shambat was the areawhere 64% of the children were well nourished, while the percentage ofthe well nourished children dropped to a range that varied from 32-41%in the three remaining areas. The moderately malnourished were 42% atDaralslam, while the percentage in the other three areas varied from20-28%. Those who were severely malnourished constituted 41% atAlsemeir, 40% at Alryad and in the other two areas ranged from 15-17%. Table 9 shows that 66% of the mothers did not receive VAsupplements during their pregnancy, while 10% of the mothers did and 24%did not know whether they received VA supplements or not. Table 10 shows that the number of times that the child received VAdepends on the area where the child was resident (p=0.000). Childrenreceiving VA supplement were 90% from Daralsalam followed by Alsemeir77%, 59% at Shambat and 32% at Alryad. Those who received VA only oncevaried in the four areas from 10-28%. In Alryad 48% of children did notreceive VA, Shambat 13%, 8% at Alsemeir while 0 at Daralslam. Table 29 shows that Shambat was the area where the percentage ofVAD was comparatively low (32%), while Daralsalam was the area where VADwas high (59%), Alryad 49% and Alsemeir 38%. At Daralslam 41% did notsuffer from VAD, 62 % at Alsemeir, 51% at Alryad and 68% at Shambat. Table 12 It is clear that Daralsam is the area where the nightblindness is more frequent (23%), 8% at Shambat, 6% at Alsemeir and 0 atAlryad. Discussion, conclusion and recommendations The daily income of the over whelming majority (98%) of thefamilies was quite low (0-8999 L. S./day) and only 2% had daily incomethat exceeded 9000 L.S./day (table 7). This may indicate that the lowincome was not enough to meet basic minimum needs especially foods withnutrients and micronutrients such as vitamin A, whose chronic deficiency In health, a chronic deficiency is a lack of some essential nutrient, such as a vitamin, mineral, or amino acid, for a prolonged period. Its symptoms are generally subclinical and therefore not easy to detect. leads to night blindness and other health complications. This is inaddition to other health hazards through contraction of diseases such asmeasles, diarrhea and respiratory infections (table 2). In all four areas, 22% of children suffered from diarrhea, 23%suffered from malaria. That means there is lack of hygienic hy��gien��icadj.1. Of or relating to hygiene.2. Tending to promote or preserve health.3. Sanitary. conditionsand this is helping the spread of various poverty associated diseases,while 15% suffered from respiratory diseases and 5% suffered frommeasles (table 2). The majority of mothers above 90% (using t-student test) in allareas started to give their children weaning food at 4-6 months exceptat Alsemeir (78%) and thus showing significant difference from the otherthree areas [t.sub.167] = 23.2 (p=0.000) as in table (3). The majority (33%) of the children (table 4) got either starchyfood or else starchy food with leafy vegetables (25.5%). This mayindicate that poor sources of vitamin A were given to children asweaning food. This also emphasizes the lack of appropriate knowledge onweaning practices and food requirements needed by children f6r healthydevelopment. Food items donated to respondents from Shambat constituted 80%Mulah and 20% Mulah + bread (table 6). The food items donated torespondents from Alryad were Mulah (55.5%), vegetables + fruits (25%)and Mulah + bread 19.5% (table 7). This means those living in Alryadarea had access to sources of VA from vegetables and fruits provided bythe surrounding communities. Only a very low percentage (10%) of the mothers received vitamin Asupplements during pregnancy. This might have negatively affected thehealth of new born infants under 6 months who are normally exclusivelybreast fed and because the first few breast feeds should particularly berich in vitamin A (table 9). In this study the area of residence was found to be of importancein connection with the nutritional status. Shambat was the area where64% of the children were well-nourished (table 8). Getting food supportfrom surrounding communities was more frequent (90%) in Alryad (table5). The times that the child received VA depended on the area where thechild was born. Ninety percent (90%) of children from Daralsalam werereceiving VA supplement (table 10). Suffering from VAD, malnutrition andnight blindness depended also on the area from where the sample wasselected. The results have also shown that VAD in the study sample was46% (table 11). The study put in evidence that residential area is a very importantfactor in nutritional status; food support from surrounding depend onthe area of living (p=0.000). Alryad is the area where the support ismore frequent compared with Shambat (table 23), while nutritional statusof children is significantly different, ([X.sup.2] = 29.408), in suchway that 64% of children in Shambat were well nourished compared withthe children in the other three areas, 41% from Daralsalam, 38% fromAlsemeir, and 32% from Alryad (table 8). Inspire of support; Alryad area revealed bad status of nutritionfor children compared to Shambat where the support is less and this maybe due to many factors such as: the supportive food taken only by theelders, or the supportive food is not regular, although the quality ofthe supportive food in Alryad contains vegetables and fruits. ReceivingVA supplement, as well is significantly different ([X.sup.2] =69.084);in Darasalam 90% compared with the other three areas where 77% were fromAlsemeir, 59% from Shambat, and 32% from Alryad (table 10). However, in conclusion, this study has shown that the prevalence ofVAD in different areas was: in Daralsalam 59%, Alsemeir 38%, Alryad49%and Shambat 32%. The percentage of night blindness was 23 % atDaralsalam, 6% at Alsemeir, and 8% at Shambat and none at Alryad. Irrespective of the area of residence, communities of lowsocioeconomic status suffered from VAD. Shambat was the area where thepercentage of VAD was lowest, while Daralsalam was the area where VADwas of highest prevalence. The number of times that a child received VAdepended on the area where the child-was resident and Daralsalam was thebest area to provide children (90%) with VA supplements. It was also concluded that populations of low socio-economic statusliving in residential pockets among populations of high socioeconomicstatus were comparatively better than those who lived in urban slums dueto the food support provided by the surrounding communities. The study put in evidence that the residential area is a veryimportant factor in nutritional status; food support from surroundingdepend on the area of living (p=0.000). Alryad is the area where thesupport is more frequent compared with Shambat (table 5), whilenutritional status of children is significantly different,([X.sup.2]=29.408), in such way that 64% of children in Shambat werewell nourished compared with the children in the other three areas, 41%from Daralsalam, 38% from Alsemeir, and 32% from Alryad (table 8). Inspite of support; Alryad area revealed bad status of nutritionfor children comparing with Shambat where the support is less and thismay be due to many factors such as: the supportive food taken only bythe elders, or the supportive food is not regular, although the qualityof the supportive food in Alryad contains vegetables and fruits.Receiving VA supplement, as well is signifcantly different ([X.sup.2]=69.084); in Darasalam 90% compared with the other three areas where 77%were from Alsemeir, 59% from Shambat, and 32% from Alryad (table 10).Finally, the following recommendations were seen pertinent to make: (1) Nutrition and health education directed to those populationsmust include: * Family planning family planningUse of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. . * Breast feeding breast feedingPediatrics The provision of a neonate and infant with liquified lacteal products 'on tap'; lactation and BF–≥ 6 months before age 20 is associated with a relative risk of 0. practices. * Gradual weaning. * Feeding practices for the sick children and the bad food taboosand habits. * Nutritive nutritive/nu��tri��tive/ (noo��tri-tiv) nutritional. nu��tri��tiveadj.1. Of or relating to nutrition.2. Nutritious; nourishing. value of locally produced cheap foods rich in vitaminA. (2) Control of endemic diseases through immunization immunization:see immunity; vaccination. mad bettersanitation conditions. (3) Promoting nutritional programs that include treatment ofvitamin A deficiency and giving prophylaxes every six months. (4) There should be a full integration between health programs andnutritional programs because there is a high association betweeninfectious diseases and vitamin A status. (5) Training of health personnel, so that they are capable of earlydetection of VAD. (6) Effecting sustainable programs of VA supplementation in riskareas of low socio-economic status. (7) Raising the socio-economic status through income generatingactivities. (8) National wide surveys are necessary to determine the magnitudeof prevalence of VAD.Table 1: Daily income of the family in Sudanese pounds (L.S.)Income(L.S.) Frequency Percentage Valid %0-2999 97 61 613000-5999 54 33 336000-8999 6 4 4>=9000 3 2 2Total 160 100 100Table 2: The distribution of the diseases for the four studied areasDiseases Frequency PercentageDiarrhea 64 22Malaria 78 23Measles 15 5Respiratory Diseases 45 15Diarrhea + Malaria(D&M) 48 16Diarrhea + Measles(D&M) 3 1Diarrhea + Respiratory diseases (D&R) 18 6Malaria + Measles (M & Me) 8 2.7Malaria + Respiratory diseases (M & R) 15 5Measles + Respiratory diseases (Me & R) 1 0.3Total 295 100Table 3: Residence and the child's timing for starting weaning foodResidence <4 months 4-8 months Number Percentage Number PercentageDaralsalam 0 0 94 94Alsemeir 10 14 54 78Shambat 2 3 56 97Alryad 0 0 48 96Residence More than 9 months Number PercentageDaralsalam 6 6Alsemeir 5 8Shambat 0 0Alryad 2 4Table 4: Food items given by mothers to their children as weaning foodFood items Frequency Percentage Valid %Milk (M) & Milk Product (MP) 2 1.5 1.5Legumes (L) 1 0.5 0.5Leafy Vegetables (LV) 1 0.5 0.5Starchy Food (SF) 53 33 33All of the above 27 17 17M&MP + L 13 8 8M&MP + LV 2 1.5 1.5M&MP + SF 11 7 7L + LV 2 1.5 1.5L + SF 7 4 4LV + SF 41 25.5 25.5Total 160 100 100Table 5: Relation between residence and getting food support fromsurrounding communitiesResidence No Yes Number Percentage Number PercentageShambat 35 88 5 12Alryad 4 10 36 90P = 0.000Table 6: Food items obtained by responding mothers in Shambat fromsurrounding communitiesFood items Frequency Percentage Valid %Mulah * 4 80 80Vegetables & Fruits 0 0 0Meat 0 0 0All of the above 0 0 0Mulah +bread 1 20 20Total 5 100 100* Stew from vegetables and meatTable 7: Food items obtained by responding mothers in Alryad fromsurrounding communitiesFood items Frequency Percentage Valid %Mulah * 20 55.5 55.5Vegetables & Fruits 9 25 25Meat 0 0 0All of the above 0 0 0Mulah + bread 7 19.5 19.5Total 36 100 100* Stew from vegetables and meaTable 8: Showing the relation between residence and nutritional stateof childrenResidence Well nourished Moderately malnourished Number Percentage Number percentageDaralsalam 42 41 43 42Alsemeir 30 38 16 21Shambat 39 64 13 20Alryad 17 32 15 28Residence Severely malnourished Number percentageDaralsalam 12 17Alsemeir 32 41Shambat 9 15Alryad 21 40[X.sup.2] =29.408Table 9: Mothers receiving VA supplements during pregnancyResponse Frequency Percentage Valid %No 105 66 66Yes 16 10 10Did not know 39 24 24Total 160 100 100Table 10: Children receiving VA supplement by residenceResidence Not received Once Number Percentage Number PercentageDaralsalam 0 0 10 10Alsemeir 6 8 12 15Shambat 8 13 17 28Alryad 25 48 11 20Residence Twice or more Number PercentageDaralsalam 93 90Alsemeir 60 77Shambat 36 59Alryad 17 32[X.sup.2] = 69.084Table 11: Area of residence by suffering from VAD on basis of ocularabnormalities observedResidence No Yes Number Percentage Number PercentageDaralsalam 42 41 61 59Alsemeir 48 62 30 38Shambat 41 68 20 32Alryad 27 51 26 49Total 158 54 137 46[X.sup.2] = 6.486Table 12: Residence and night blindnessResidence No Yes Number Percentage Number PercentageDaralsalam 79 77 24 23Alsemeir 73 94 5 6Shambat 55 92 6 8Alryad 53 100 0 0 References (1.) United Nations (1990): Elimination of Vitamin A Deficiency andResulting Blindness in Children and Development in 1990s. New York New York, state, United StatesNew York,Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : UN. (2.) Mohamed, M. and Hassan, S. (1999): Vitamin A Deficiency as aHealth Problem Among Children Aged 6 Months to 6 Years: Dissertationsubmitted to the School of Family Sciences. Ahfad University for Women Ahfad University for Women is a private women's university in Omdurman, Sudan,and was originaly founded as a girls school by babiker badri in 1905 and was awarded the status of university in 1966. ,Omdurman, Sudan. (3.) Izzideen, S. and Tanios V. (1996): Hidden Hunger: Vitamin ADeficiency Among the Displaced Children In Khartoum: Dissertationsubmitted to the School of Family Sciences. Ahfad University for Women,Omdurman, Sudan. (4.) Kuhhlein, Harriet (1997): Culture, Environment and Food toPrevent Vitamin A Deficiency. Boston: INFDC INFDC International Nutrition Foundation for Developing Countries (Boston, MA). (5.) Under Wood, B. A. (1992): Hypovitaminosis A : Hidden Hunger,News on Health Care in Developing Countries, (special issue), Vol. 6. (6.) El-Karib, N. (1989): Plasma Retinol and Tocopherols of BreastFeeding Sudanese Women, Tropical Medical Parasitology Medical parasitologyThe study of diseases of humans caused by parasitic agents. It is commonly limited to parasitic worms (helminths) and the protozoa. , Vol. 40, No: 4,p.405-408. (7.) Hussain M. (1991): Xerophthalmia in Malnourished SudaneseChildren, Tropical Doctors, Vol. 21, No. 4, P. 139-141. (8.) NDN NDN IndianNDN Naples Daily News (Daily news paper in Naples Florida)NDN Non Delivery NotificationNDN National Data NetworkNDN NecdinNDN New Democratic NetworkNDN Next Door NeighborNDN Nevada Donor Network and WHO (1997): A Comprehensive Nutrition Survey:Report-Kassala, Daffur, N. Kordofan, Red Sea, Gezira and Nahr ElneilStates, Khartoum: Ministry of Health and Nutrition Departments. Elham Ahmed Hamed, Ahmed Abdel Magied and Ammar Hassan Ammar Hassan (Arabic: عمار حسن) (born November 13 1976 in Palestine) is a singer who rose to popularity around the world after placing second in Super Star 2, the pan-Arabic version of Pop Idol. Khamis(School of Family Sciences, and School of Organizational Management,Ahfad University for Women, Omdurman, Sudan.)