Association of vitamin A deficiency with early childhood stunting in Uganda: A population-based cross-sectional study

PLoS ONE
Q1
May 2020
Citations:56
Influential Citations:3
Observational Studies (Human)
80
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Enhanced Details

Methods
Population-based cross-sectional analysis of 4,765 preschool children aged 6–59 months in Uganda; mean age 32.5 months; 50% male; vitamin A deficiency assessed by retinol-binding protein (RBP) with inflammation adjustment using CRP; generalized linear mixed-effects models with a logit link used to estimate associations between VAD and stunting, wasting, and underweight, adjusting for child-, household-, and community-level confounders.
Results
VAD prevalence 8.9% (95% CI 8.1-9.6%). Stunting: 34.7% in VAD vs 26.6% in non-VAD; severe stunting: 15.7% vs 9.4%. After adjustment for confounders, VAD associated with higher odds of stunting (aOR 1.43; 95% CI 1.08-1.89; p=0.01). Severe stunting also higher (aOR 1.64; 95% CI 1.14-2.35). No association with wasting or underweight. Sensitivity analysis with propensity-score weighting yielded stunting aOR 1.52 (95% CI 1.16-1.99). Conclusion: Vitamin A deficiency is linked to linear growth faltering in preschool children in Uganda, independent of measured confounders. Prospective studies are needed to determine causality and assess catch-up growth after supplementation; to improve vitamin A status, scale up supplementation in high-risk regions; Uganda's coverage in past 6 months was ~59%, below WHO target of 85%.
Limitations
Cross-sectional design limits causal inference; RBP is a surrogate marker for serum retinol and can be affected by inflammation and other conditions, though CRP adjustment reduces misclassification; residual confounding possible; Neyman bias may affect associations with wasting and underweight; limited precision for wasting/underweight due to low prevalence; results may be generalizable mainly to similar settings.

Abstract

Background Despite the high prevalence of childhood protein-energy malnutrition and vitamin A deficiency in sub-Saharan Africa, their association has not been explored in this region. A better understanding of the epidemiologic link could help define...