Mass distribution of vitamin A and the prevention of keratomalacia

A retrospective review of 3,490 admissions to the major pediatric facility in El Salvador was undertaken to determine whether biannual administration of massive doses of vitamin A (200,000 international units) to all available 1- to 4-year-old children was effective in preventing keratomalacia. During the 12 months preceding and following initiation of the program, the number of children admitted with presumed vitamin-A-related corneal destruction (33 vs. 31) and proportion of all malnourished admissions with such destruction (26 vs. 25 per 1,000) were similar. The seasonal distribution of these cases remained unchanged, the usual summer peak closely following the first distribution. Unexpectedly, 48% of the children had been ineligible for participation in the program, the vast majority being under 1 year of age. Only 80% of eligible children had actually received the vitamin. Corneal destruction was invariably accompanied by severe, generalized malnutrition. Mortality among girls with corneal destruction (28 per 1,000) was almost three times that of boys, or malnourished patients as a whole.