The prevalence of presumed vitamin A-related corneal scars among 5,589 preschool-age Haitian children ranged from 1.2 per 1,000 in the south, to almost 1% in the famine-afflicted north. These scars accounted for at least 45% of all corneal scars, and all bilateral corneal blindness encountered. Most lesions were acquired during the first three years of life. There was no variation by sex or ecology of the sample site. This country of 5.5 million inhabitants acquires 345 new surviving cases of vitamin A-related corneal destruction, over one fourth bilaterally blind, each year, although local ophthalmologists rarely encounter the disease and Bitot's spots were absent from our study population. Countrywide clinical prevalence surveys are the only unbiased means of determining the magnitude, severity, and geographic distribution of vitamin A-related corneal destruction, prerequisites for the design of public health prevention programs.
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