PREVALENCE AND ASSOCIATED FACTORS OF CLINICAL MANIFESTATIONS OF VITAMIN -A DEFICIENCY(BITOT’S SPOT AND NIGHT BLINDNESS) AMONG PRESCHOOL CHILDREN IN ENDAMOHONI RURAL DISTRICTS, SOUTHERN TIGRAY, ETHIOPIA, CROSS SECTIONAL STUDY, 2024

Abstract

Background Vitamin A deficiency (VAD) remains a significant public health issue, particularly among preschool children in low-income countries. In Ethiopia, despite national efforts to address micronutrient deficiencies, clinical signs of VAD—such as night blindness and Bitot’s spots— persist, especially in rural communities. However, existing research has largely focused on biochemical assessments or national-level data, with limited attention to the clinical presentation and contextual risk factors of VAD in rural districts. This study was conducted to assess the prevalence of clinical Vitamin A deficiency and its associated factors among preschool-aged children in a rural district of Southern Tigray, Endamokoni wereda, where local evidence is scarce and the problem remains poorly addressed. Methods A community-based cross-sectional study was conducted among 609 preschool children of Endamohoni District Southern Tigrai, from August to October, 2024. A multi-stage sampling, followed by a systematic sampling technique was employed to select study participants. A structured interviewer-administered questionnaire was used to collect data. Quantitative data were entered using Epi Data statistical software and analysed by using SPSS version 20 statistical software package.Using a descriptive, binary logistic regression model and multivariable analysis was fitted to identify the associated factors of vitamin-A deficiency. The adjusted odds ratio (AOR) with a 95 % confidence interval was computed to assess the strength of the association, and variables with a p value of <0.25 in binarylogistic regression model and <0.05 in multivariable analysis were considered as statistically significant. Results Six hundred nine preschool children were included in the study, The overall prevalence of Clinical vitamin A deficiency was 3.3%,and prevalence of Bitot’s spot and night blindness was 1.8% and 1.5%, respectively. The result of the multivariable analysis revealed that Children aged 12–35 months are at the highest risk of Vitamin A deficiency(AOR = 56.028 (95% CI: 2.545 – 1233.445, p = 0.011) , followed by those aged 36–47 months(AOR = 20.120 (95% CI: 1.706 – 237.224, p = 0.017), when compared to older preschool children (48–72 months). Both groups are statistically significant predictors of VAD in the multivariate model, indicating that younger preschool children are more vulnerable to Vitamin A deficiency. Children who had both diarrhea and respiratory infections were found to have significantly higher odds of Vitamin A deficiency (AOR = 10.001; 95% CI: 0.000–20.604; p = 0.035). However, the extremely wide confidence interval indicates considerable uncertainty in the estimate, likely due to a small sample size or sparse data. Mothers who had experienced stillb irth had significantly lower odds of having a child with Vitamin A deficiency compared to those who had not (AOR = 0.142; 95% CI: 0.023–0.867; p = 0.034). Conclusions Based on WHO thresholds, the overall finding indicates that clinical vitamin A deficiency is a severe public health problem in the population studied. All three indicators — clinical VAD (3.3%), Bitot’s spots (1.8%), and night blindness (1.5%) — exceed the WHO cutoff of 1%, which classifies the situation as severe and requiring urgent public health intervention, and is associated with age of the child,a child with diarrhea and respiratory tract infection and a mother who had experienced still birth which could be used to target interventions to further reduce existing VAD. Overall, the findings highlight the need for targeted nutritional interventions among younger children and those with frequent infections in rural settings. Further strengthening antenatal and postnatal care utilization and giving emphasis to preschool children will help to mitigate vitamin A deficiency in the study area.