Factors associated with low serum retinol levels in children aged 6-24 months in a rural South African community.

Objective: : To identify risk factors for variation in serum retinol levels in children younger than 2 years of age in a rural South African community.

Design: : Children (n = 97), 6-24 months of age, were divided into two groups according to their serum retinol levels, using 20 microg dl-1 as the cut-off point. The chi-square test, Fischer exact two-tailed test and analysis of variance were used to identify related variables which were significantly different between the two groups. To evaluate simultaneously the association between several potential risk factors and low serum retinol levels, a multiple regression model for categorical data was developed which included potential risk factors that were statistically significant in the bivariate analysis as the independent variables, and either low or normal vitamin A status as the dependent variable.

Results: : There was an association between serum retinol levels and: (i) the place of birth (hospital vs. home deliveries); (ii) the attitude of the care-giver towards family life; and (iii) the health status of the child. Although not included in the multiple variable model because of small numbers, all children who had a previous episode of measles, all underweight children, and all children of widowed care-givers were in the low serum retinol group.

Conclusions: : The care-giver's attitude towards family life was positively associated with the child's vitamin A status, while home deliveries were associated with a low vitamin A status.