Serum retinol in 1-6-year-old children from a low socio-economic South African community with a high intake of liver: implications for blanket vitamin A supplementation

Objective: To assess serum retinol, liver intake patterns, breast-feeding history and anthropometric status in pre-school children of a low socio-economic community where liver is regularly consumed. Design: Cross-sectional study. Setting: Northern Cape Province, South Africa. Subjects: Children aged 1-6 years (n 243) who attended the local primary health-care facility and had not received a vitamin A supplement in the 6 months preceding the study. Non-pregnant female caregivers (n 225), below 50 years of age, were also assessed. Results: Despite stunting, underweight and wasting being prevalent in 40.5%, 23.1% and 8.4% of the children, only 5.8% had serum retinol concentrations <20 mu g/dl, which is in sharp contrast to the national prevalence of 63.6%. None of the caregivers were vitamin A deficient. Liver was eaten by 89.2% of children, with 87% of households eating liver at least once monthly and 30% eating it at least once weekly; liver was introduced into the diet of the children at a median age of 18 months. Ninety-three per cent of the children were being breast-fed or had been breast-fed in the past; children were breast-fed to a median age of 18 months. A significant negative correlation was found between educational level of the caregiver and frequency of liver intake (r = 20.143, P = 0.032). There was no correlation between serum retinol and indicators of anthropometric or socio-economic status. Conclusions: The blanket approach in applying the national vitamin A supplementation programme may not be appropriate for all areas in the country, even though the community may be poor and undernourished.