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Impact of 6-monthly massive dosings of preschool-age children with oral vitamin A (VAC: 200,000 IU of oil soluble retinyl palmitate with 40 IU vitamin E) was evaluated in Bangladesh. In 100 sites, 11,889 households were visited and eyes of 22,335 children aged 3-71 mo were examined. About half the rural target population and less than 20% urban slum population were being reached. Risk of night blindness was halved for children reportedly given VAC, although 2.5% of the reportedly protected population were still night blind. There was no significant reduction in prevalence of Bitot's spot. Risk of corneal ulcers or keratomalacia (X3A/B) was 2.7 times higher in children not given VAC. Based on reported coverage, efficacy of protection against potentially blinding corneal lesions was 63%. For maximum impact on eye lesions, massive dosing with vitamin A at ideally less than 6-monthly intervals needs to be combined with other nutrition and health interventions.

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The author uses case abstracts to illustrate deficiencies of thiamine! vltamln-B complex and vitamin C associated with confusional states in the elderly. The biochemical indicators were chiefly the pyruvate metabolism test and the level of ascorbic acid in the leukocyte layer ("buffy coat") of the blood. The confusional states usually disappeared or improved with appropriate vitamin therapy.Nutritional deficiencies are being recognized with increasing frequency in the practice of geriatric medicine. Among elderly people in countries like Great Britain it is not uncommon to see "subclinical" vitamin deficiency, in contrast to the frank avitaminosis seen in less affluent countries.The following are 28 illustrative cases of confusional states associated with various vitamin deficiencies.Two hundred and fifty-four patients were admitted during a period of six months (May-November) to a Geriatric Unit of 96 beds. For this study, elderly patients with confusional states were selected at the time of admission; in addition, one 38-year-old patient was "inherited" from a psychiatric ward. Vitamin deficiency was detected by the pyruvate metabolism test! (P.M.T.) (1) and in some cases by the determination of ascorbic acid in the "buffy coat" (blood leukocyte layer)," and vitamin C in the serum. THIAMINE/VITAMIN-B COMPLEX DEFICIENCYE. F., a 66-year-old female, living with her husband, had arteriosclerosis and Parkinson's disease. She was taking orphenadrine hydrochloride three times daily. She was re-admitted because of deterioration in gait and mobility, and a confusional state. Examination showed the signs and symptoms of parkinsonism and also glossitis and angular stomatitis (the latter attributable to dentures). Results of the P.M.T. two days after admission were: 1) 1.2 mg; 2) 1.8 mg; 3) 2.5 mg. per 100 ml. Ascorbic acid values (leukocyte layer) were normal. The patient was treated for two weeks by oral administration of a concentrated solution of vitamin-B complex," The confusional state cleared up, and mobility and gait improved.

Background Globally 36% of deaths and 42% of Disability Adjusted Life Years (DALYs) are due to communicable, maternal, perinatal and nutritional disorders (CMPND). We examined the state-wise disease burden and treatment cost for these diseases in India for 2017. Methods DALYs for CMPND was obtained from National Disease Burden Estimate (NBE) Study and the expenditure was determined from the unit level records of persons who reported hospitalization for one or more CMPND in National Sample Survey (NSS)—75th Round. Results The top conditions resulting in high DALYs for India were perinatal conditions and nutritional deficiency disorders. Odisha had the highest DALY rate, while Kerala had the lowest DALY rate for CMPNDs. The out-of-pocket expenditure (OOPE) was highest in Chattisgarh, while percentage of households pushed to CHE was highest in Uttar Pradesh for CMPND. Conclusion The public healthcare facilities need to be strengthened to facilitate patients with CMPND to undergo treatment that is timely, affordable and cost-effective. Efforts should be made for optimization of strategies aimed at primary and secondary prevention of CMPND and reduce OOPE for treatment of these diseases. In addition, advocacy spreading awareness will reduce the burden and treatment expenditure for CMPNDs in India.