Objective: To assess the magnitude and determinants of vitamin A deficiency (VAD) and coverage of vitamin A supplementation (VAS) among pre-school children. Design: A community-based cross-sectional study was carried out by adopting a multistage, stratified, random sampling procedure. Setting: Rural areas of eight states in India. Subjects: Pre-school children and their mothers were covered. Results: A total of 71 591 pre-school children were clinically examined for ocular signs of VAD. Serum retinol concentrations in dried blood spots were assessed in a sub-sample of 3954 children using HPLC. The prevalence of Bitot spots was 0?8 %. The total ocular signs were significantly higher (P , 0?001) among boys (2?6 %) compared with girls (1?9 %) and in older children (3-4 years) compared (P , 0?001) with younger (1-2 years), and were also high in children of labourers, scheduled castes and illiterate mothers. The odds of having Bitot spots was highest in children of scheduled caste (OR 5 3?8; 95 % CI 2?9, 5?0), labourers (OR 5 2?9; 95 % CI 2?1, 3?9), illiterate mothers (OR 5 2?7; 95 % CI 2?2, 2?3) and households without a sanitary latrine (OR 5 5?9; 95 % CI 4?0, 8?7). Subclinical VAD (serum retinol level ,20 mg/dl) was observed in 62 % of children. This was also relatively high among scheduled caste and scheduled tribe children. The rate of coverage of VAS was 58 %. Conclusions: The study revealed that VAD is a major nutritional problem and coverage of VAS was poor. The important determinants of VAD were illiteracy, low socio-economic status, occupation and poor sanitation. Strengthening the existing VAS programme and focused attention on dietary diversification are essential for prevention of VAD.

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Objective: To develop a psychometrically valid questionnaire for testing knowledge on micronutrients and to assess the relationship between knowledge and biomarkers of micronutrient status among adolescents. Design: Cross-sectional, institution-based, validity and reliability study. Setting: Seven higher secondary schools were covered in the limits of Greater Hyderabad Municipal Corporation, Hyderabad, India. Subjects: Students aged 15-19 years, n 92 for the pre-test, n 108 for test-retest and n 109 for studying the relationship between knowledge and biomarkers of Fe, retinol, ascorbic acid, a-tocopherol, folic acid and vitamin B 12 status. Results: From an item pool of 106, thirty-one items were selected based on content validity. Statistical tools to obtain a valid and reliable questionnaire among adolescent boys and girls resulted in eighteen items with a difficulty index of 0?11-0?86, discrimination index of 0?20-0?72 and validity index (point bi-serial correlation) of 0?10-0?62. Reliability as measured by Cronbach's a was 0?71 and the intra-class correlation coefficient was 0?80. A Bland-Altman plot showed good agreement between test and retest scores. The mean response score to the eighteen-item questionnaire was 5?2 (SD 2?68). The mean values of serum retinol were significantly different (P 5 0?022) between groups below (24?8 (SD 6?64) mg/dl) and above (28?0 (SD 7?67) mg/dl) the 50th percentile of knowledge score. The relationship persisted after controlling for economic status as a covariate using analysis of covariance (P 5 0?018). Other micronutrients did not show any significant relationship. Conclusions: A valid and reliable eighteen-item knowledge questionnaire was constructed and found to have a significant positive relationship with plasma retinol status alone.