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Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia

Authors: Andargachew Mulu, Afework Kassu, Kahsay Huruy, Birhanemeskel Tegene, Gashaw Yitayaw, Masayo Nakamori, Nguyen Van Nhien, Assegedech Bekele, Yared Wondimhun, Shigeru Yamamoto, Fusao Ota

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia.

Methods

In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.

Results

After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).

Conclusion

The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.
Literature
1.
go back to reference World Health Organization: Global prevalence of vitamin A deficiency in populations at risk 1995-2005, Global Database on Vitamin A Deficiency. 2009, Geneva: WHO World Health Organization: Global prevalence of vitamin A deficiency in populations at risk 1995-2005, Global Database on Vitamin A Deficiency. 2009, Geneva: WHO
2.
go back to reference Katz J, Khatry SK, West KP, et al: Night blindness during pregnancy and lactation in rural Nepal. J Nutr. 1995, 125: 2122-2127.PubMed Katz J, Khatry SK, West KP, et al: Night blindness during pregnancy and lactation in rural Nepal. J Nutr. 1995, 125: 2122-2127.PubMed
3.
go back to reference World Health Organization: Trace elements in human nutrition and health. WHO. 1996, Geneva: WHO, 72-104. World Health Organization: Trace elements in human nutrition and health. WHO. 1996, Geneva: WHO, 72-104.
4.
go back to reference Scrimshaw NS, San Giovanni JP: Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr. 1997, 66 (suppl): 464S-77S.PubMed Scrimshaw NS, San Giovanni JP: Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr. 1997, 66 (suppl): 464S-77S.PubMed
5.
go back to reference Ziari SA, Mireles VL, Cantu CG, et al: Serum vitamin A, vitamin E, and beta-carotene levels in preeclamptic women in northern Nigeria. Am J Perinatol. 1996, 13: 287-2911. 10.1055/s-2007-994343.CrossRefPubMed Ziari SA, Mireles VL, Cantu CG, et al: Serum vitamin A, vitamin E, and beta-carotene levels in preeclamptic women in northern Nigeria. Am J Perinatol. 1996, 13: 287-2911. 10.1055/s-2007-994343.CrossRefPubMed
6.
go back to reference Semba RD, Miotti PG, Chiphangwi JD, et al: Maternal vitamin A deficiency and infant mortality in Malawi. J Trop Pediatr. 1998, 44: 232-234. 10.1093/tropej/44.4.232.CrossRefPubMed Semba RD, Miotti PG, Chiphangwi JD, et al: Maternal vitamin A deficiency and infant mortality in Malawi. J Trop Pediatr. 1998, 44: 232-234. 10.1093/tropej/44.4.232.CrossRefPubMed
7.
go back to reference Ross AC: Vitamin A status; relationship to immunity and the antibody response. Proc Soc Exp Biol Med. 1992, 200: 303-320.CrossRefPubMed Ross AC: Vitamin A status; relationship to immunity and the antibody response. Proc Soc Exp Biol Med. 1992, 200: 303-320.CrossRefPubMed
8.
go back to reference Christian P, Schulze K, Stoltzfus RJ, et al: Hyporetinolemia, illness symptoms, and acute phase protein response in pregnant women with and without night blindness. Am J Clin Nutr. 1998, 67: 1237-1243.PubMed Christian P, Schulze K, Stoltzfus RJ, et al: Hyporetinolemia, illness symptoms, and acute phase protein response in pregnant women with and without night blindness. Am J Clin Nutr. 1998, 67: 1237-1243.PubMed
9.
go back to reference Christian P, West KP, Khatry SK, et al: Night blindness of pregnancy in rural Nepal-nutritional and health risks. Int J Epidemiol. 1998, 27: 231-237. 10.1093/ije/27.2.231.CrossRefPubMed Christian P, West KP, Khatry SK, et al: Night blindness of pregnancy in rural Nepal-nutritional and health risks. Int J Epidemiol. 1998, 27: 231-237. 10.1093/ije/27.2.231.CrossRefPubMed
10.
go back to reference Semba RD: Vitamin A and immunity to viral, bacterial and protozoan infections. Proc Nutr Soc. 1999, 58: 719-727. 10.1017/S0029665199000944.CrossRefPubMed Semba RD: Vitamin A and immunity to viral, bacterial and protozoan infections. Proc Nutr Soc. 1999, 58: 719-727. 10.1017/S0029665199000944.CrossRefPubMed
11.
go back to reference Semba RD: Vitamin A, immunity and infection. Clin Infect Dis. 1994, 19: 489-499. 10.1093/clinids/19.3.489.CrossRefPubMed Semba RD: Vitamin A, immunity and infection. Clin Infect Dis. 1994, 19: 489-499. 10.1093/clinids/19.3.489.CrossRefPubMed
12.
go back to reference Sommer A, West KP: Vitamin A deficiency: health, survival, and vision. 1996, New York: Oxford University Press Sommer A, West KP: Vitamin A deficiency: health, survival, and vision. 1996, New York: Oxford University Press
13.
go back to reference Mikhail MS, Anyaegbunam A, Garfinkel D, et al: Pre-eclampsia and antioxidant nutrients: decreased plasma levels of reduced ascorbic acid, alpha-tocopherol, and beta-carotene in women with pre-eclampsia. Am J Obstet Gynecol. 1994, 171: 150-157.CrossRefPubMed Mikhail MS, Anyaegbunam A, Garfinkel D, et al: Pre-eclampsia and antioxidant nutrients: decreased plasma levels of reduced ascorbic acid, alpha-tocopherol, and beta-carotene in women with pre-eclampsia. Am J Obstet Gynecol. 1994, 171: 150-157.CrossRefPubMed
14.
go back to reference Barrett BM, Sowell A, Gunter E, et al: Potential role of ascorbic acid and beta-carotene in the prevention of preterm rupture of fetal membranes. Int J Vit Nutr Res. 1994, 64: 192-195. Barrett BM, Sowell A, Gunter E, et al: Potential role of ascorbic acid and beta-carotene in the prevention of preterm rupture of fetal membranes. Int J Vit Nutr Res. 1994, 64: 192-195.
15.
go back to reference Fawzi WW, Hunter DJ: Vitamins in HIV disease and vertical transmission. Epidemiol. 1998, 9: 457-466. 10.1097/00001648-199807000-00019.CrossRef Fawzi WW, Hunter DJ: Vitamins in HIV disease and vertical transmission. Epidemiol. 1998, 9: 457-466. 10.1097/00001648-199807000-00019.CrossRef
16.
go back to reference Fawzi WW: Nutritional factors and vertical transmission of HIV-1. Epidemiology and potential mechanisms. Ann N Y Acad Sci. 2000, 918: 99-114.CrossRefPubMed Fawzi WW: Nutritional factors and vertical transmission of HIV-1. Epidemiology and potential mechanisms. Ann N Y Acad Sci. 2000, 918: 99-114.CrossRefPubMed
17.
go back to reference Dushimimana A, Graham MN, Humphrey JH, et al: Maternal vitamin A levels and HIV-related birth outcome in Rwanda. Int Conf AIDS Amsterdam. 1992, doi:10.1016/S0140-6736(94)93056-2. Abstract no POC 4221 Dushimimana A, Graham MN, Humphrey JH, et al: Maternal vitamin A levels and HIV-related birth outcome in Rwanda. Int Conf AIDS Amsterdam. 1992, doi:10.1016/S0140-6736(94)93056-2. Abstract no POC 4221
18.
go back to reference Semba RD, Miotti PG, Chiphanwi JD, et al: Maternal vitamin A deficiency and mother to child transmission of HIV-1. Lancet. 1994, 343: 1593-1597. 10.1016/S0140-6736(94)93056-2.CrossRefPubMed Semba RD, Miotti PG, Chiphanwi JD, et al: Maternal vitamin A deficiency and mother to child transmission of HIV-1. Lancet. 1994, 343: 1593-1597. 10.1016/S0140-6736(94)93056-2.CrossRefPubMed
19.
go back to reference Semba RD, Miotti PG, Chipangwi JD, et al: Infant mortality and vitamin A deficiency during human immunodeficiency virus infection. Clin Infect Dis. 1995, 21: 966-972. 10.1093/clinids/21.4.966.CrossRefPubMed Semba RD, Miotti PG, Chipangwi JD, et al: Infant mortality and vitamin A deficiency during human immunodeficiency virus infection. Clin Infect Dis. 1995, 21: 966-972. 10.1093/clinids/21.4.966.CrossRefPubMed
20.
go back to reference Greenberg BI, Semba RD, Vink , et al: Vitamin A deficiency and maternal-infant transmission of HIV in two metropolitan areas in the United States. AIDS. 1997, 11: 325-332. 10.1097/00002030-199703110-00010.CrossRefPubMed Greenberg BI, Semba RD, Vink , et al: Vitamin A deficiency and maternal-infant transmission of HIV in two metropolitan areas in the United States. AIDS. 1997, 11: 325-332. 10.1097/00002030-199703110-00010.CrossRefPubMed
21.
go back to reference Landesmand S: Vitamin A relationships to mortality in HIV disease and effects on HIV infection and late breaking studies. Bethesda, National Institutes of Health (Lawton Chiles International House). 1996 Landesmand S: Vitamin A relationships to mortality in HIV disease and effects on HIV infection and late breaking studies. Bethesda, National Institutes of Health (Lawton Chiles International House). 1996
22.
go back to reference Coutsoudis A, Bobat RA, Coovadia HM, et al: The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women. Am J Public Health. 1995, 85: 1076-1081. 10.2105/AJPH.85.8_Pt_1.1076.CrossRefPubMedPubMedCentral Coutsoudis A, Bobat RA, Coovadia HM, et al: The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women. Am J Public Health. 1995, 85: 1076-1081. 10.2105/AJPH.85.8_Pt_1.1076.CrossRefPubMedPubMedCentral
23.
go back to reference Thein M: Study of milk vitamin A, serum vitamin A and serum protein levels of lactating mothers of Bochessa village, rural Ethiopia. East Afr Med J. 1979, 56: 542-547.PubMed Thein M: Study of milk vitamin A, serum vitamin A and serum protein levels of lactating mothers of Bochessa village, rural Ethiopia. East Afr Med J. 1979, 56: 542-547.PubMed
24.
go back to reference Demissie M, Omer OA, Lindjorn B, Hombergh J: The Epidemiology and Ecology of Health and Disease in Ethiopia. Edited by: Nutrition In: Berhane Y, Hailemariam D, Kloos (Eds). 2006, Shama Books, Addis Ababa, Ethiopia Demissie M, Omer OA, Lindjorn B, Hombergh J: The Epidemiology and Ecology of Health and Disease in Ethiopia. Edited by: Nutrition In: Berhane Y, Hailemariam D, Kloos (Eds). 2006, Shama Books, Addis Ababa, Ethiopia
25.
go back to reference Yared Wondmikun: Dark adaptation pattern of pregnant women as an indicator of functional disturbance at acceptable serum vitamin A levels. Eur J Clin Nutr. 2002, 56: 462-466. 10.1038/sj.ejcn.1601383. Yared Wondmikun: Dark adaptation pattern of pregnant women as an indicator of functional disturbance at acceptable serum vitamin A levels. Eur J Clin Nutr. 2002, 56: 462-466. 10.1038/sj.ejcn.1601383.
26.
go back to reference Kassu A, Yabutani T, Mulu A, et al: Serum zinc, copper, selenium, calcium, and magnesium levels in pregnant and non-pregnant women in Gondar, Northwest Ethiopia. Biol Trace Elem Res. 2008, 122: 97-106. 10.1007/s12011-007-8067-6.CrossRefPubMed Kassu A, Yabutani T, Mulu A, et al: Serum zinc, copper, selenium, calcium, and magnesium levels in pregnant and non-pregnant women in Gondar, Northwest Ethiopia. Biol Trace Elem Res. 2008, 122: 97-106. 10.1007/s12011-007-8067-6.CrossRefPubMed
27.
go back to reference Kassu A, Andualem B, Van Nhien N, et al: Vitamin A deficiency in patients with diarrhea and HIV infection in Ethiopia. Asia Pac J Clin Nutr. 2007, 16 (Suppl 1): 323-328.PubMed Kassu A, Andualem B, Van Nhien N, et al: Vitamin A deficiency in patients with diarrhea and HIV infection in Ethiopia. Asia Pac J Clin Nutr. 2007, 16 (Suppl 1): 323-328.PubMed
28.
go back to reference World Health organization: Physical status: the use and interpretation of anthropometry. World Health organization Tech Rep Ser. 1995, Report of WHO Expert Committee, 854: 1-452. Geneva World Health organization: Physical status: the use and interpretation of anthropometry. World Health organization Tech Rep Ser. 1995, Report of WHO Expert Committee, 854: 1-452. Geneva
29.
go back to reference Ethiopian Health and Nutrition Institute: Manual for HIV-1 Diagnosis. 2002, MOH, Addis Ababa, Ethiopia Ethiopian Health and Nutrition Institute: Manual for HIV-1 Diagnosis. 2002, MOH, Addis Ababa, Ethiopia
30.
go back to reference Arroyave G, Chichester CO, Flores H, et al: Biochemical methodology for the assessment of vitamin A status: a report of the International Vitamin A Consultative Group (IVACG). 1982, Nutrition Foundation, Washington DC, USA Arroyave G, Chichester CO, Flores H, et al: Biochemical methodology for the assessment of vitamin A status: a report of the International Vitamin A Consultative Group (IVACG). 1982, Nutrition Foundation, Washington DC, USA
31.
go back to reference Tietz NW: Fundamentals of Clinical Chemistry. Pa: W.B. Saunders. 1995 Philadelphia 299 Tietz NW: Fundamentals of Clinical Chemistry. Pa: W.B. Saunders. 1995 Philadelphia 299
32.
go back to reference Peggy Papathakis, Nigel Rollins, Caroline Chantry, et al: Micronutrient status during lactation in HIV-infected and HIV-uninfected South African women during the first 6 months after delivery. Am J Clin Nutr. 2007, 85: 182-192. Peggy Papathakis, Nigel Rollins, Caroline Chantry, et al: Micronutrient status during lactation in HIV-infected and HIV-uninfected South African women during the first 6 months after delivery. Am J Clin Nutr. 2007, 85: 182-192.
33.
go back to reference Yared Wondmikun: Lipid-soluble antioxidants status and some of its socio-economic determinants among pregnant Ethiopians at the third trimester. Public Health Nutr. 2005, 8: 582-587. Yared Wondmikun: Lipid-soluble antioxidants status and some of its socio-economic determinants among pregnant Ethiopians at the third trimester. Public Health Nutr. 2005, 8: 582-587.
34.
go back to reference Ahmed F, Mahudal I, Sattar A, et al: Anaemia and vitamin A deficiency in poor urban pregnant women of Bangladesh. Asia Pac J Cli Nutr. 2003, 12: 460-466. Ahmed F, Mahudal I, Sattar A, et al: Anaemia and vitamin A deficiency in poor urban pregnant women of Bangladesh. Asia Pac J Cli Nutr. 2003, 12: 460-466.
35.
go back to reference Vanessa Lee, Faruk Ahmed, Shoko Wada, et al: Extent of vitamin A deficiency among rural pregnant women in Bangladesh. Public Health Nutr. 2003, 11: 1326-1331. Vanessa Lee, Faruk Ahmed, Shoko Wada, et al: Extent of vitamin A deficiency among rural pregnant women in Bangladesh. Public Health Nutr. 2003, 11: 1326-1331.
36.
go back to reference Semba RD, Miotti PG, Chipangwi JD, et al: Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet. 2003, 343: 1593-1597.CrossRef Semba RD, Miotti PG, Chipangwi JD, et al: Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet. 2003, 343: 1593-1597.CrossRef
37.
go back to reference Semba RD, Miotti PG, Chipangawi JD, et al: Infant mortality and maternal vitamin A deficiency during human immunodeficiency virus infection. Clin Infect Dis. 1995, 21: 966-972. 10.1093/clinids/21.4.966.CrossRefPubMed Semba RD, Miotti PG, Chipangawi JD, et al: Infant mortality and maternal vitamin A deficiency during human immunodeficiency virus infection. Clin Infect Dis. 1995, 21: 966-972. 10.1093/clinids/21.4.966.CrossRefPubMed
38.
go back to reference Graham N, Bulterys M, Chao A, et al: Effect of maternal vitamin A deficiency on infant mortality and perinatal HIV transmission. National Conference on Human Retroviruses and Related Infection. MD, 1993 December 12-16, Baltimore Graham N, Bulterys M, Chao A, et al: Effect of maternal vitamin A deficiency on infant mortality and perinatal HIV transmission. National Conference on Human Retroviruses and Related Infection. MD, 1993 December 12-16, Baltimore
39.
go back to reference Friis H, Gomo E, Koestel P, et al: HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe. Am J Clin Nutr. 2001, 73: 1058-1065.PubMed Friis H, Gomo E, Koestel P, et al: HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe. Am J Clin Nutr. 2001, 73: 1058-1065.PubMed
40.
go back to reference International Vitamin A Consultative Group: 25 year progress in controlling vitamin A deficiency. looking to the future. Washington, DC: ILSI, In XX IVACG Meeting Program, 2001 p. 12. International Vitamin A Consultative Group: 25 year progress in controlling vitamin A deficiency. looking to the future. Washington, DC: ILSI, In XX IVACG Meeting Program, 2001 p. 12.
41.
go back to reference Radhikaa MS, Bhaskarama P, Balakrishnaa , et al: Effects of vitamin A deficiency during pregnancy on maternal and child health. BJOG: an International Journal of ObstetGynaecol. 2002, 109: 689-693. 10.1111/j.1471-0528.2002.01010.x.CrossRef Radhikaa MS, Bhaskarama P, Balakrishnaa , et al: Effects of vitamin A deficiency during pregnancy on maternal and child health. BJOG: an International Journal of ObstetGynaecol. 2002, 109: 689-693. 10.1111/j.1471-0528.2002.01010.x.CrossRef
42.
go back to reference Filteau SM, Tomkins AM: Micronutrients and tropical infections. Trans R Soc Trop Med Hyg. 1994, 88: 1-3.CrossRefPubMed Filteau SM, Tomkins AM: Micronutrients and tropical infections. Trans R Soc Trop Med Hyg. 1994, 88: 1-3.CrossRefPubMed
43.
go back to reference Nega Berhe, Bente Halvorsen, Thomas E, et al: Reduced serum concentrations of retinol and alpha -tocopherol and high concentrations of hydroperoxides are associated with community levels of S. mansoni infection and schistosomal periportal fibrosis in Ethiopian school children. Am J Trop Med Hyg. 2007, 76: 943-949. Nega Berhe, Bente Halvorsen, Thomas E, et al: Reduced serum concentrations of retinol and alpha -tocopherol and high concentrations of hydroperoxides are associated with community levels of S. mansoni infection and schistosomal periportal fibrosis in Ethiopian school children. Am J Trop Med Hyg. 2007, 76: 943-949.
Metadata
Title
Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia
Authors
Andargachew Mulu
Afework Kassu
Kahsay Huruy
Birhanemeskel Tegene
Gashaw Yitayaw
Masayo Nakamori
Nguyen Van Nhien
Assegedech Bekele
Yared Wondimhun
Shigeru Yamamoto
Fusao Ota
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-569

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