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Nightblindness

The term for nigh/blindness is que hu (literally: "bird fuzzy") in Doumen. This term was new to our working team. Local people also use the expression ji xu yan (literally "chicken's eye"), a term that is widespread in China.

The first step on entering the community was to interview the head of the village and the village doctors. They informed us that there were four recent cases of nightblindness two school-aged children and two adults. All four cases were examined by the working team, and all sought treatment from the village doctor, which was cod liver oil. They all said that when they had the cod liver oil for a few days, their eyes became normal or much better. None were found suffering from vitamin A deficiency with Bitot's spots.

Liver (from pig, goat, or any animal) is the other usual remedy for nightblindness Goat liver is said to be the best, however, it is not always easily available. The Chinese traditional medical belief system includes the idea that liver (especially goat and pig liver) is good for the eyes.

Key-informants reported that there was a general occurrence of nightblindness, particularly among young people, during the construction of the irrigation works in the 1960s. Many of the youths had difficulty returning home on their bicycles from the work site in the winter darkness.

Fish liver oil has been commonly used in China (and hence in this area) only since the 1960s and 1970s. However, the general idea that liver is good for the eyes has been a common feature of Chinese health beliefs and traditional medicine for a long time.

The production and eating of carrots was introduced in the 1960s and 1970s. This may be the reason that vitamin A deficiency (nightblind-ness and Bitot's spots) was controlled to a very low level before the 1980s. Along with the economic growth, the quantity and quality of food intake has greatly improved, and clinical vitamin A deficiency cases are very rare.

In detailed discussions with the four individuals with nightblindness we learned that although the standard of living has improved a lot, personal food habits and preferences still remain factors contributing to vitamin A deficiency. None of them had any basic knowledge about nutrition and vitamin deficiency. One school-aged girl said that she dislikes hot peppers, peanuts, and liver. Her parents and the village doctors encouraged her to eat more pig or goat liver, but she would not. None of the individuals liked carrots, nor did they eat chives or spinach. This means that dietary vitamin A and carotene intakes were very low. Nutrition education for basic nutrition knowledge and prevention of vitamin deficiency is urgently needed. The people in Doumen should be taught that poor dietary habits will lead to nutrient deficiency, and that they will be healthier with more variety of food and a more balanced diet.

The respondents generally recognized nigh/blindness and measles, but could not identify the diseases. The people in Doumen considered eyes very important. Although they cannot recognize the kinds of diseases, their first recommendation was that more attention should be paid to eyes, and the cases should be brought to the village doctor. Few respondents said that if a person suffers from quhu (nigh/blindness), they should be given cod fish oil and liver, especially pig and goat liver. I hey said that if a patient eats liver for a few days, his eyes will recover after two to three months. If the disease become severe, the patient should go to a hospital in Kai Feng city. Liver is good for any kind of eye disease. Eggs and green leafy vegetables were also mentioned as good foods for patients. Eleven respondents said that if a child suffers from measles, he should stay home with all the windows closed to avoid the wind. The home remedy is boiled reed rhizome water with sugar. After drinking the reed rhizome water the child will sweat, and then recover. This home remedy is based on traditional Chinese medicine. The people in Doumen heavily rely on the village doctors for their health care and medical treatment. They also have the same ideas about the effects of some Chinese herbs.

Generalizations about Vitamin A Intake

Sixteen food intake checklists that give food frequencies of individuals were collected, as well as twenty-five household food frequency checklists. From these lists, the following results were summarized:

• Hot chili peppers are the most frequent source of vitamin A in this population. Hot peppers are eaten nearly every day during the summer and winter. However, fresh peppers are available only during summer and fall during which time a typical household might consume as much as 250 grams of fresh hot pepper every day. Peppers are sun-dried for winter use. Dried hot chili pepper is used as a spice in cooking. It is also used to produce gua dou, a type of bean paste that is consumed every day.

• Eggs are consumed regularly. As they are produced in households their high price and economic value in the market is not important.

• Peanut oil is the universal cooking oil. Households grow their own peanuts and process their own supply for cooking oil. Informants estimate that thirty-five to sixty kilograms of peanut oil are used during the year. Their estimates would appear to be fairly credible since they take the peanut oil harvest from the processing plant to their homes only one to three times each year.

• Celery, chives, and spinach are the next most common vitamin A-rich foods in the diet. Chives are used as a vegetable, not as a garnish or spice as in Western cuisine. The researchers found three families who used celery leaves in cooking. They mixed the leaves with wheat, soya, or corn flour, added salt and spices, and steamed them. This was unusual, as Chinese generally eat only the stalks of celery. Celery leaves, of course, are a fairly good source of vitamin A. Spinach is generally stir-fried during the peak season, late spring and early summer, and boiled in soup during the off season.

• Despite the prevalence of greenhouse vegetables, there still appears to be a greater likelihood of vitamin A deficiency in the winter. The use of chili peppers continues, but sun-dried peppers probably have a considerably lower vitamin A content.

• Pork, goat, and chicken are consumed, but not frequently. Fish consumption is about the same as chicken (very low), four to five times a year on special holidays. There are many fish ponds in the area for carp. Fish is bought only for very special occasions as it is expensive. Every family tries to have at least one fish dinner during the New Year. The symbol for fish is yu, a very lucky character. Note that Chinese protein intakes are also marginal, and mainly from cereals. Nutrition workers and researchers in China are trying to promote soybeans and family husbandry of meat products, especially fish.

• Some wild plants that appear to be rich in vitamin A are gathered for cooking. However, they are seasonal and the quantities are small.

• Greenhouses are widespread, so vegetables such as tomatoes, celery, and chives are available during the winter months. Some newly imported varieties have been produced and sold in the market. For example, kong xin cai (Ipomoea aquatica) has just been introduced there. Although most of the people do not recognize the new vegetables as rich in vitamin A, some respondents said that they taste good.

• Beans are another fairly common source of vitamin A. The long kidney bean is consumed every day, especially during the autumn.

Vitamin A deficiency is one of the most severe nutritional problems in the world. Many factors contribute to this problem. It has been controlled in China for a long time, although there is some prevalence of nightblindness Some researchers found that dietary vitamin A intake is very low, especially among preschool children. Four cases of nightblindness were identified in Doumen. This in-depth study probed for some factors that may be related to the problem.

Doumen is a typical rural community in the central part of China. People there are engaged in agriculture production. Due to the poor soil quality, the production is monotonous and practically no green leafy vegetables are grown. The practice of home gardening is also very poor. The food produced is not even enough for the family's consumption. Because of low production, the income level is very low which affects accessibility to vitamin A-rich foods.

The people of Doumen rely heavily on the nearby Wang Fu Zai market where vitamin A-rich foods are available, but the price is high, especially for animal foods, and they cannot afford to buy them. Another problem is that the vegetables rich in vitamin A are seasonal.

The people of Doumen purchase foods mainly based on taste. Nutritional value has not been considered, and some of their nutrition knowledge is incorrect. They tend to use their limited income to purchase high priced processed foods with poor nutritional value.

The diet of women does not change during pregnancy, although some of the respondents were aware of the need for more nutrients. The diet of children is simple and consists mainly of noodles and steamed bread. It is necessary to recommend more green leafy vegetables and animal foods.

Eggs are one of the good sources of vitamin A-rich food commonly consumed by the local people. This practice should continue to be encouraged.

Hot pepper is a commonly consumed vitamin A-rich food, however, the preservation method, sun-drying, decreases the vitamin A content.

The use of carrots should be encouraged, not only because of the high content of vitamin A, bat also their low cost. The sandy soil is also suitable for carrot production. There is a need to conduct nutrition education activities to teach the people about the value of carrots. Cooperation with the agriculture sector will help shorten the growing period and increase total production.

Traditional beliefs about food should be maintained, such as the use of goat liver for eyes, but some concepts might be changed, such as that children should not eat much meat, especially rabbit. The food taboos for pregnant women may also be changed. The large number of eggs consumed during the first thirty days after the delivery could be modified. It is better to eat two or three eggs a day for a long time rather than to consume ten to twenty a day only for thirty days.

The breastfeeding practices in Doumen village could be modified. The newborn should be breastfed as early as possible after delivery, and not wait for the third day. People need to know the nutritional value of the colostrum. It should be fed to the baby and not wasted. Under the current situation in China, the consumption of egg by infants should be encouraged, especially in poor rural areas.

The local people rely heavily on the village doctors for their general health care and medication. The doctor should be well trained in the prevention and treatment of vitamin A deficiency.

The consumption of vitamin A-rich foods should be encouraged. Carotene and retinol values for community food sources of vitamin A are shown in table 6.5. People can select foods according to nutritional value and price.

TABLE 6.5
Community Vitamin A Food Sources

7. Peru: The rural community of Chamis and the urban suburb of San Vicente in Cajamarca

Hilary Creed-Kanashiro

Introduction
Overview of the location
Food sources of Vitamin A
Principal differences between Chamis and San Vicente
Family and individual food patterns
Feeding patterns by age gender
Vitamin A-rich food patterns
Cultural beliefs
Vitamin A and health
Summary and conclusions
Policy recommendations
Recommendations for research

Introduction

Peru, situated on the Pacific coast of South America, comprises three major ecological regions: the coastal desert plains, the highland region of the Andean mountains, and the expansive jungle area on the east side of the Andes. Although the country produces a variety of natural products, poverty, health, and nutrition problems affect a large proportion of the population. Within Peru the population of the highland region is most affected. Cajamarca is situated in the northern highlands in the region Nor Oriental del Marañon (Map 5). This region has one of the highest levels of poverty and has been selected as a priority zone by the government for providing services and promoting development.

Interventions to improve the vitamin A status of the population are part of the government's nutrition strategy. Clinical deficiency of vitamin A is rarely observed although there is considerable evidence of subclinical deficiency in children. Consequently, among the possible strategies for intervention, improving the intake of vitamin A from dietary sources is of prime importance, particularly since much of the population has access to potential vitamin A food sources, at least during certain times of the year.

The highland areas are among those where vitamin A deficiencies, as measured by serum retinol levels and low dietary intakes, have been described. For the community assessment of natural foods sources of vitamin A two sites were selected in the department of Cajamarca: one rural population, the Comunidad Campesino (peasant community) of Chamis, and one urban, the suburb (barrio) of San Vicente. As well as an evaluation of each of the sites this permitted a comparison of feeding patterns related to vitamin A between urban and rural communities.

MAP 5. The FES Protocol was Tested in Both an Urban and a Rural site in the Department of Cajamarca, Peru

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