Vitamin A deficiency — DTM&H MCQ

Correct answer: B — Oral vitamin A 200,000 IU immediately, repeated at day 1 and day 14

The correct answer is B, oral vitamin A 200,000 IU immediately, repeated at day 1 and day 14. Night blindness with Bitot's spots corresponds to WHO xerophthalmia stages XN and X1B, indicating vitamin A deficiency requiring urgent high-dose replacement to prevent progression to keratomalacia and irreversible corneal damage. WHO/UNICEF/IVACG guidance mandates the standard three-dose oral regimen (200,000 IU for children over 12 months, given on day 0, day 1, and day 14) for any child with active ocular deficiency signs, regardless of corneal involvement. The oral route achieves rapid hepatic and serum retinol repletion and is the treatment of choice in resource-limited settings such as rural Bangladesh, where this remains a leading cause of preventable childhood blindness. Why the other options are wrong: E. Topical vitamin A ointment: topical retinoids do not correct the systemic hepatic depletion driving xerophthalmia and are not part of WHO emergency treatment; topical measures are adjunctive corneal care only. C. Oral zinc for 14 days: zinc supports retinol-binding protein synthesis and may be an adjunct in malnutrition, but has no role as monotherapy for acute xerophthalmia. D. IM vitamin A injection: intramuscular vitamin A is reserved for vomiting, severe malabsorption, or corneal involvement precluding oral intake, and is dosed differently (100,000 IU); it is not first-line when oral intake is tolerated. A. Dietary counselling alone: dietary improvement matters for long-term prevention but is far too slow to prevent keratomalacia in a child with active deficiency signs; immediate pharmacological repletion is required. Key point: any child with night blindness or Bitot's spots needs the full WHO three-dose oral vitamin A regimen (200,000 IU on day 0, day 1, and day 14) as a medical emergency to prevent keratomalacia and blindness.

Reference: WHO/UNICEF/IVACG Task Force. Vitamin A supplements: a guide to their use in the treatment and prevention of vitamin A deficiency and xerophthalmia, 2nd edition. World Health Organization, 1997. https://www.who.int/publications/i/item/9241545062