Vitamin A deficiency with measles — DTM&H MCQ

Correct answer: A — High-dose vitamin A according to age

The correct answer is A, high-dose vitamin A according to age. This 3-year-old has measles with conjunctival xerosis and night blindness, both classic signs of vitamin A deficiency causing xerophthalmia, and measles itself depletes vitamin A stores while worsening deficiency-related eye disease. WHO recommends that all children with measles in areas where deficiency is prevalent receive an age-appropriate oral dose of vitamin A, with children showing ocular signs of deficiency receiving the dose on diagnosis, repeated the next day, and again some weeks later. This treats the eye disease and reduces measles-associated morbidity and mortality, including pneumonia and death, making it both curative for the eye signs and protective against systemic complications in a malnourished, high-risk child. Why the other options are wrong: B. Riboflavin drops alone: riboflavin (vitamin B2) deficiency causes angular stomatitis and glossitis, not xerophthalmia or night blindness, and topical drops do not address the underlying retinol deficiency driving corneal risk. D. Niacin replacement as the priority: niacin deficiency causes pellagra (dermatitis, diarrhoea, dementia), which is not the clinical picture described and does nothing for xerophthalmia. E. Iron replacement without vitamin supplementation: iron treats anaemia, not xerophthalmia or night blindness, and withholding vitamin A in this scenario risks progression to corneal ulceration and irreversible blindness. C. Ivermectin as single therapy: ivermectin treats parasitic infestations such as strongyloidiasis or onchocerciasis, has no role in vitamin A deficiency, and would not address the ocular or systemic risks from measles-associated deficiency. Key point: conjunctival xerosis plus night blindness in a child with measles signals vitamin A deficiency, mandating immediate age-appropriate high-dose vitamin A to prevent blindness and reduce measles mortality.

Reference: WHO/Cochrane summary of WHO vitamin A dosing for measles: oral vitamin A 200,000 IU (100,000 IU in infants) given at diagnosis, repeated the following day, with a further age-specific dose 2 to 4 weeks later if ocular signs of deficiency (night blindness, xerophthalmia) are present. Vitamin A for treating measles in children, Cochrane Database of Systematic Reviews, https://pmc.ncbi.nlm.nih.gov/articles/PMC7076287/