Validation of night blindness reports among children and women in a vitamin A deficient population in rural Tanzania.

OBJECTIVE: This study validates different definitions of reported night blindness (XN) in a vitamin A deficient African population with no local term for XN. DESIGN: Case-control study with follow-up after treatment. SETTING: Eight primary schools and health centres in rural Tanzania. SUBJECTS: A total of 1214 participants were screened for reported XN and other eye signs of xerophthalmia: 461 children aged 24-71 months, 562 primary school-age children and 191 pregnant or breast-feeding women. All 152 cases of reported XN were selected for the validation study and group matched with 321 controls who did not complain of XN. XN reports were validated against serum retinol concentrations and pupillary dark adaptation measurements in cases and controls. INTERVENTION: All children and women who reported XN or had other signs of active xerophthalmia were treated with vitamin A and followed up 3-4 weeks later. Half of the untreated control group who had their serum retinol examined in the baseline examination were also followed up. RESULTS: The overall prevalence of reported XN was 12.5%. At baseline, mean pupillary threshold (-1.52 vs -1.55 log cd/m(2), P=0.501) and median serum retinol concentrations (0.95 vs 0.93 micromol/l, P=0.734) were not significantly different in cases and controls either overall or in each population group. More restricted case definitions reduced the prevalence of reported XN to 5.5% (P<0.001), but there was still no significant difference between cases and controls although the results were in the expected direction. After treatment, the median serum retinol concentration improved significantly only in the most deficient group, the young children. Dark adaptation improved in all the subgroups but the difference was only significant for young children and primary school-age children when the restricted case definitions were used. CONCLUSIONS: XN reports are a poor indicator of vitamin A deficiency in this population. SPONSORSHIP: Task Force Sight and Life, Basel, Switzerland.

From 'trailing wives' to the emergence of a 'trailing husbands' phenomenon: Retirement migration to rural areas

Migration and gender studies have focused on economically active heterogeneous couples and traditionally highlight a dominant male role in migration decision-making. The female partner is commonly portrayed as a 'trailing wife' or 'trailing mother' with the move found to have a negative effect on her employment prospects. Much less is known about if or how the balance of power shifts between husbands and wives when employment or career-motivated moves are removed from the decision-making process. This is analysed with reference to retirement migration to rural areas of the UK and involved interviews with both partners present. For this cohort of retired couples, and in common with the literature, migration during economically active life course stages demonstrates strong 'trailing wife' and 'trailing mother' tendencies. The male's decision to retire signalled the commencement of a retirement life course stage for the couple. However, in contrast to the earlier male dominated decision-making, retirement migration saw the emergence of a 'trailing husband' phenomenon. Wives appear to adapt most successfully to the new rural environment while many husbands found it difficult to adjust (at least initially) to the multiple life changes: moving from largely urban areas to a rural setting alongside exiting the workforce. The findings suggest that the role of leader/ follower changed during the course of these couples' lives together and in relation to their reasons for moving.