Vitamin A (Retinol) deficiency in Africans: All you need to know


By: Victoria Iyeduala (Freelance Health and Wellness Writer). Medically reviewed by the DLHA Team.


Three glasses of juice made with vitamin A-rich vegetables

Three glasses of juice made with vitamin A-rich vegetables, Click on image to enlarge





From promoting proper growth and development to boosting your vision, immune system and fertility, you need vitamin A to stay strong and healthy.


In nature, vitamin A is found as special substances in animal and plant sources (retinoids and carotenoids respectively). Carotenoids are called Provitamin A because your body converts them to retinol, an active form of vitamin A.


Because vitamin A is fat-soluble, your body stores the excess in the liver and other tissues. You develop vitamin A deficiency when you don't get enough vitamin A, and your body has used up its stores of it.


This article explains simply what African need to know about vitamin A deficiency; its causes, symptoms, complications and treatment.



What is vitamin A (retinol) deficiency?


You have vitamin A deficiency when your body lacks sufficient vitamin A. Vitamin A deficiency is among the most common micronutrient deficiencies globally, with more than 50% of all countries, mainly African and South-East Asian countries, battling it as a public health problem.


It's particularly common in:

  • Young children aged 0 to 5 years
  • Breastfeeding mothers
  • People with inflammatory bowel disease like Crohn's disease and ulcerative colitis
  • People who have had weight loss surgery like gastric bypass



How do you know if you have vitamin A deficiency?


You most likely have vitamin A deficiency if you notice any or a combination of the following:

  • Problems with seeing at night or in dim light (Night blindness)
  • Dry eyes
  • Cloudy eyes
  • White or greyish foamy spots on the eyes (bitot spots)
  • Falling ill often
  • Dry skin
  • Itchy, scaly bumps on your knees, elbows, shoulders and buttocks
  • Blindness (from prolonged severe deficiency)




What causes vitamin A deficiency in Africans?


The causes of vitamin A are:

  • A diet low in vitamin A
  • Infections
  • Malabsorption problems
  • Zinc deficiency


A diet low in vitamin A


Since your body can't make its own vitamin A, you need to eat various foods that contain vitamin A. You can get vitamin A deficiency when you don't eat enough of these foods.


Breastfed infants can develop vitamin A deficiency if their mothers don't get enough vitamin A.




Infections, such as measles and diarrhoea, can cause vitamin A deficiency. They can also make an already existing vitamin A deficiency worse.


Insufficient vitamin A intake, coupled with infections that affect your digestive system, is the most common cause of vitamin A globally.


Measles reduces the processing of vitamin A. It also hinders the absorption of vitamin A from your intestine.


Malabsorption problems


Certain bowel (digestive system) conditions, such as inflammation of the intestines, improper functioning of some bowel-related organs and weight loss surgeries, can reduce vitamin A absorption and cause vitamin A insufficiency.


Zinc deficiency


Your body needs zinc to absorb, process, transport and use vitamin A. So, Zinc deficiency usually occurs with vitamin A deficiency in developing countries with nutrition-related public health problems.



What are the complications of vitamin A deficiency?


When left untreated, vitamin A deficiency causes several health problems, including:

  • Xerophthalmia
  • Frequent infections
  • Phrynoderma




Vitamin A deficiency causes a series of eye problems collectively called xerophthalmia.

  • Night blindness: Without vitamin A, you lose your ability to see in low light and at night. It's one of the first signs of vitamin A deficiency.
  • Conjunctival xerosis: The conjunctiva, the thin membrane that covers the surface of your eyes, becomes dry.
  • Bitot spots: These are white or silver-grey foamy spots which form on the right and left sides of your eyes.
  • Corneal xerosis: This is when the cornea, the transparent layer that covers the front of your eyes, becomes dry and cloudy.
  • Corneal ulceration: This is when sores form on your cornea.
  • Corneal necrosis: This is when the cornea cells die.
  • Keratomalacia: This is when the cornea softens and thins out. Corneal perforation with extrusion of eye content and corneal scarring may follow this condition.
  • Corneal scarring: In vitamin A deficiency, this condition is the end result of corneal keratomalacia as the damaged cornea bulges out or the eye shrinks.


These eye problems usually affect both eyes and can lead to permanent vision loss. According to WHO, vitamin A deficiency is the leading cause of preventable blindness in children. Every year, about 250,000 to 500,000 children with vitamin A deficiency become blind, and 50% of them die within one year of going blind.


Frequent infections


Because vitamin A helps your body fight against infections, chronic vitamin A deficiency causes you to fall sick from infections frequently. Children with vitamin A deficiency are especially vulnerable to respiratory, diarrhoeal and measles infections. Severe cases may lead to death.




Phrynoderma causes itchy bumps or rashes on your elbows, knees, shoulders and buttocks that may spread to your arms, thighs, abdomen and back if left untreated. The skin on affected areas can become darker (hyperpigmentation) for a long time or form scars.


Other complications


Chronic vitamin A deficiency contributes to:

  • Anaemia: This is when your body has an unhealthy low amount of red blood cells
  • Problems in pregnancy and childbirth
  • Delayed growth and development in children
  • Maternal and child deaths



How do you prevent vitamin A deficiency?


To prevent vitamin A deficiency, you must eat foods that will give you sufficient amounts of vitamin A daily or take dietary supplements.


Examoles of vitamin A rich foods in AricaAfrican food sources of natural vitamin A include:

  • Organ meats, especially liver
  • Meat
  • Fish and fish oils
  • Dairy products like whole milk and cheese
  • Eggs
  • Green leafy vegetables like spinach, pumpkin leaf, scent leaf, bitter leaf and lettuce
  • Brightly coloured vegetables like carrots (super rich in provitamin A), tomatoes and peppers
  • Sweet potatoes
  • Fruits


You can also eat food products like cereals and oils that are rich in vitamin A (e.g. palm oil) or fortified with vitamin A. To know if a product is enriched with vitamin A, check its label.


Multivitamins or vitamin A supplements are another source of vitamin A. You can get them without a prescription.


The World Health Organisation (WHO) says, "Breastfeeding is the best way to protect babies from vitamin A deficiency and, in areas where vitamin A deficiency is a public health problem, vitamin A supplementation is recommended in infants and children 6-59 months of age."


Although pregnant women need vitamin A for themselves and their babies, too much is dangerous. However, as a pregnant mother, you should go for your antenatal checkups regularly to ensure that you and your baby are getting all the nutrients you need in healthy amounts.


Other people who are in danger of having vitamin A deficiency should get routine checkups to ensure they're maintaining sufficient vitamin A levels.


You should also limit your alcohol intake because excess alcohol increases your risk of nutrient deficiencies.


At the population level, large scale public health supplementation of staple foods like rice, cassava by-products, etc, during production or distribution with vitamin A is a preferred method of preventing vitamin A deficiency. 



How is vitamin A deficiency diagnosed?


Healthcare professionals use your complaints (symptoms), nutrition history and blood tests to diagnose vitamin A deficiency.


WHO says, "The various stages of xerophthalmia are regarded both as disorders and clinical indicators of vitamin A deficiency. Night blindness (in which it is difficult or impossible to see in relatively low light) is one of the clinical signs of vitamin A deficiency, and is common during pregnancy in developing countries."


Since the form of vitamin A in your blood is mostly retinol, healthcare professionals can use it to determine how much vitamin A is in your body.


When using blood test;

  • Retinol levels of less than 20 µg/dL mean you have vitamin A deficiency
  • You may start having xerophthalmia at retinol levels lower than 10 µg/dL


NOTE: µg/dL means micrograms per decilitre.



How is vitamin A deficiency treated?


Your healthcare professional will treat or help you manage any underlying health condition while ensuring your vitamin A levels increase.


You can increase your vitamin A levels by

  • improving your diet to contain more vitamin A-rich foods
  • taking vitamin A supplements
  • reducing your alcohol intake


However, vitamin A deficiency is commonly treated with a high dosage of vitamin A supplements.


Treatment cures early consequences of vitamin A deficiency, like the early stages of xerophthalmia. Late complications of vitamin A deficiency, such as keratomalacia and others, can cause incurable eye damage and lead to permanent blindness.





Vitamin A deficiency affects your eyes, ability to fight infections and general wellbeing. It can lead to blindness and death, but early diagnosis and treatment can prevent severe complications and facilitate good recovery.


You can prevent vitamin A deficiency by eating a well-balanced nutritious diet, taking recommended supplements, reducing alcohol consumption and properly managing any health condition that increases your risk of vitamin A deficiency.



  • Micronutrients. (2019, December 20). WHO. Retrieved October 28, 2023.
  • Hodge, C. & Taylor, C. (2023, January 2). Vitamin A Deficiency. StatPearls - NCBI Bookshelf. Retrieved October 28, 2023.
  • Feroze, K. B. & Kaufman, E. J. (2023, April 17). Xerophthalmia. StatPearls - NCBI Bookshelf. Retrieved October 28, 2023.




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Published: November 13, 2023

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