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© 1992 Oxford University Press

research-article

Conjunctival Impression Cytology with Transfer as a Field-Applicable Indicator of Vitamin A Status for Mass Screening

CÉCILE CARLIER*,**, JOEL COSTE{dagger}, MICHEL ETCHEPARE{ddagger} and OLIVIER AMÉDÉE-MANESME*,§

*Institut National de la Sante et de la Recherche Médicale (INSERM), Unité 56, Höpital de Bicêtre 78 av du Gal Leclerc, 94275 Le Kremlin-Bicêtre, France
**Environnement et Developpement en Afrique (ENDA-TM) 3 rue Rêcamier, 75006 Paris, France
{dagger}Institut National de la Santê et de la Recherche Mêdicale (INSERM), Unitê 292, Höpital de Bicêtre 78 av du Gal Leclerc, 94275 Le Kremlin-Bicêtre, France
{ddagger}Organisme de Recherche en Alimentation et en Nutrition Africaines (ORANA) 39 Av Pasteur, BP 2089, Dakar, Senegal
§Association de Recherche en Vitaminologie Pédiatrique (ARVP) 11 Parc A. Dumas, 78160 Marly-Le Roi, France

The increasing importance of vitamin A deficiency in even its mild subclinical form underlines the need for a mass screening test. Clinical, biochemical and cytological methods of assessing vitamin A deficiency in a public health setting have been described and widely used. The cytological method shows promise because it enables early detection of vitamin A deficiency. However interpretation is problematic since histopathological changes are gradual with the progressive disappearance of goblet cells and appearance of enlarged epithelial cells. The reliability and validity of the im pression cytology with transfer (ICT) test were assessed in order to produce a meaningful standard for this cytological method.

The ICT test was performed in Senegal on 1451 children, in the course of two surveys conducted in 1989 and 1990 in rural areas. Reliability, estimated by Cohen's kappa test for evaluating intra-reader variability, and sensitivity were highest for the abnormal-normal classification (kappa = 0.91; 95% confidence interval (CII: 0.89–0.93; and sensitivity = 74%; 95% CI 66–82%).

The ICT method is a cheap, noninvasive and easy test to perform in the field. This method is also reproducible and fairly sensitive according to the abnormal-normal classification. As illustrated by our proposed 50% cutoff of abnormal cytology calculated in relation to 5% of serum retinol values below 0.35 µmol/L criterion, ICT only requires a small sample for the assessment of the overall health of a community in contrast to xerophthalmia and blood vitamin A deficiency tests.

Received 1 August 1991


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