Scientists have long been concerned about the impact of maternal malnutrition on breast milk quantity and quality and thus on infant growth and health.

When viewed from the other direction, there is general agreement that lactation can increase the nutritional stress on malnourished women, especially when it overlaps with more than one trimester of the next pregnancy. It is common that women lose weight during sustained lactation.

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This “Minor Field Study” by Anna Wallén was conducted in 1993 in Lalmonirhat, a rural district in northern Bangladesh under my supervision. The Worldview International Foundation was running a blindness prevention program in this and other districts and finding that, in spite of consuming large amounts of green vegetables, it was taking a very long time to achieve remission of night blindness. (The local health officials were unwilling themselves to visit the homes of the hundreds of cases that WIF identified, but they were also not willing to provide vitamin A capsules to WIF.)

This was before Saskia de Pee’s research suggested that carotene from green leaves was poorly absorbed. In discussions with Barbara Underwood, she suggested we check on whether low fat consumption might be the explanation.

Anna did a remarkable study, showing that provision of a small amount of additional daily fat to these children did lead to a slightly more rapid remission. But everyone was amazed at how much more rapidly night blindness disappeared, even among the placebo children.

I believe this was because Anna dewormed all the children first, a factor that still has not been adequately studied. When people are free from helminths, especially ascaris, will carotene turn out to be much better absorbed than de Pee and others have suggested?

Click here to download the scanned file in pdf format.

IMAGE: Wall of a WIF thana (sub-district) office in northern Bangladesh, c 1993, showing a vitamin A poster and record-keeping charts.