354 CHAPTER EIGHT TABLE 8-82. PREVALENCE, ESTIMATED NUMBER OF CASES, AND DISTRIBUTION BY DISTANCE TO DRINKING WATER, ACTIVE XEROPHTHALMIA (AND BITOT'S SPOTS), CHILDREN UNDER AGE 6, DECEMBER-APRIL (NBS 1981) Estimated Number of Children Affected Prevalence per 100 Children Percentage of Nepal's Total Sample N Distance Within house courtyard Less than 5- minute walk More than 5- minute walk Subtotal Missing data 1,131 2,107 (1,848) 0.5 (0.5) 10.1 (11.9) 2,702 12,007 (9,561) 1.3 (1.0) 57.6 (61.6) 3,368 7,201 379 6,745 (4,126) 20,858 (15,534) 6 (0) 0.6 (0.3) 0.9 (0.6) NA (NA) 32.3 (26.5) 100.0 (100.0) NA(NA) Total 7,580 20,858 (15,534) 0.9 (0.6) 100.0 (100.0) Source: FRB.002 AN.133, 149 M Note: Figures in parentheses refer to the estimated number of cases, prevalence, and distribution of cases of active xerophthalmia that are Bitot's spots. Hygiene: While it is difficult to separate socioeconomic condi- tions from sanitation, certain aspects of hygiene are within the pur- view of the family. Some of these are listed in Table- 8-33. The interviewers examined the surroundings of each house at the time of the village census, comparing each house to others in the same community. The household was marked "clean" outside if there was evidence that the courtyard and surroundings had been recent- ly swept and if there was no garbage within the courtyard. If the house was entered for enumeration (one house of seven was not entered) then evidence of recent interior sweeping was also noted. Finally, the presence or absence of human and animal feces in the immediate house courtyard was noted. In all cases, there was a higher prevalence of xerophthalmia in houses that the enumerator felt were lacking in cleanliness. Obviously, this is a very subjective evaluation and possibly limited by observer bias, time of day visited, etc.39 However, since the cases of xerophthalmia were not diagnosed until the following day and the ophthalmologist did not know the enumerator's evaluation of the child's home environment, this provides one small piece of supportive evidence to the importance of household sanitation. There is a nearly two-fold decrease
