The first population-based study of xerophthalmia in Africa was conducted in the Lower Shire River Valley of Malawi in the autumn of 1983. A total of 5,436 children under six years of age were examined by three survey teams over an eight-week period. The prevalence of active xerophthalmia was 3.9%. Rates for night blindness and active corneal disease were more than five times the World Health Organization criterion for a problem of public health importance. Xerophthalmic corneal scarring occurred at a rate of 5.9/1,000, more than 10 times the World Health Organization criterion. All cases of bilateral blindness in this age group were considered to be due to vitamin A deficiency. Given recent evidence from Asia linking even subclinical vitamin A deficiency to increased risk of mortality and morbidity, this disease is not only a leading cause of blindness in this area, but may have an important impact on child survival as well.