BACKGROUND: Vitamin A deficiency makes children vulnerable to infections and influences the outcome of various infections. In 1993 vitamin A deficiency was found to be a public health problem in Bungoma district of western Kenya. OBJECTIVE: To determine the prevalence of vitamin A deficiency, anaemia and malaria parasitaemia and to correlate these with haemoglobin, ferritin and acute phase response. DESIGN: A cross-sectional study. SETTING: Bungoma district of western Kenya. SUBJECTS: Three hundred and three children aged one to three years were studied. MAIN OUTCOME MEASURES: Serum retinol, haemoglobin, serum ferritin, alpha-1 acid glycoprotein, C-reactive protein and malaria parasite density. RESULTS: Twentynine percent of the children had severe vitamin A deficiency, 92% had anaemia (haemoglobin less than 10 g/dl) 24(7%) of these were severely anaemic while 76% had malaria parasitaemia. There was no significant difference in the retinol levels of children with malaria parasitaemia and those without malaria parasitaemia (P = 0.6). Retinol levels were significantly lower among children with high C-reactive protein (P < 0.001). Malaria parasitaemia negatively correlated with haemoglobin (r = -0.13, P < 0.05) and C-reactive protein (r = 0.21, P < 0.01). There was no difference in haemoglobin level of children with normal serum retinol and those with low serum retinol (P = 0.16). Ferritin did not differ significantly among children with normal haemoglobin and those with low haemoglobin (P = 0.13). CONCLUSION: Vitamin A deficiency and anaemia are a public health problem among the children studied. The high prevalence of vitamin A deficiency may have resulted from acute phase response induced by infections.