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Vitamin A Supplementation on Childhood Mortality

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More Intervention Effect Estimate Summaries

Reference
Imdad A, Yakoob MY, Sudfeld C, Haider BA, Black RE, Bhutta ZA. Impact of vitamin A supplementation on infant and childhood mortality. BMC Public Health 2011; 11 (Suppl 3): S20.

Background

  • Vitamin A includes a group of fat soluble compounds that are involved in growth and differentiation of various body cells; including cells of the respiratory epithelium gastrointestinal tract, retina and immune system (1).
  • Vitamin A has been termed as an anti-infectious vitamin because of its role in regulating human immune function.  Its deficiency makes humans, especially infants, vulnerable to diseases of eye, respiratory and gastrointestinal tract (2).
  • In all but 3 included studies, children were supplemented according to WHO Guidelines (3).  Neonates (0-28 days of life) were supplemented with 50,000 IU; infants 1-12 months were supplemented with 100,000 IU, and children 13-59 months were supplemented with 200,000 IU.

Intervention Effects

Vitamin A Supplementation on All-cause Mortality among Neonates (0-28 days of life)

  • 12% reduction in all-cause mortality at 6 months of age (RR: 0.88; 95% CI 0.79-0.98) 
  • 6 RCTs (moderate quality of evidence)

Vitamin A Supplementation on All-cause Mortality among Infants (1-6 months of age)

  • There was no effect in reducing all-cause mortality (RR: 1.05; 95% CI 0.88-1.26) - 5 RCTs (low quality of evidence)

Vitamin A Supplementation on All-cause Mortality among Children (6-59 months of age)

  • 25% reduction in all-cause mortality (RR: 0.75; 95% CI 0.64-0.88) – 12 RCTs (moderate quality evidence)

Vitamin A Supplementation on Diarrhea-specific Mortality among Children (6-59 months of age)

  • 30% reduction in diarrhea-specific mortality (RR: 0.70; 95% CI 0.58-0.86)  
  • 7 RCT studies (moderate quality of data)

Vitamin A Supplementation on Mortality (Other Disease-specific Findings) among Children 6-59 Months of Age

  • No effect on measles-specific mortality (RR: 0.71; 95% CI 0.43-1.16) – 5 RCTs (low quality of evidence)
  • No effect on meningitis-specific mortality (RR: 0.73; 95% CI 0.22-2.48) – 3 RCTs (low quality of evidence)
  • No effect on pneumonia-specific mortality (RR: 0.94; 95% CI 0.67-1.30) – 7 RCTs (low quality of evidence)

Intervention Recommendation:  

  • Preventive vitamin A supplementation reduces diarrhea-specific mortality by 30% in children 6-59 months of age in community settings in developing countries.
  • No recommendation is made for infants 1-6 months because vitamin A supplementation has no effect in this age group, and no recommendations are made in regards to neonatal vitamin A supplementation as more evidence will be available soon.
  • There is not sufficient evidence to decide in favor or against a true differential effect for vitamin A supplementation in Asia vs. Africa and Latin America in children 6-59 months of age.

References from Imdad Paper Cited Here

  1. Bates CJ. Vitamin A. Lancet. 1995;345(8941):31–35. 
  2. Underwood BA. Vitamin A deficiency disorders: international efforts to control a preventable "pox". J Nutr. 2004;134(1):231S–236S.
  3. WHO. Vitamin A supplements, a guide to their use in the treatment of vitamin A deficiency and xeropthalmia. Geneva: Prepared by WHO/UNICEF/IVACG task force; 1997.

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