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Vitamin A supplementation and child survival
M G Herrera1, P Nestel, A el Amin
1Harvard Institute for International Development, Cambridge, Massachusetts 02138.
Insights
High-dose vitamin A supplementation every six months did not reduce child mortality in Sudan. Factors like poverty, poor sanitation, and inadequate diets remain critical for improving child survival rates.
Area of Science:
- Public Health
- Nutrition Science
- Pediatrics
Background:
- Conflicting results exist regarding the efficacy of 6-monthly vitamin A supplementation in reducing child mortality.
- More frequent vitamin A dosing has shown promise in reducing mortality in deficient populations.
- Vitamin A deficiency remains a significant public health concern for children globally.
Purpose of the Study:
- To evaluate the effect of 6-monthly high-dose vitamin A supplementation on child mortality.
- To assess the impact of vitamin A and vitamin E co-supplementation versus placebo in a high-risk population.
Main Methods:
- A double-blind, placebo-controlled trial involving 28,753 children aged 9-72 months in Sudan.
- Children received either 200,000 IU vitamin A with 40 IU vitamin E or placebo (40 IU vitamin E) every 6 months.
- Follow-up was conducted over 18 months, with mortality as the primary outcome.
Main Results:
- No significant difference in mortality rates between the vitamin A and placebo groups (1.06 relative risk).
- Mortality was significantly higher in children from impoverished, unsanitary environments, younger children, and those with poor nutritional status or low dietary vitamin A intake.
- Statistical adjustments for various factors did not alter the primary finding.
Conclusions:
- Large-dose, 6-monthly vitamin A supplementation did not demonstrate a mortality benefit in this population.
- Despite the lack of supplement efficacy, a strong association between dietary vitamin A and mortality was observed.
- Addressing underlying factors like poverty, sanitation, and diet is crucial for improving child survival.
Abstract:
Previous studies of the effect of 6-monthly vitamin A supplementation on child mortality have given conflicting results. In other trials, more frequent doses of vitamin A have significantly reduced mortality among children at risk of vitamin A deficiency. We have done a double-blind, placebo-controlled trial of vitamin A supplementation in the Sudan among 28,753 children aged 9-72 months at risk of vitamin A deficiency. Children were assigned to receive either 200,000 IU vitamin A and 40 IU vitamin E every 6 months (vitamin A group) or 40 IU vitamin E alone (placebo group). During the 18 months of follow-up, there were 120 deaths (8.4/1000) in the vitamin A group and 112 (7.9/1000) in the placebo group (relative risk 1.06, 95% confidence interval 0.82-1.37). Controlling for geographic site, round of observation, anthropometry, morbidity, dietary intake of vitamin A, sex, and all baseline differences between the two groups did not change the results. Children living in poor and unsanitary environments, younger children, and those sick, stunted, wasted, or consuming diets low in vitamin A were at a significantly higher risk of dying. The lack of an effect of large-dose vitamin A supplementation on mortality, despite a clear association between dietary vitamin A and mortality, underscores the need to identify factors that modify the efficacy of vitamin A supplements as a public-health measure. Reducing poverty, improvements in sanitation, and access to adequate diets should remain the main goals to improve child survival.
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