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Efficacy of vitamin A in reducing preschool child mortality in Nepal
K P West1, R P Pokhrel, J Katz
1Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland 21205.
Insights
Vitamin A supplementation significantly reduces preschool child mortality by 30% in developing countries. This finding from a Nepal trial resolves conflicting evidence on vitamin A
Area of Science:
- Public Health
- Nutritional Science
- Pediatrics
Background:
- Conflicting results from community trials on vitamin A supplementation's impact on preschool child mortality.
- Need for definitive evidence to guide public health interventions.
Purpose of the Study:
- To resolve conflicting evidence regarding the efficacy of vitamin A supplementation in reducing preschool child mortality.
- To provide robust data on the impact of vitamin A on child survival in a representative South Asian population.
Main Methods:
- A randomized, double-masked, placebo-controlled community trial involving 28,630 children aged 6-72 months in rural Nepal.
- Children received either vitamin A (60,000 retinol equivalents) or placebo every 4 months.
- Randomization was conducted at the administrative ward level.
Main Results:
- A 30% reduction in mortality was observed in the vitamin A-supplemented group compared to the placebo group (Relative Risk = 0.70; 95% CI: 0.56-0.88) after 12 months.
- Mortality reduction was consistent across sexes, all age groups (6-72 months), and throughout the year.
- The benefit was independent of acute nutritional status, measured by arm circumference.
Conclusions:
- Periodic community-based vitamin A supplementation is a highly effective strategy for reducing child mortality in developing countries.
- The study provides strong evidence supporting the widespread implementation of vitamin A supplementation programs.
- Early discontinuation of the trial due to significant observed benefit underscores the intervention's impact.
Abstract:
Community trials of the efficacy of vitamin A supplementation in reducing preschool childhood mortality have produced conflicting results. To resolve the question, a randomised, double-masked, placebo-controlled community trial of 28,630 children aged 6-72 months was carried out in rural Nepal, an area representative of the Gangetic flood plain of South Asia. Randomisation was carried out by administrative ward; the vitamin-A-supplemented children received 60,000 retinol equivalents every 4 months and placebo-treated children received identical capsules containing 300 retinol equivalents. After 12 months, the relative risk of death in the vitamin-A-supplemented compared with the control group was 0.70 (95% confidence interval 0.56-0.88), equivalent to a 30% reduction in mortality. The trial, which had been planned to last 2 years, was discontinued. The reduction in mortality was present in both sexes (relative risk for boys 0.77; for girls 0.65), at all ages (range of relative risks 0.83-0.50), and throughout the year (0.76-0.67). The reduction in mortality risk was not affected by acute nutritional status, as measured by arm circumference. Thus, periodic vitamin A delivery in the community can greatly reduce child mortality in developing countries.
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