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Vitamin A levels and mortality among hospitalized measles patients, Kinshasa, Zaire
Insights
Low vitamin A levels are linked to increased measles mortality in children under 24 months. Further research is needed to confirm if vitamin A supplements can prevent measles deaths.
Area of Science:
- Pediatrics
- Nutritional Science
- Infectious Diseases
Background:
- High-dose vitamin A is recommended for children with measles in vitamin A-deficient areas.
- The link between vitamin A and measles mortality requires further clarification.
Purpose of the Study:
- To investigate serum vitamin A levels in children with measles.
- To determine the association between vitamin A levels and measles mortality in young children.
Main Methods:
- Serum vitamin A levels were measured in 283 children (≤5 years) using high-performance liquid chromatography.
- Statistical analyses, including univariate and multivariate logistic regression, were performed.
Main Results:
- Overall case-fatality rate was 26%.
- Factors associated with death included younger age, pneumonia, lymphopenia, and low vitamin A levels.
- Vitamin A levels < 5 µg/dL were associated with fatal outcomes in children < 24 months (RR=2.9).
Conclusions:
- Low vitamin A levels may predispose younger children to severe measles and increased mortality.
- The role of vitamin A supplementation in preventing measles mortality needs additional investigation.
Abstract:
Treatment with high dose vitamin A has recently been recommended for children with measles in communities where vitamin A deficiency is a recognized problem. However, the relationship between vitamin A and measles mortality has not been clearly established. We studied serum vitamin A levels in 283 children less than or equal to 5 years of age admitted to Mama Yemo and Kalembe Lembe Hospitals in Kinshasa, Zaire, between January and March, 1987. Vitamin A levels were determined by high performance liquid chromatography. Vitamin A levels ranged from less than 5 to 63 micrograms/dl (median, 8). The overall case-fatality rate was 26 per cent. On univariate analysis, age less than 24 months, pneumonia on admission, lymphopenia (less than 2000/mm3), and lower vitamin A levels were associated with death during hospitalization. In a multivariate logistic regression model, a vitamin A level less than 5 micrograms/dl was associated with fatal outcome for children younger than 24 months old (relative risk = 2.9, 95 per cent CI 1.3, 6.8), but not for older children. Further studies are needed to determine whether low vitamin A levels predispose children to severe measles and the role of vitamin A supplements in the prevention of measles mortality.