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Vitamin A supplements and mortality related to measles: a randomised clinical trial
Insights
High-dose vitamin A supplementation may reduce measles mortality in young children. This intervention showed a significant benefit for children under two years old, particularly those with severe respiratory complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutritional Science
Background:
- Measles is a significant cause of childhood mortality, especially in vitamin A deficient populations.
- Vitamin A deficiency is common in children admitted with measles, correlating with poor outcomes.
- Previous research suggests a potential benefit of vitamin A in reducing measles-related deaths.
Purpose of the Study:
- To evaluate the efficacy of high-dose vitamin A supplementation in reducing mortality among children with measles.
- To assess if vitamin A impacts mortality in specific subgroups, such as young children or those with complications.
Main Methods:
- A randomized controlled trial involving 180 children admitted with measles.
- Children were assigned to receive either routine care or routine care plus high-dose vitamin A (200,000 IU on two consecutive days).
- Baseline characteristics, including age, measles severity, and nutritional status, were recorded. Serum vitamin A levels were assessed.
Main Results:
- Overall mortality was 7% in the vitamin A group (6/88) versus 13% in the control group (12/92), though not statistically significant (p=0.13).
- A significant reduction in mortality was observed in children under 2 years old receiving vitamin A (p<0.05).
- Vitamin A supplementation showed a trend towards benefit in cases with croup or laryngotracheobronchitis. Malnourished children had significantly higher mortality regardless of treatment.
Conclusions:
- High-dose vitamin A supplementation may reduce mortality in children with measles, particularly in those under two years old.
- The benefit appears more pronounced in younger children and those with severe respiratory complications like croup.
- Severe malnutrition remains a critical risk factor for measles mortality, irrespective of vitamin A status.
Abstract:
One hundred and eighty children admitted with measles were randomly allocated to receive routine treatment alone or with additional large doses of vitamin A (200,000 IU orally immediately and again the next day). Baseline characteristics of the two groups were virtually identical for age, severity of measles, and vitamin A and general nutritional states. In 91% of the children serum vitamin A concentrations were less than 0.56 mumol/l. Of the 88 subjects given vitamin A supplements, six (7%) died; of the 92 controls, 12 (13%) died (p = 0.13). This difference in mortality was most obvious for children aged under 2 years (one death out of 46 children receiving supplements versus seven deaths out of 42 controls; p less than 0.05) and for cases complicated by croup or laryngotracheobronchitis. Mortality was several times higher in marasmic than in better nourished children, regardless of study allocation (p less than 0.01).