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Vitamin A supplementation and child mortality. A meta-analysis
W W Fawzi1, T C Chalmers, M G Herrera
1Department of Nutrition, Harvard School of Public Health, Boston, MA 02115.
JAMA
|February 17, 1993
Summary
Vitamin A supplementation significantly reduces child mortality, especially for hospitalized measles patients and in community settings. These findings support widespread vitamin A supplementation programs in developing nations.
Area of Science:
- Public Health
- Nutritional Epidemiology
- Pediatrics
Background:
- Child mortality remains a significant global health challenge, particularly in developing countries.
- Vitamin A deficiency is endemic in many regions, contributing to increased child morbidity and mortality.
- Previous studies suggested a potential role for vitamin A supplementation in reducing child mortality, but evidence was inconsistent.
Purpose of the Study:
- To conduct a meta-analysis evaluating the relationship between vitamin A supplementation and child mortality.
- To synthesize evidence from controlled trials to determine the efficacy of vitamin A supplementation in reducing mortality.
- To provide evidence-based recommendations for vitamin A supplementation strategies in children.
Main Methods:
- A comprehensive literature search was conducted using MEDLARS and Current Contents from 1966 to 1992.
- Twelve controlled trials of vitamin A supplementation with mortality data were included in the meta-analysis.
- Data extraction and quality assessment were performed independently by two investigators, with formal testing for heterogeneity.
Main Results:
- Vitamin A supplementation demonstrated a highly protective effect against mortality in hospitalized measles patients (OR, 0.39; P = .0004).
- Supplementation also showed a significant protective effect against overall mortality in community-based studies (OR, 0.70; P = .001).
- The analysis accounted for study quality and the clustered nature of community-based interventions.
Conclusions:
- Vitamin A supplements are associated with a significant reduction in child mortality when administered periodically at the community level.
- The findings strongly support the routine administration of vitamin A supplements to all measles patients in developing countries, irrespective of vitamin A deficiency symptoms.
- Further research is needed to understand factors influencing the bioavailability of large vitamin A doses.