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Vitamin A status, other risk factors and acute respiratory infection morbidity in children
L Dudley1, G Hussey, J Huskissen
1Department of Community Health, University of Cape Town.
Insights
Children with lower vitamin A levels experienced more severe acute respiratory infections (ARIs). This suggests a dose-response relationship, highlighting vitamin A
Area of Science:
- Pediatric Infectious Diseases
- Nutritional Immunology
- Public Health Nutrition
Background:
- Acute respiratory infections (ARIs) are a leading cause of childhood morbidity and mortality globally.
- Vitamin A deficiency is prevalent in many regions and is associated with increased susceptibility to infections.
- The specific relationship between vitamin A status and ARI severity, independent of other risk factors, requires further elucidation.
Purpose of the Study:
- To evaluate the association between vitamin A status and the severity of acute respiratory infections (ARIs) in children.
- To control for the influence of other known ARI risk factors in this association.
- To investigate potential dose-response effects between vitamin A levels and ARI severity.
Main Methods:
- A case-control study design was employed, including ambulatory and hospital-based settings.
- Participants comprised severe ARI cases (hospitalized), mild ARI cases (outpatient), and a control group with non-infectious diseases, matched for age and residence.
- Serum vitamin A levels were measured, and various ARI risk factors were analyzed.
Main Results:
- Mean serum vitamin A levels were significantly lower in severe ARI cases (13.79 µg/dL) compared to mild cases (20.27 µg/dL) and controls (22.09 µg/dL).
- Odds ratios indicated a higher likelihood of severe infection with lower vitamin A levels (severe vs. controls: OR 6.0; 95% CI 2.0-19.4).
- Factors like prior hospitalizations, lack of clinic card, poor housing, and indoor fuel use were associated with ARI severity, while low weight-for-age, diarrhea, and poor housing correlated with poor vitamin A status.
Conclusions:
- Vitamin A status demonstrates a strong, dose-dependent association with the severity of acute respiratory infections in children.
- The multifactorial nature of ARI severity necessitates comprehensive public health strategies.
- Findings support vitamin A supplementation for at-risk groups, emphasizing its integration into broader health initiatives.
Objective:
This study evaluated the association between vitamin A status and the severity of acute respiratory infections (ARIs) in children, controlling for the influence of other known ARI risk factors.
Design:
Case control study.
Setting:
Ambulatory and hospital-based study.
Patients:
Severe cases (N = 35) were children with ARI who were admitted to hospital for inpatient treatment, while mild cases (N = 32) were children with ARI who were treated as outpatients. The control group (N = 54) was selected from children with non-infectious diseases attending the outpatient department. Cases and controls were matched for age and area of residence.
Main Outcome Measures:
Serum vitamin A levels and analysis of ARI risk factors.
Results:
The mean (SD) vitamin A levels were 22.09 (7.27) micrograms/dl for the controls, 20.27 (11.11) micrograms/dl for the mild cases and 13.79 (7.60) micrograms/dl for the severe cases. All pairwise comparisons of levels of the three patient groups achieved statistical significance-severe and mild (P < 0.01), severe and control (P < 0.001) and mild and control (P = 0.03). After vitamin A levels were dichotomised, the odds ratios (and 95% confidence intervals) for severe versus mild cases were 2.1 (0.8-5.6), for mild versus controls 2.9 (0.8-10.5) and for severe versus controls 6.0 (2.0-19.4). A chi 2 for trend across the three groups was 13.2 (P = 0.001). Risk factors significantly associated with disease status included a history of hospital admission in the preceding 6 months, absence of a clinic card, poor housing and lack of electricity for indoor fuel use. Factors associated with poor vitamin A status included low weight for age, previous diarrhoeal disease and poor housing. Vitamin A status was independently associated with disease status in logistic regression modelling.
Conclusion:
Vitamin A status has a strong association with severity of infection. The gradient of that association suggests a dose-response effect. The multifactorial nature of ARI severity and vitamin A status highlights the need for a comprehensive approach to public health programmes to address ARI. The role of vitamin A supplementation for at-risk groups is supported by this study, but needs to be clearly defined within a broader approach to health.