Objective To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood.Design Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation. Setting South central, rural Nepal.Participants 2378 adolescents and young adults aged 14 to 23, representing 51% of those who finished the original trial and 71% of those living in the study area in 2006.Interventions Every four months for 16 months preschool children were visited at home, given an oral 200 000 IU dose of vitamin A (half dose at age 1-11 months, quarter dose at <1 month) or placebo and the parents were queried about any childhood illnesses in the previous week, including purulent discharge from the ears.Main outcome measures Prevalence of mild or worse hearing loss (≥30 dB) in the most affected ear and tympanometric measures of middle ear function (peak height, ear canal volume, and gradient).Results During the original trial, the prevalence of middle ear infection during the preschool years did not differ between the supplement groups. By adolescence and early adulthood, a non-significant 17% reduction in hearing loss occurred among those who had periodically received vitamin A compared with placebo as preschool aged children (odds ratio 0.83, 95% confidence interval 0.62 to 1.12). Among participants with any ear discharge in early childhood, vitamin A supplementation was associated with a reduced risk of hearing loss, by 42% (0.58, 0.37 to 0.92) compared with controls, after adjusting the confidence interval for the design effect of the original trial. Abnormal tympanometric peak height of the middle ear system was less likely among participants supplemented with vitamin A in childhood. ConclusionIn undernourished settings, periodic, high dose vitamin A supplementation may reduce the risk of hearing loss associated with purulent ear infections in early childhood.

Objective: We estimated the prevalence of food insecurity among people who inject drugs (PWID) in Los Angeles and San Francisco and explored correlates of food insecurity. Design: A cross-sectional study that measured 30 d food insecurity using the US Adult Food Security Survey ten-item Module developed by the US Department of Agriculture. Food insecurity was defined as including low and very low food security. Setting: Two cities in the state of California, USA. Subjects: Male and female active PWID (n 777). Results: Among participants, 58 % reported food insecurity and 41 % reported very low food security. Food-insecure PWID were more likely to report being homeless (prevalence ratio (PR) = 1·20; 95 % CI 1·05, 1·37), chest pain in the past 12 months (PR = 1·19; CI 1·06, 1·35), acquiring syringes from someone who goes to a syringe exchange programme (PR = 1·27; 95 % CI 1·13, 1·43) and feeling at risk for arrest for possession of drug paraphernalia (PR = 1·30; 95 % CI 1·15, 1·46). Conclusions: Current food insecurity was common among PWID in these two cities, yet few factors were independently associated with food insecurity. These data suggest that broad strategies to improve food access for this high-risk population are urgently needed.

A cross-sectional survey was conducted among 3646 persons, 15 to 23 years of age, in the southern plains District of Sarlahi, Nepal, to assess the prevalence and severity of hearing loss and middle-ear dysfunction, and adverse effects of hearing loss on social integration. Between 2006 and 2008, subjects were enumerated and underwent otoscopic, tympanometric, and audiometric evaluations at central sites in villages. Hearing loss was diagnosed in subjects who failed a hearing screening and exhibited an average air conduction threshold value greater than or equal to 30 dBHL in the worse ear. Clinically, 32.8% of subjects exhibited a dull or retracted tympanic membrane, and 18% had abnormal tympanometry. Nearly 12% failed the hearing screening test, among whom more than half, or 6.1% overall, had hearing loss. Hearing-impaired subjects were six- to eight-fold (ORs, with 95% CIs excluding 1.0) more likely to report problems in hearing usual sounds or communicating with other people. Among young adults living in southern Nepal, hearing loss is common, and associated with social disability.

Early childhood undernutrition is a modifiable risk factor for early adulthood hearing loss.