A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania

Fawzi, Wafaie W.; Mbise, Roger; Hertzmark, Ellen; Fataki, Maulidi; Herrera, M G; Ndossi, Godwin; Spiegelman, Donna

doi:10.1097/00006454-199902000-00009

Cited by 136 publications

(82 citation statements)

References 30 publications

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“…Direct Effect of vitamin supplementation to HIV-infected pregnant womensupplementation to neonates is one alternative that has proven effective in decreasing child mortality (Humphrey et al, 1996;Rahmathullah et al, 2003); however, it is not known whether vitamin A supplementation to HIV-uninfected infants born to HIV-infected mothers could increase their risk of becoming infected. Vitamin A supplementation to HIV-infected infants appears to be safe and effective to decrease mortality (Fawzi et al, 1999), morbidity from diarrhea (Coutsoudis et al, 1995), and growth retardation (Villamor et al, 2002). Supplementation starting at 6 months among children who are not at risk of becoming HIV infected is an important public health intervention to decrease overall mortality and morbidity from measles, severe diarrhea, and possibly malaria (Villamor & Fawzi, 2000).…”

Section: Discussionmentioning

confidence: 99%

Effect of vitamin supplementation to HIV-infected pregnant women on the micronutrient status of their infants

et al. 2005

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Objective: We examined whether supplementation with vitamin A and/or vitamins B, C, and E to HIV-infected women during pregnancy and lactation is related to increased concentrations of vitamins A, B12, and E in their infants during the first 6 months of life. Design: We carried out a randomized clinical trial among 716 mother-infant pairs in Dar-es-Salaam, Tanzania. Women were randomly allocated to receive a daily oral dose of one of four regimens: vitamin A, multivitamins (B, C, and E), multivitamins including A, or placebo. Supplementation started at first prenatal visit and continued after delivery throughout the breastfeeding period. The serum concentration of vitamins A, E and B12 was measured in infants at 6 weeks and 6 months postpartum. Results: Maternal vitamin A supplementation increased serum retinol in the infants at 6 weeks (mean difference ¼ 0.09 mmol/l, Po0.0001) and 6 months (mean difference ¼ 0.06 mmol/l, P ¼ 0.0002), and decreased the prevalence of vitamin A deficiency, but had no impact on serum vitamins E or B12. Multivitamins increased serum vitamin B12 at 6 weeks and 6 months (mean differences ¼ 176 pmol/l, Po0.0001 and 127 pmol/l, Po0.0001, respectively) and vitamin E (mean differences ¼ 1.8 mmol/l, P ¼ 0.0008 and 1.1 mmol/l, P ¼ 0.004, respectively) and decreased the prevalence of vitamin B12 deficiency. Conclusions: Vitamin supplementation to HIV-1-infected women is effective in improving the vitamin status of infants during the first 6 months of age.

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Section: Discussionmentioning

confidence: 99%

Effect of vitamin supplementation to HIV-infected pregnant women on the micronutrient status of their infants

et al. 2005

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“…In the present study, a decline in serum retinol was observed in both groups. The consequences of the potential prevention of decline in serum retinol would positively impact on morbidity (Dudley, 1997;Fawzi et al , 1999;Lartey et al , 2000) and the efficacy of immunisation (Bhaskaram & Rao, 1997), especially in this age group.…”

Section: Discussionmentioning

confidence: 99%

The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants

Oelofse

Raaij

Benadé

et al. 2003

International Journal of Food Sciences and Nutrition

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“…It was found that improvement in vitamin A status was more likely to impact on mortality attributed to diarrhoeal disease and measles than on mortality attributed to respiratory infection or malaria 23 . One trial showed that periodic vitamin A supplementation of HIV-positive children could reduce all-cause mortality by as much as 63% 24 . It was also found that HIV-infected infants born to mothers who were given vitamin A in the last trimester had better intestinal mucosal integrity when tested at 1-14 weeks, which was not found in non-infected infants 22 .…”

Section: Discussionmentioning

confidence: 99%

The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa

Schoeman

Hendricks

Hattingh

et al. 2006

PHN

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Aim: The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa. Methodology: Nutritional risk status of infants and children , 6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally atrisk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein -Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status. Results: One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P ¼ 0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P , 0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P ¼ 0.003). The weight results of the nurses and the researcher differed significantly (P , 0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P , 0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart. Conclusions: Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.

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A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania

Abstract: Vitamin A deficiency, which is common among children in many developing countries, is particularly severe among HIV-infected children. Our findings indicate that vitamin A supplements, a low cost intervention, reduce mortality of HIV-infected children.

Cited by 136 publications

References 30 publications

Effect of vitamin supplementation to HIV-infected pregnant women on the micronutrient status of their infants

Effect of vitamin supplementation to HIV-infected pregnant women on the micronutrient status of their infants

The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants

The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa

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