Effect of daily low dose of vitamin A compared with single high dose on morbidity and mortality of hospitalized mainly malnourished children in senegal: a randomized controlled clinical trial

Abstract

Background: In vitamin A-deficient populations, children hospitalized with infections and/or malnutrition are at particular risk of developing severe vitamin A (VA) deficiency. High-dose VA supplements are recommended as part of the treatment but results on its effect on recovery from morbidity and on prevention from nosocomial morbidity are conflicting. Objective: We aimed to assess the effect of a single high dose and daily low dose of VA on hospitalized malnourished children's morbidity. Design: We carried out a double-blind, randomized trial in 604 and 610 Senegalese hospitalized children. The first mentioned batch received a high-dose VA supplement (200 000 IU) on admission, the second a daily low-dose VA supplement (5000 IU per day) during hospitalization. Children were followed up until discharged. Data on all-cause morbidity were collected daily. Results: Survival analysis showed that the incidence of respiratory disease was significantly lower in the low-dose group than in the high-dose group, hazard ratios (HR): 0.26, 95% CI: 0.07-0.92. The duration of respiratory infection was also significantly lower in the low-dose group than in the high-dose group (HR of cure: 1.41, 95% CI: 1.05-1.89). Duration and incidence of diarrhoea were not significantly different between treatment groups. In children with oedema on admission, mortality was significantly lower in the low-dose group (Adjusted odds ratio: 0.21; 95% CI: 0.05-0.99). Conclusions: Daily low dose of VA compared with single high dose significantly reduced duration and incidence of respiratory infection but not of diarrhoea in hospitalized children.

Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutrition

“…Only one trial included children with SAM exclusively [19]. The remaining 14 included non-malnourished and malnourished children [20-33]. VA dosing also varied; only five trials administered the recommended high-dose on day 1 [19,26,30,31,33], while the remaining administered VA doses in varying quantities and forms.…”

Diarrhea is a Major killer of Children with Severe Acute Malnutrition Admitted to Inpatient Set-up in Lusaka, Zambia

“…In addition, the value of a supplementary feeding program, which is lacking in the current CTC program in Lusaka, needs to be looked into in order to prevent fast deterioration of children into severe malnutrition during peak malnutrition periods. Related to the documented high prevalence of kwashiorkor, the current practice of providing high doses of vitamin A as part of the inpatient management is questionable in the face of evidence demonstrating increased risk of mortality in children with edematous forms of malnutrition receiving high doses of vitamin A [27]. …”

Effect of biscuits fortified with different doses of vitamin A on indices of vitamin A status, haemoglobin and physical growth levels of pre-school children in Chongqing

“…There is no clear evidence, however, that a large dose is better than a smaller one. Serial population-based field trials (19)(20)(21)(22)(23) have studied the effect of different administered doses of vitamin A on children's mortality and/or morbidity. Previous researches have HAZ, height-for-age Z-score; WAZ, weight-for-age Z-score; WHZ, weight-for-height Z-score; SNK, Student-Newman-Keuls test.…”