Vitamin A Supplementation and Child Morbidity and Mortality in Developing Countries

Abstract

A meta-analysis of eight mortality trials indicates that improving the vitamin A status of children aged six months to five years reduced mortality rates by about 23% in populations with at least low prevalence of clinical signs of vitamin A deficiency. The observed effect of supplementation, described in terms of relative risk (RR), was RR =0.77 (95% confidence interval 0.68-0.88; p < .001) and did not differ by sex or age. However, the number of lives saved was greater at younger ages because of higher mortality. A significant RR was shown for deaths attributed to diarrhoea and measles, but not for respiratory infection. Variability among the trials in effects was apparent, but attempts to explain it by descriptors of the population (baseline anthropometric status, prevalence of xerophthalmia, age profile, baseline mortality) were unsuccessful. Owing to the lack of data, firm conclusions could not be reached about effectiveness in children of less than six months and in settings where biochemical but not clinical evidence of vitamin A deficiency exists. Information about morbidity outcomes from about two dozen studies was reviewed. No consistent effects on frequency or prevalence of diarrhoeal and respiratory infections were found. Improvement in vitamin A status did appear to reduce severe morbidity, particularly in children with measles.

Vitamin A status, hospitalizations, and other outcomes in young children with sickle cell disease

“…Vitamin A deficiency impairs epithelial integrity and systemic immunity and increases the incidence and severity of infections during childhood. 6,8 Numerous studies in developing countries have shown that vitamin A supplementation reduces both mortality and morbidity from measles, 10,11,27 gastroenteritis and diarrhea, 10,11,13,27 malaria, 13 and HIV infections 8 and may decrease the number and length of hospitalizations and severity of illness events in at-risk populations. [12][13][14] From 15% to 92% of children in developing countries have serum retinol levels < 20 lg/dL.…”

“…8,9 Vitamin A supplementation reduced mortality rates from infectious disease in community-based studies 10,11 and morbidity, particularly from measles, gastrointestinal diseases, and malaria. [8][9][10][11][12][13][14] Vitamin A supplementation also provides a benefit to the population in developing countries as a whole by reducing the number of visits for medical care and shortening the length of hospital stay. [12][13][14] We previously reported decreased serum vitamin A (retinol) and carotenoids in children with SCD.…”

A health and nutritional profile of rural school children in KwaZulu-Natal, South Africa

“…Standard 1 pupils were chosen as they had the bene t of at least 2 years of schooling, and after 10 years of age pubertal changes affect growth. 1,4 In KZN, attendance rate among primary schools is high, with 89.2% of children attending. 8…”

“…1 The prevalence of these public health problems in South African school children, their persistence beyond pre-school age and cost-effective strategies for control and prevention are poorly understood. [2][3][4] It has been recommended that vitamin A supplementation and de-worming should be part of a basic package of health services and incorporated into supplementary feeding programmes. 5 This has major policy and scal implications for ef cient use of health resources and the therapeutic ef cacy of the recommendations needs to be established under local conditions.…”

Review: genetically modified plants for the promotion of human health

“…According to United Nations Administrative Committee on Coordination/subcommittee on nutrition (UN ACC/ SCN, The United Nations System Chief Executive's Board for Coordination at present), average availability in the world is 777 lg retinol equivalents (RE) per person per day (Beaton et al 1993) and minimum average requirements are around 250 lg RE per person per day (http://www.unsystem.org/scn/archives/ rwns02vol1/index.htm). RE is a concept introduced by the UN Food and Agriculture Organization (FAO)/WHO Expert Group in 1967 and is defined as 6 lg b-carotene or 11.9 lg of the other provitamin A carotenoids in food sources (World Health Organization 1967).…”