Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: Systematic review and meta-analysis

Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK.
BMJ (online) (Impact Factor: 17.45). 08/2011; 343(aug25 1):d5094. DOI: 10.1136/bmj.d5094
Source: PubMed


To determine if vitamin A supplementation is associated with reductions in mortality and morbidity in children aged 6 months to 5 years.
Systematic review and meta-analysis. Two reviewers independently assessed studies for inclusion. Data were double extracted; discrepancies were resolved by discussion. Meta-analyses were performed for mortality, illness, vision, and side effects.
Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, Embase, Global Health, Latin American and Caribbean Health Sciences, metaRegister of Controlled Trials, and African Index Medicus. Databases were searched to April 2010 without restriction by language or publication status. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised trials of synthetic oral vitamin A supplements in children aged 6 months to 5 years. Studies of children with current illness (such as diarrhoea, measles, and HIV), studies of children in hospital, and studies of food fortification or β carotene were excluded.
43 trials with about 215,633 children were included. Seventeen trials including 194,483 participants reported a 24% reduction in all cause mortality (rate ratio=0.76, 95% confidence interval 0.69 to 0.83). Seven trials reported a 28% reduction in mortality associated with diarrhoea (0.72, 0.57 to 0.91). Vitamin A supplementation was associated with a reduced incidence of diarrhoea (0.85, 0.82 to 0.87) and measles (0.50, 0.37 to 0.67) and a reduced prevalence of vision problems, including night blindness (0.32, 0.21 to 0.50) and xerophthalmia (0.31, 0.22 to 0.45). Three trials reported an increased risk of vomiting within the first 48 hours of supplementation (2.75, 1.81 to 4.19).
Vitamin A supplementation is associated with large reductions in mortality, morbidity, and vision problems in a range of settings, and these results cannot be explained by bias. Further placebo controlled trials of vitamin A supplementation in children between 6 and 59 months of age are not required. However, there is a need for further studies comparing different doses and delivery mechanisms (for example, fortification). Until other sources are available, vitamin A supplements should be given to all children at risk of deficiency, particularly in low and middle income countries.

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    • "It leads to night blindness, Bitot's spots, corneal ulceration, and ultimately blindness. Vitamin A deficiency has also been associated with increased morbidity and mortality from measles, diarrhea, and respiratory and other infections, presumably due to impaired immune response caused by the deficiency (Mayo-Wilson et al., 2011). Vitamin A deficiency is more prevalent in areas where poverty is widespread and where the availability of vitamin A containing foods is limited (Sherwin et al., 2012). "
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    • "The World Health Organization recommends twice-yearly VAS in areas where vitamin A deficiency (VAD) is a public health concern to reduce all-cause mortality in children aged 6–59 months. Robust evidence from randomized controlled trials has shown twiceyearly VAS can reduce all-cause mortality by 24% in children 6–59 months of age [2]. Twice-yearly delivery of VAS through integrated Child Health Days (CHDs) is an effective method for reaching high and equitable coverage of child survival interventions including VAS. "
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    ABSTRACT: Twice-yearly child health weeks are an effective way of reaching children with essential child survival services in developing countries. In Kenya, child health weeks, or Malezi Bora, were restructured in 2007 from an outreach-based delivery structure to a health facility-based delivery structure to reduce delivery costs and increase sustainability of the events. Administrative data from 2007 to 2011 have demonstrated a decrease in coverage of Malezi Bora services to targeted children. A post-event coverage (PEC) survey was conducted after the May 2012 Malezi Bora to validate coverage of vitamin A supplementation (VAS) and deworming and to inform program strategy. Nine hundred caregivers with children aged 6–59 months were interviewed using a randomized, 30 × 30 cluster design. For each cluster, one facility-based health worker and one community-based health worker were also interviewed. Coverage of VAS was 31.0% among children aged 6–59 months and coverage of deworming was 19.6% among children aged 12–59 months. Coverage of VAS was significantly higher for children aged 6–11 months (45.7%, n = 116) than for children aged 12–59 months (28.8%, n = 772) (p < 0.01). Eighty-five percent (51/60) of health workers reported that Malezi Bora was implemented in their area while 23.6% of primary caregivers reported that Malezi Bora occurred in their area. The results of this PEC survey indicate that the existing Malezi Bora programmatic structure needs to be reviewed and reformed to meet WHO guidelines of 80% coverage with VAS.
    Journal of Epidemiology and Global Health 09/2014; 4(3). DOI:10.1016/j.jegh.2013.12.005
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    • "[43]; (RR 0.76; 95% CI: 0.69-0.83) [44] as well as mortality due to diarrhea: (RR 0.68; 95 % CI: 0.57-0.81) [42], (RR 0.72; 95% CI: 0.57-0.91) "
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    ABSTRACT: Child health is a growing concern at the global level, as infectious diseases and preventable conditions claim hundreds of lives of children under the age of five in low-income countries. Approximately 7.6 million children under five years of age died in 2011, calculating to about 19 000 children each day and almost 800 every hour. About 80 percent of the world's under-five deaths in 2011 occurred in only 25 countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. The implications and burden of such statistics are huge and will have dire consequences if they are not corrected promptly. This paper reviews essential interventions for improving child health, which if implemented properly and according to guidelines have been found to improve child health outcomes, as well as reduce morbidity and mortality rates. It also includes caregivers and delivery strategies for each intervention. Interventions that have been associated with a decrease in mortality and disease rates include exclusive breastfeeding, complementary feeding strategies, routine immunizations and vaccinations for children, preventative zinc supplementation in children, and vitamin A supplementation in vitamin A deficient populations.
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