Impact of massive dose of vitamin A given to preschool children with acute diarrhoea on subsequent respiratory and diarrhoeal morbidity

Department of Paediatrics, All India Institute of Medical Sciences, New Delhi.
BMJ Clinical Research (Impact Factor: 14.09). 12/1994; 309(6966):1404-7. DOI: 10.1136/bmj.309.6966.1404
Source: PubMed


To assess the impact of vitamin A supplementation on morbidity from acute respiratory tract infections and diarrhoea.
Double blind randomised placebo controlled field trial.
An urban slum area in New Delhi, India.
900 children aged 12-60 months attending a local health facility for acute diarrhoea of less than seven days' duration randomly allocated to receive vitamin A 200,000 IU or placebo.
Incidence and prevalence of acute lower respiratory tract infections and diarrhoea during the 90 days after termination of the enrolment diarrhoeal episode measured by twice weekly household surveillance.
The incidence (relative risk 1.07; 95% confidence interval 0.92 to 1.26) and average number of days spent with acute lower respiratory tract infections were similar in the vitamin A supplementation and placebo groups. Among children aged 23 months or less there was a significant reduction in the incidence of measles (relative risk 0.06; 95% confidence interval 0.01 to 0.48). The incidence of diarrhoea was also similar (relative risk 0.95; 0.86 to 1.05) in the two groups. There was a 36% reduction in the mean daily prevalence of diarrhoea associated with fever in the vitamin A supplemented children older than 23 months.
Results were consistent with a lack of impact on acute lower respiratory tract related mortality after vitamin A supplementation noted in other trials and a possible reduction in the severity of diarrhoea.

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Available from: Nita Bhandari, Oct 09, 2014
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    • "In this setting, over half of under-5- y-old children were stunted and about 20% wasted. In children aged 1 – 5 y seeking care at an outpatient clinic in a neighboring slum, the prevalence of clinical vitamin A deficiency was about 3.5% and that of sub-clinical vitamin A deficiency (serum vitamin A 0.7 mmol=l) was 37% (Bhandari et al, 1994). "
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    ABSTRACT: Vitamin A supplementation to mothers in the postpartum period and to their infants at routine immunization contacts is being considered to reduce vitamin A deficiency in infancy. This study was conducted to determine the impact of maternal and infant vitamin A supplementation on antibody response to oral polio vaccine (OPV). Randomized, double blind, placebo-controlled trial. Mothers in the intervention group received 60 mg retinol equivalent (RE) vitamin A 3-4 weeks after delivery and their infants 7.5 mg RE with each OPV dose at 6, 10 and 14 weeks of age. The control group mothers and their infants received a placebo at each of these contacts. Geometric mean (GM) titer of neutralizing antibodies and proportion of children with protective titer to the three polioviruses at 26 weeks of age. Vitamin A supplementation increased the proportion of infants with protective antibody titer against poliovirus type 1 (relative risk (RR) 1.15, 95% confidence interval (CI) 1.03-1.28) and the GM antibody titer (ratio of GM 1.55, 95% CI 1.03-2.31) following immunization. The proportion of infants with protective antibody titer against poliovirus type 2 (RR 0.99, 95% CI 0.94-1.05) or type 3 (RR 1.05, 95% CI 0.96-1.15) was not significantly different in vitamin A and placebo groups. The GM antibody titer for poliovirus type 2 (ratio of GM 0.99, 95% CI 0.64-1.54) or poliovirus type 3 (ratio of GM 1.10, 95% CI 0.69-1.75) also did not differ across groups. Vitamin A given to the mothers in the postpartum period and their infants with OPV did not interfere with the antibody response to any of the three polioviruses and enhanced the response to poliovirus type 1.
    Full-text · Article · May 2002 · European Journal of Clinical Nutrition
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    • "a and Kiribati ( Gopaldas et . al . 1993 ; WHO 1995 ; Schaumberg et . al . 1996 ) . Vitamin A deficiency increases the risk and impact of illness ( affecting the severity of diarrhea , if not its prevalence ) , but certain infections such as malaria and measles can in turn impair vitamin A status ( De Sole et . al . 1987 ; Barreto et . al . 1994 ; Bhandari et . al . 1994 ; West et . al . 1997 ; Hautvast et . al . 1998 ) . Thus , infants with a history of malaria in the Congo were much more likely to have low levels of serum retinol compared with children less affected by malaria ( Samba et . al . 1990 ) . And in Turkey children with measles were more than twice as likely to have low serum retinol levels"
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    ABSTRACT: Although micronutrient deficiency is a global problem, it is not a universal one; the burden is not evenly shared within countries or households. Empirical evidence from 69 studies compiled for this review indicates that there are important non-linearities in relationships among food intakes, sharing and caring behaviour, and micronutrient status that lead to a diversity of outcomes not always predictable by age or gender. Mothers and girls display a higher prevalence of some deficiencies than men or boys, but the situation is confounded or reversed in other contexts. No single age cohort, gender or location is invariably worse off than every other, all of the time. The manifestation of deficiencies is determined by synergies among nutrients, diseases and biological functions, on the one hand, and interacting social, economic and environmental processes, on the other. The unmasking of age and gender diversity in risks and outcomes is important for better establishing the global prevalence of micronutrient problems and for improving the focus of public action. The tools used in assessing deficiencies need to be re-examined in light of multiple interactions among micronutrients, on the one hand, and among health and behavioural confounders, on the other. Understanding local dietary practices, health care preferences, activity patterns and tradeoffs in resource access is as crucial as specifying physiological benchmarks. Clinical rigour needs to be combined with rigourous contextual insight. The conventional narrow focus on one deficiency, for one priority group at a time needs to be questioned. Progress in tackling single micronutrient problems for single target groups may not mean that everyone is, or remains, better off. Sustainable gains for whole populations are likely to require combinations of actions at various levels to influence the incentive and behaviour structures operating down to the intrahousehold level.
    Full-text · Article · Apr 2002
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    • "is greater than 1 % , children with measles should be supplemented with vitamin A ( World Health Organization , 1997b ) . A number of studies have shown that vitamin A supplementation decreases the severity but not the incidence of diarrhoea in children ( Bloem et al . 1990 ; Ghana VAST Study Team , 1993 ; Lie et al . 1993 ; Barreto et al . 1994 ; Bhandari et al . 1994 ; Biswas et al . 1994 ; Sempertegui et al . 1999 ) . However , some vitamin A supplementation studies do not report a reduction in either incidence or severity of diarrhoea ( Rahmathullah et al . 1991 ; Ramakrishnan et al . 1995 ) . It is possible that those studies which show no effect of vitamin A supplementation included children wit"
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    ABSTRACT: Undernutrition and infection are the major causes of morbidity and mortality in the developing world. These two problems are interrelated. Undernutrition compromises barrier function, allowing easier access by pathogens, and compromises immune function, decreasing the ability of the host to eliminate pathogens once they enter the body. Thus, malnutrition predisposes to infections. Infections can alter nutritional status mediated by changes in dietary intake, absorption and nutrient requirements and losses of endogenous nutrients. Thus, the presence of infections can contribute to the malnourished state. The global burden of malnutrition and infectious disease is immense, especially amongst children. Childhood infections impair growth and development. There is a role for breast-feeding in protection against infections. Key nutrients required for an efficient immune response include vitamin A, Fe, Zn and Cu. There is some evidence that provision of the first three of these nutrients does improve immune function in undernourished children and can reduce the morbidity and mortality of some infectious diseases including measles, diarrhoeal disease and upper and lower respiratory tract infections. Not all studies, however, show benefit of single nutrient supplementation and this might be because the subjects studied have multiple nutrient deficiencies. The situation regarding Fe supplementation is particularly complex. In addition to immunization programmes and improvement of nutrient status, there are important roles for maternal education, improved hygiene and sanitation and increased supply of quality water in the eradication of infectious diseases.
    Full-text · Article · Jul 2000 · Nutrition Research Reviews
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