Childhood mortality after a high dose of vitamin A in a high risk population

Abstract

Objectives: To determine whether a single high dose of vitamin A given to all children in communities with high mortality and malnutrition could affect mortality and to assess whether periodic community wide supplementation could be readily incorporated into an ongoing primary health programme.

Design: Opportunistic controlled trial.

Setting: Jumla district, Nepal.

Subjects: All children aged under 5 years; 3786 in eight subdistricts given single dose of vitamin A and 3411 in remaining eight subdistricts given no supplementation.

Main outcome measures: Mortality and cause of death in the five months after supplementation.

Results: Risk of death for children aged 1-59 months in supplemented communities was 26% lower (relative risk 0.74, 95% confidence interval 0.55 to 0.99) than in unsupplemented communities. The reduction in mortality was greatest among children aged 6-11 months: death rate (deaths/1000 child years at risk) was 133.8 in supplemented children and 260.8 in unsupplemented children (relative risk 0.51, 0.30 to 0.89). The death rate from diarrhoea was also reduced (63.5 supplemented v 97.5 unsupplemented; relative risk 0.65, 0.44 to 0.95). The extra cost per death averted was about $11.

Conclusion: The results support a role for Vitamin A in increasing child survival. The supplementation programme was readily integrated with the ongoing community health programme at little extra cost.

PIP: The objective of this study was to determine whether a single high dose of Vitamin A given to all children in communities with high mortality and malnutrition could affect mortality and whether periodic community-wide supplementation could be readily incorporated into an ongoing primary health program. This opportunistic controlled trial was conducted in Jumla district, Nepal and subjects included all children under age 5--3786 in 8 subdistricts were given single doses of Vitamin A and 3411 in the remaining 8 subdistricts were given no supplementation. Mortality and cause of death in the 5 months after supplementation were the main outcome measures assessed. The risk of death for children ages 1-59 months in supplemented communities was 26% lower (relative risk 0.74, 95% confidence interval 0.55-0.99) than in unsupplemented communities. The reduction in mortality was greatest among children ages 6-11 months; the death rate (deaths/1000 child-years at risk) was 133.8 in supplemented children and 260.8 in unsupplemented children (relative risk 0.51, 0.30-0.89). The death rate from diarrhea was also reduced (63.5 supplemented vs. 97.5 unsupplemented; relative risk 0.65, 0.44-0.95). The extra cost/death averted was about $11.00. These results support a role for Vitamin A in increasing child survival. The supplementation program was readily integrated with the ongoing community health program at little extra cost.