Impact of vitamin A supplementation on infant and childhood mortality

Abstract

Introduction: Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG) guidelines.

Methods: A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A and mortality. Data were abstracted into standardized forms and quality of studies was assessed according to standardized guidelines. Pooled estimates were generated for preventive effect of vitamin A supplementation on all-cause and disease specific mortality of diarrhea, measles, pneumonia, meningitis and sepsis. We did a subgroup analysis for vitamin A supplementation in neonates, infants 1-6 months and children aged 6-59 months. In this paper we have focused on estimation of efficacy of vitamin A supplementation in children 6-59 months of age. Results for neonatal vitamin A supplementation have been presented, however no recommendations are made as more evidence on it would be available soon.

Results: There were 21 studies evaluating preventive effect of vitamin A supplementation in community settings which reported all-cause mortality. Twelve of these also reported cause specific mortality for diarrhea and pneumonia and six reported measles specific mortality. Combined results from six studies showed that neonatal vitamin A supplementation reduced all-cause mortality by 12 % [Relative risk (RR) 0.88; 95 % confidence interval (CI) 0.79-0.98]. There was no effect of vitamin A supplementation in reducing all-cause mortality in infants 1-6 months of age [RR 1.05; 95 % CI 0.88-1.26]. Pooled results for preventive vitamin A supplementation showed that it reduced all-cause mortality by 25% [RR 0.75; 95 % CI 0.64-0.88] in children 6-59 months of age. Vitamin A supplementation also reduced diarrhea specific mortality by 30% [RR 0.70; 95 % CI 0.58-0.86] in children 6-59 months. This effect has been recommended for inclusion in the Lives Saved Tool. Vitamin A supplementation had no effect on measles [RR 0.71, 95% CI: 0.43-1.16], meningitis [RR 0.73, 95% CI: 0.22-2.48] and pneumonia [RR 0.94, 95% CI: 0.67-1.30] specific mortality.

Conclusion: Preventive vitamin A supplementation reduces all-cause and diarrhea specific mortality in children 6-59 months of age in community settings in developing countries.

Figure 1

Synthesis of study identification in review of the effects of vitamin A supplementation on infant and childhood mortality

Figure 2

Forest plot for preventive effect of vitamin A supplemenation on all-cause mortality at six months of age with subgroup analysis according to geographical region: supplementation in neonatal period

Figure 3

Forest plot for preventive effect of vitamin A supplemenation on all-cause mortality with subgroup analysis for geographical region: supplementation in children 1-6 months of age

Figure 4

Forest plot for preventive effect of vitamin A supplemenation on all-cause mortality with subgroup analysis for geographical region: supplementation in children 6-59 months of age

Figure 5

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality of diarrhea: Supplementation in children 6-59 months of age

Figure 6

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality of diarrhea: Supplementation in neonatal period

Figure 7

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality of pneumonia: Supplementation in children 6-59 months of age

Figure 8

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality pneumonia: Supplementation in neonatal period

Figure 9

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality of measles: Supplementation in children 6-59 months of age

Figure 10

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality of Meningitis: Supplementation in neonatal period

Figure 11

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality of Meningitis: Supplementation in children 6-59 months of age

Figure 12

Forest plot for preventive effect of vitamin A supplementation on cause specific mortality of Sepsis: Supplementation in neonatal period

Figure 13

Distribution of Biochemical vitamin A deficiency (retinol) as a public health problem by country 1995-200 in Preschool-age children: (Taken from; Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO Global Database on Vitamin A Deficiency? Geneva, World Health Organization, 2009)