0
February 17, 1993, Vol 269, No. 7 >
ARTICLE | February 17, 1993

Vitamin A Supplementation and Child Mortality: Title and subTitle BreakA Meta-analysis FREE

Wafaie W. Fawzi, MD; Thomas C. Chalmers, MD; M. Guillermo Herrera, MD; Frederick Mosteller, PhD
[+] Author Affiliations

Reprint requests to Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston MA 02115 (Dr Fawzi).


JAMA. 1993;269(7):898-903. doi:10.1001/jama.1993.03500070078033
Text Size: A A A
Published online
Article
References

Objective.  —A two-part meta-analysis of studies examining the relationship of vitamin A supplementation and child mortality.

Data Sources.  —We identified studies by searching the MEDLARS database from 1966 through 1992 and by scanning Current Contents and bibliographies of pertinent articles.

Study Selection.  —All 12 vitamin A controlled trials with data on mortality identified in the search were used in the analysis.

Data Extraction.  —Data were independently extracted by two investigators who also assessed the quality of each study using a previously described method.

Data Synthesis.  —We formally tested for heterogeneity across studies. We pooled studies using the Mantel-Haenszel and the DerSimonian and Laird methods and adjusted for the effect of cluster assignment of treatment groups in community-based studies. Vitamin A supplementation to hospitalized measles patients was highly protective against mortality (DerSimonian and Laird odds ratio, 0.39; 95% confidence interval, 0.22 to 0.66; P=.0004) (part 1 of the meta-analysis). Supplementation was also protective against overall mortality in community-based studies (DerSimonian and Laird odds ratio, 0.70; clustering-adjusted 95% confidence interval, 0.56 to 0.87; P=.001) (part 2 of the meta-analysis).

Conclusions.  —Vitamin A supplements are associated with a significant reduction in mortality when given periodically to children at the community level. Factors that affect the bioavailability of large doses of vitamin A need to be studied further. Vitamin A supplements should be given to all measles patients in developing countries whether or not they have symptoms of vitamin A deficiency.(JAMA. 1993;269:898-903)

REFERENCES

1 +
Underwood BA.  Vitamin A prophylaxis programs in developing countries: past experiences and future prospects. Nutr Rev . 1990;;48:265-274.
2 +
Ellison JB.  Intensive vitamin therapy in measles. BMJ . 1932;;2:708-711.
3 +
Sommer A. Nutritional Blindness: Xerophthalmia and Keratomalacia . Oxford, England: Oxford University Press; 1982;.
4 +
Hussey GD, Klein M.  A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med . 1990;;323:160-164.
5 +
Barclay AJ, Foster A, Sommer A.  Vitamin A supplements and mortality related to measles: a randomized clinical trial. BMJ . 1987;;294:294-296.
6 +
Coutsoudis A, Broughton M, Coovadia HM.  Vitamin A supplementation reduces measles morbidity in young African children: a randomized, placebocontrolled, double-blind trial. Am J Clin Nutr . 1991;; 54:890-895.
7 +
West KP, Pokhrel RP, Katz J, et al.  Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet . 1991;;338:67-71.
8 +
Herrera MG, Nestel P, El Amin A, Fawzi WW, Muhammad KA, Weld L.  Vitamin A supplementation and child survival. Lancet . 1992;;340:267-271.
9 +
Rahmathullah L, Underwood BA, Thulasiraj RD, et al.  Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N Engl J Med . 1990;;323:929-935.
10 +
Sommer A, Tarwotjo I, Djunaedi E, et al.  Impact of vitamin A supplementation on childhood mortality: a randomized controlled community trial. Lancet . 1986;;1:1169-1173.
11 +
Vijayaraghavan K, Radhaiah G, Prakasam B, Rameshwar KV, Reddy V.  Effect of a massive dose of vitamin A on morbidity and mortality in Indian children. Lancet . 1990;;336:1342-1345.
12 +
Daulaire NM, Starbuck ES, Houston RM, Church MS, Stukel TA, Pandey MR.  Childhood mortality after a high dose of vitamin A in a high risk population. BMJ . 1992;;304:207-210.
13 +
Muhilal, Permeisih D, Idjradinata YR, Muherdiyantiningsih, Karyadi D.  Vitamin A—fortified monosodium glutamate and health, growth, and survival of children: a controlled field trial. Am J Clin Nutr . 1988;;48:1271-1276.
14 +
Kothari G.  The effect of vitamin A prophylaxis on morbidity and mortality among children in urban slums in Bombay. J Trop Pediatr . 1991;;37:141.
15 +
Chalmers TC, Smith H, Blackburn B, et al.  A method for assessing the quality of a randomized control trial. Controlled Clin Trials . 1981;;2: 31-49.
16 +
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbe KA.  Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol . 1992;;45:255-265.
17 +
Rothman KJ. Modern Epidemiology . Boston, Mass: Little Brown & Co Inc; 1986;.
18 +
DerSimonian R, Laird N.  Meta-analysis in clinical trials. Controlled Clin Trials . 1986;;7:177-188.
19 +
Coutsoudis A, Coovadia H, Broughton M, Salisbury R, Elson I.  Micronutrient utilisation during measles treated with vitamin A or placebo. Int J Vitam Nutr Res . 1991;;61:199-204.
20 +
United Nations Children's Fund. The State of the World's Children, 1991 . Oxford, England: Oxford University Press; 1991;.
21 +
World Health Organization.  Joint WHO/ UNICEF statement on vitamin A for measles. Wkly Epidemiol Rec . 1987;;62:133-134.
22 +
Frieden TR, Sowell AL, Henning KJ, Huff DL, Gunn RA.  Vitamin A levels and severity of measles: New York City. AJDC . 1992;;146:182-186.
23 +
Arrieta A, Zaleska M, Stutman H, Marks M.  Vitamin A levels in children with measles in Long Beach, California. J Pediatr . 1992;;121:75-78.
24 +
Mejia LA.  Vitamin A-nutrient interrelationships.  In: Bauernfeind JC, ed. Vitamin A Deficiency and Its Control . Orlando, Fla: Academic Press Inc; 1986;.
25 +
Sivakumar B, Reddy V.  Absorption of labelled vitamin A in children during infection. Br J Nutr . 1972;;27:297-304.
26 +
Mahalanabis D, Simpson TN, Chakraborty ML, Ganguli C, Bhattacharjee AK, Mukherjee KL.  Malabsorption of water miscible vitamin A in children with giardiasis and ascariasis. Am J Clin Nutr . 1979;;32:313-318.
27 +
Wolbach S, Howe P.  Epithelial repair in recovery from vitamin A deficiency. J Exp Med . 1933;; 57:511-526.
28 +
Nauss KM.  Influence of vitamin A status on the immune system.  In: Bauernfeind JC, ed. Vitamin A Deficiency and Its Control . Orlando, Fla: Academic Press Inc; 1986;.
29 +
Abdeljaber MH, Monto AS, Tilden RL, Schork MA, Tarwotjo I.  The impact of vitamin A supplementation on morbidity: a randomized community intervention trial. Am J Public Health . 1991;;81: 1654-1656.
30 +
Rahmathullah L, Underwood BA, Thulasiraj RD, Milton RC.  Diarrhea, respiratory infections, and growth are not affected by a weekly low-dose vitamin A supplement: a masked, controlled field trial in children in southern India. Am J Clin Nutr . 1991;;54:568-577.
31 +
Arthur P, Kirkwood B, Ross D, et al.  Impact of vitamin A supplementation on childhood morbidity in northern Ghana. Lancet . 1992;;339:361-362.
32 +
Arroyave G, Bauernfeind J, Olson J, Underwood B.  Selection of intervention strategies: IVACG Task Force on Intervention.  In: Guidelines for the Eradication of Vitamin A Deficiency and Xerophthalmia: A Report of the International Vitamin A Consultative Group (IVACG) . New York, NY: The Nutrition Foundation Inc; 1977;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Underwood BA.  Vitamin A prophylaxis programs in developing countries: past experiences and future prospects. Nutr Rev . 1990;;48:265-274.
2 +
Ellison JB.  Intensive vitamin therapy in measles. BMJ . 1932;;2:708-711.
3 +
Sommer A. Nutritional Blindness: Xerophthalmia and Keratomalacia . Oxford, England: Oxford University Press; 1982;.
4 +
Hussey GD, Klein M.  A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med . 1990;;323:160-164.
5 +
Barclay AJ, Foster A, Sommer A.  Vitamin A supplements and mortality related to measles: a randomized clinical trial. BMJ . 1987;;294:294-296.
6 +
Coutsoudis A, Broughton M, Coovadia HM.  Vitamin A supplementation reduces measles morbidity in young African children: a randomized, placebocontrolled, double-blind trial. Am J Clin Nutr . 1991;; 54:890-895.
7 +
West KP, Pokhrel RP, Katz J, et al.  Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet . 1991;;338:67-71.
8 +
Herrera MG, Nestel P, El Amin A, Fawzi WW, Muhammad KA, Weld L.  Vitamin A supplementation and child survival. Lancet . 1992;;340:267-271.
9 +
Rahmathullah L, Underwood BA, Thulasiraj RD, et al.  Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N Engl J Med . 1990;;323:929-935.
10 +
Sommer A, Tarwotjo I, Djunaedi E, et al.  Impact of vitamin A supplementation on childhood mortality: a randomized controlled community trial. Lancet . 1986;;1:1169-1173.
11 +
Vijayaraghavan K, Radhaiah G, Prakasam B, Rameshwar KV, Reddy V.  Effect of a massive dose of vitamin A on morbidity and mortality in Indian children. Lancet . 1990;;336:1342-1345.
12 +
Daulaire NM, Starbuck ES, Houston RM, Church MS, Stukel TA, Pandey MR.  Childhood mortality after a high dose of vitamin A in a high risk population. BMJ . 1992;;304:207-210.
13 +
Muhilal, Permeisih D, Idjradinata YR, Muherdiyantiningsih, Karyadi D.  Vitamin A—fortified monosodium glutamate and health, growth, and survival of children: a controlled field trial. Am J Clin Nutr . 1988;;48:1271-1276.
14 +
Kothari G.  The effect of vitamin A prophylaxis on morbidity and mortality among children in urban slums in Bombay. J Trop Pediatr . 1991;;37:141.
15 +
Chalmers TC, Smith H, Blackburn B, et al.  A method for assessing the quality of a randomized control trial. Controlled Clin Trials . 1981;;2: 31-49.
16 +
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbe KA.  Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol . 1992;;45:255-265.
17 +
Rothman KJ. Modern Epidemiology . Boston, Mass: Little Brown & Co Inc; 1986;.
18 +
DerSimonian R, Laird N.  Meta-analysis in clinical trials. Controlled Clin Trials . 1986;;7:177-188.
19 +
Coutsoudis A, Coovadia H, Broughton M, Salisbury R, Elson I.  Micronutrient utilisation during measles treated with vitamin A or placebo. Int J Vitam Nutr Res . 1991;;61:199-204.
20 +
United Nations Children's Fund. The State of the World's Children, 1991 . Oxford, England: Oxford University Press; 1991;.
21 +
World Health Organization.  Joint WHO/ UNICEF statement on vitamin A for measles. Wkly Epidemiol Rec . 1987;;62:133-134.
22 +
Frieden TR, Sowell AL, Henning KJ, Huff DL, Gunn RA.  Vitamin A levels and severity of measles: New York City. AJDC . 1992;;146:182-186.
23 +
Arrieta A, Zaleska M, Stutman H, Marks M.  Vitamin A levels in children with measles in Long Beach, California. J Pediatr . 1992;;121:75-78.
24 +
Mejia LA.  Vitamin A-nutrient interrelationships.  In: Bauernfeind JC, ed. Vitamin A Deficiency and Its Control . Orlando, Fla: Academic Press Inc; 1986;.
25 +
Sivakumar B, Reddy V.  Absorption of labelled vitamin A in children during infection. Br J Nutr . 1972;;27:297-304.
26 +
Mahalanabis D, Simpson TN, Chakraborty ML, Ganguli C, Bhattacharjee AK, Mukherjee KL.  Malabsorption of water miscible vitamin A in children with giardiasis and ascariasis. Am J Clin Nutr . 1979;;32:313-318.
27 +
Wolbach S, Howe P.  Epithelial repair in recovery from vitamin A deficiency. J Exp Med . 1933;; 57:511-526.
28 +
Nauss KM.  Influence of vitamin A status on the immune system.  In: Bauernfeind JC, ed. Vitamin A Deficiency and Its Control . Orlando, Fla: Academic Press Inc; 1986;.
29 +
Abdeljaber MH, Monto AS, Tilden RL, Schork MA, Tarwotjo I.  The impact of vitamin A supplementation on morbidity: a randomized community intervention trial. Am J Public Health . 1991;;81: 1654-1656.
30 +
Rahmathullah L, Underwood BA, Thulasiraj RD, Milton RC.  Diarrhea, respiratory infections, and growth are not affected by a weekly low-dose vitamin A supplement: a masked, controlled field trial in children in southern India. Am J Clin Nutr . 1991;;54:568-577.
31 +
Arthur P, Kirkwood B, Ross D, et al.  Impact of vitamin A supplementation on childhood morbidity in northern Ghana. Lancet . 1992;;339:361-362.
32 +
Arroyave G, Bauernfeind J, Olson J, Underwood B.  Selection of intervention strategies: IVACG Task Force on Intervention.  In: Guidelines for the Eradication of Vitamin A Deficiency and Xerophthalmia: A Report of the International Vitamin A Consultative Group (IVACG) . New York, NY: The Nutrition Foundation Inc; 1977;.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems