Impact of massive dose of vitamin A given to preschool children with acute diarrhoea on subsequent respiratory and diarrhoeal morbidity
What this study found
No overall reduction in incidence or mean days of acute lower respiratory tract infection (ALRI) or pneumonia over 90 days (ALRI RR 1.07, 95% CI 0.92–1.26; pneumonia RR 0.96, 95% CI 0.72–1.27). Measles incidence did not differ overall (RR 0.54, 95% CI 0.27–1.08), but was significantly reduced in children ≤23 months (RR 0.06, 95% CI 0.01–0.48). Diarrhoea incidence was similar overall (RR 0.95, 95% CI 0.86–1.05), with a 36% reduction in mean daily prevalence of diarrhoea with fever among children >23 months (prevalence ratio ~0.64; P=0.05). In summary, a single high-dose vitamin A did not…
- Study & population
- Double-blind randomized placebo-controlled field trial in Govindpuri, an urban slum in south Delhi, India.
- Intervention
- Vitamin A 200,000 IU given orally as a single dose at enrolment to children aged 12-60 months with acute diarrhoea.
- Key limitation
- Power focused on diarrhoea outcomes; not powered for pneumonia; 58 withdrawals (final analyzed n=842); single urban setting in India; 90-day follow-up; outcome assessment relied on household surveillance and caregiver reporting; baseline vitamin A status not assessed for all; generalizability may be limited.
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Open PDFOriginal abstract
Abstract Objective: To assess the impact of vitamin A supplementation on morbidity from acute respiratory tract infections and diarrhoea. Design: Double blind randomised placebo controlled field trial. Setting: An urban slum area in New Delhi, India. Subjects—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 200000 IU or placebo. Main outcome measures: 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. Results: 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. Conclusions: 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.