Efficacy of vitamin A in reducing preschool child mortality in Nepal.
Community trials of the efficacy of vitamin A supplementation in reducing preschool childhood mortality have produced conflicting results. To resolve the question, a randomised, double-masked, placebo-controlled community trial of 28,630 children aged 6-72 months was carried out in rural Nepal, an area representative of the Gangetic flood plain of South Asia. Randomisation was carried out by administrative ward; the vitamin-A-supplemented children received 60,000 retinol equivalents every 4 months and placebo-treated children received identical capsules containing 300 retinol equivalents. After 12 months, the relative risk of death in the vitamin-A-supplemented compared with the control group was 0.70 (95% confidence interval 0.56-0.88), equivalent to a 30% reduction in mortality. The trial, which had been planned to last 2 years, was discontinued. The reduction in mortality was present in both sexes (relative risk for boys 0.77; for girls 0.65), at all ages (range of relative risks 0.83-0.50), and throughout the year (0.76-0.67). The reduction in mortality risk was not affected by acute nutritional status, as measured by arm circumference. Thus, periodic vitamin A delivery in the community can greatly reduce child mortality in developing countries.
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland 21205.
K P
KP
West
R P
RP
Pokhrel
J
J
Katz
S C
SC
LeClerq
S K
SK
Khatry
S R
SR
Shrestha
E K
EK
Pradhan
J M
JM
Tielsch
M R
MR
Pandey
A
A
Sommer
D000328:Adult; D002214:Capsules; D002423:Cause of Death; D002675:Child, Preschool; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009390:Nepal; D009752:Nutritional Status / Q000187:drug effects; D012307:Risk Factors; D012423:Rural Health; D016019:Survival Analysis; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D014802:Vitamin A Deficiency / Q000401:mortality / Q000517:prevention & control*
D002214:Capsules; D014801:Vitamin A