Vitamin A status, other risk factors and acute respiratory infection morbidity in children.
OBJECTIVE
This study evaluated the association between vitamin A status and the severity of acute respiratory infections (ARIs) in children, controlling for the influence of other known ARI risk factors.


METHODS
Case control study.


METHODS
Ambulatory and hospital-based study.


METHODS
Severe cases (N = 35) were children with ARI who were admitted to hospital for inpatient treatment, while mild cases (N = 32) were children with ARI who were treated as outpatients. The control group (N = 54) was selected from children with non-infectious diseases attending the outpatient department. Cases and controls were matched for age and area of residence.


METHODS
Serum vitamin A levels and analysis of ARI risk factors.


RESULTS
The mean (SD) vitamin A levels were 22.09 (7.27) micrograms/dl for the controls, 20.27 (11.11) micrograms/dl for the mild cases and 13.79 (7.60) micrograms/dl for the severe cases. All pairwise comparisons of levels of the three patient groups achieved statistical significance-severe and mild (P < 0.01), severe and control (P < 0.001) and mild and control (P = 0.03). After vitamin A levels were dichotomised, the odds ratios (and 95% confidence intervals) for severe versus mild cases were 2.1 (0.8-5.6), for mild versus controls 2.9 (0.8-10.5) and for severe versus controls 6.0 (2.0-19.4). A chi 2 for trend across the three groups was 13.2 (P = 0.001). Risk factors significantly associated with disease status included a history of hospital admission in the preceding 6 months, absence of a clinic card, poor housing and lack of electricity for indoor fuel use. Factors associated with poor vitamin A status included low weight for age, previous diarrhoeal disease and poor housing. Vitamin A status was independently associated with disease status in logistic regression modelling.


CONCLUSIONS
Vitamin A status has a strong association with severity of infection. The gradient of that association suggests a dose-response effect. The multifactorial nature of ARI severity and vitamin A status highlights the need for a comprehensive approach to public health programmes to address ARI. The role of vitamin A supplementation for at-risk groups is supported by this study, but needs to be clearly defined within a broader approach to health.
Dudley
L
L
Department of Community Health, University of Cape Town.
Hussey
G
G
Huskissen
J
J
Kessow
G
G
D000208:Acute Disease; D017677:Age Distribution; D000886:Anthropometry; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009752:Nutritional Status; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014801:Vitamin A / Q000627:therapeutic use; D014802:Vitamin A Deficiency / Q000097:blood / Q000150:complications* / Q000517:prevention & control
D014801:Vitamin A