The impact of vitamin A supplementation on mortality inequalities among children in Nepal.
OBJECTIVE
This paper examines gender, caste and economic differentials in child mortality in the context of a cluster-randomized trial of vitamin A distribution, in order to determine whether or not the intervention narrowed these differentials.


METHODS
The study involved secondary analysis of data from a placebo-controlled randomized field trial of vitamin A supplements. The study took place between 1989-1991 in rural Sarlahi District of Nepal, with 30,059 children age 6 to 60 months. The main outcome measures were differences in mortality between boys and girls, between highest Hindu castes and others, and between the poorest quintile and the four other quintiles.


RESULTS
Without vitamin A, girls in rural Nepal experience 26.1 deaths per 1000, which is 8.3 deaths more than the comparison population of boys. With vitamin A the mortality disadvantage of girls is nearly completely attenuated, at only 1.41 additional deaths per 1000 relative to boys. Vitamin A supplementation also narrowed mortality differentials among Hindu castes, but did not lower the concentration of mortality across quintiles of asset ownership. The vitamin A-related attenuation in mortality disadvantage from gender and caste is statistically significant.


CONCLUSIONS
We conclude that universal supplementation with vitamin A narrowed differentials in child death across gender and caste in rural Nepal. Assuring high-coverage vitamin A distribution throughout Nepal could help reduce inequalities in child survival in this population.
Bishai
David
D
Department of Population and Family Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA. Email: dbishai@jhu.edu
Kumar K C
Samir
S
Waters
Hugh
H
Koenig
Michael
M
Katz
Joanne
J
Khatry
Subarna K
SK
West
Keith P
KP
D001294:Attitude to Health / Q000208:ethnology*; D001766:Blindness / Q000517:prevention & control; D002662:Child Health Services / Q000706:statistics & numerical data*; D046688:Child Mortality; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D018672:Community Health Planning; D019587:Dietary Supplements / Q000600:supply & distribution*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009390:Nepal / Q000453:epidemiology; D010919:Placebos; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage* / Q000600:supply & distribution*
D010919:Placebos; D014801:Vitamin A