Vitamin A supplementation during war-emergency in Guinea-Bissau 1998-1999.
BACKGROUND
Vitamin A supplementation is recommended by WHO in emergency situations.


OBJECTIVE
To evaluate the impact of Vitamin A supplementation on childhood mortality in an emergency situation.


METHODS
Since this was not a randomised study, we evaluated the impact in different ways; we used the variation in the delay of provision of Vitamin A in a step-wedged design, compared wartime with pre-wartime mortality and examined whether Vitamin A as a free commodity reduced cultural and social-economic inequalities in childhood mortality.


METHODS
5926 children 6 months to 5 years of age, resident in four suburbs in the capital of Guinea-Bissau between October 1, 1998 and March 31, 1999.


METHODS
From October 1, 1998 until the end of the war in 1999 all children present in the study area were offered Vitamin A at regular three-monthly visits to their homes.


RESULTS
Using the variation in the provision of Vitamin A, we found a slight non-significant reduction in mortality for children between 6 months and 5 years of age (mortality ratio (MR) 0.49; 95% CI 0.09-2.70). Comparing with a three-year period before the war, children offered Vitamin A at home during the war had a 12% reduction in mortality (MR 0.88; 0.41-1.87), whereas the overall impact of the war was an 89% increase in mortality (MR 1.89; 1.32-2.71). Vitamin A supplementation was associated with a reduction in cultural and socio-economic inequalities.


CONCLUSIONS
Vitamin A supplementation may have a beneficial impact on childhood mortality in an emergency situation.
Nielsen
Jens
J
Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau, West Africa. nls@ssi.dk
Benn
Christine S
CS
Balé
Carlitos
C
Martins
Cesario
C
Aaby
Peter
P
D000533:Altruism; D046688:Child Mortality; D002675:Child, Preschool; D004630:Emergencies; D006169:Guinea-Bissau; D006801:Humans; D007223:Infant; D044342:Malnutrition / Q000188:drug therapy*; D012923:Social Class; D014801:Vitamin A / Q000627:therapeutic use*; D014857:Warfare
D014801:Vitamin A