Randomised trial of vitamin A supplementation in pregnant women in rural Malawi found to be anaemic on screening by HemoCue.
OBJECTIVE
To assess the effects of vitamin A supplementation in women with anaemia during pregnancy.


METHODS
Single-centre randomised controlled trial.


METHODS
Rural community in southern Malawi, central Africa.


METHODS
Seven hundred women with singleton pregnancies at 12-24 weeks measured by ultrasound scan and with haemoglobin <11.0 g/dl by HemoCue screening method. Analysis was by intention to treat. All received iron and folate, and sulphadoxine/pyrimethamine for antimalarial prophylaxis.


METHODS
Women were randomised to receive oral supplementation with daily 5000 or 10,000 iu vitamin A, or placebo.


METHODS
Anaemia, as assessed by Coulter counter, severe anaemia, iron status and indices of infection.


RESULTS
Vitamin A deficiency was, in this rural population, less common than predicted. Vitamin A supplementation had no significant impact on anaemia, severe anaemia, iron status and indices of infection. Vitamin A stores were less likely to be depleted at the end of pregnancy in supplemented groups.


CONCLUSIONS
Vitamin A supplementation programmes to reduce anaemia should not be implemented in similar antenatal populations in rural sub-Saharan Africa unless evidence emerges of positive benefit on substantive clinical outcomes. Introducing public health interventions of unknown benefit and with unclear biological mechanisms can divert scarce resources from clinical and social interventions more likely to impact maternal mortality.
Liverpool School of Tropical Medicine, Liverpool, UK.
N R
NR
van den Broek
S A
SA
White
C
C
Flowers
J D
JD
Cook
E A
EA
Letsky
S A
SA
Tanumihardjo
C
C
Mhango
M
M
Molyneux
J P
JP
Neilson
D000284:Administration, Oral; D000328:Adult; D000740:Anemia / Q000150:complications / Q000188:drug therapy*; D000962:Antimalarials / Q000627:therapeutic use; D019587:Dietary Supplements; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000097:blood; D008288:Malaria / Q000150:complications / Q000188:drug therapy; D008295:Malawi; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy; D012423:Rural Health; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage*; D014802:Vitamin A Deficiency / Q000188:drug therapy*
D000962:Antimalarials; D006454:Hemoglobins; D014801:Vitamin A; D007501:Iron