title: Mortality and morbidity among postpartum HIV-positive and HIV-negative women in Zimbabwe: risk factors, causes, and impact of single-dose postpartum vitamin A supplementation.
abstract: BACKGROUND
  Vitamin A deficiency is common among women in resource-poor countries and is associated with greater mortality during HIV.
  
  
  METHODS
  Fourteen thousand one hundred ten mothers were tested for HIV and randomly administered 400,000 IU vitamin A or placebo at less than 96 hours postpartum. The effects of vitamin A and HIV status on mortality, health care utilization, and serum retinol were evaluated.
  
  
  RESULTS
  Four thousand four hundred ninety-five (31.9%) mothers tested HIV positive. Mortality at 24 months was 2.3 per 1000 person-years and 38.3 per 1000 person-years in HIV-negative and HIV-positive women, respectively. Vitamin A had no effect on mortality. Tuberculosis was the most common cause of death, and nearly all tuberculosis-associated deaths were among HIV-positive women. Among HIV-positive women, vitamin A had no effect on rates of hospitalization or overall sick clinic visits, but did reduce clinic visits for malaria, cracked and bleeding nipples, pelvic inflammatory disease, and vaginal infection. Among HIV-negative women, serum retinol was responsive to vitamin A, but low serum retinol was rare. Among HIV-positive women, serum retinol was largely unresponsive to vitamin A, and regardless of treatment group, the entire serum retinol distribution was shifted 25% less than that of HIV-negative women 6 weeks after dosing.
  
  
  CONCLUSIONS
  Single-dose postpartum vitamin A supplementation had no effect on maternal mortality, perhaps because vitamin A status was adequate in HIV-negative women and apparently unresponsive to supplementation in HIV-positive women.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.
authors.forename: Partson
authors.initials: P
authors.lastname: Zvandasara
authors.forename: John W
authors.initials: JW
authors.lastname: Hargrove
authors.forename: Robert
authors.initials: R
authors.lastname: Ntozini
authors.forename: Henry
authors.initials: H
authors.lastname: Chidawanyika
authors.forename: Kuda
authors.initials: K
authors.lastname: Mutasa
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Iliff
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Faith
authors.initials: F
authors.lastname: Mzengeza
authors.forename: Lucie C
authors.initials: LC
authors.lastname: Malaba
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Ward
authors.forename: Kusum J
authors.initials: KJ
authors.lastname: Nathoo
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Zijenah
authors.forename: Michael
authors.initials: M
authors.lastname: Mbizvo
authors.forename: Clare
authors.initials: C
authors.lastname: Zunguza
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
mesh_terms: D000328:Adult; D002423:Cause of Death; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D009017:Morbidity; D011247:Pregnancy; D011644:Puerperal Disorders / Q000821:virology*; D012307:Risk Factors; D015996:Survival Rate; D014376:Tuberculosis / Q000150:complications / Q000401:mortality; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D014801:Vitamin A