title: Newborn vitamin A dosing reduces the case fatality but not incidence of common childhood morbidities in South India.
abstract: Vitamin A supplementation reduces mortality in young children in areas of endemic vitamin A deficiency. However, it has no impact on the incidence of common morbidities. This discrepancy has been explained by an impact on case fatality, although with the exception of hospitalized measles cases, there is little direct evidence to support this hypothesis. We assessed the impact of newborn dosing with vitamin A on the incidence and case fatality of common childhood morbidities in early infancy in a community-based, randomized trial in South India. Morbidity for each day in the previous 2 wk was assessed for the first 6 mo of life. A total of 11,619 live-born infants were enrolled and randomized to receive either 48,000 IU (50.4 micromol retinol) of oral vitamin A or placebo following delivery. There was no difference between treatment groups in the incidence of acute or chronic diarrhea, dysentery, or fever but a small increased incidence of acute respiratory illness (ARI). Case fatality for diarrhea and fever were significantly reduced in the vitamin A group compared with placebo (relative case fatality [95% CI] of 0.50 [0.27, 0.90] and 0.60 [0.40, 0.88], respectively). There was a trend in reduction of case fatality for various definitions of ARI, but the evidence for this effect was modest. Survival analysis among those with morbid episodes confirmed the case fatality analysis. This trial demonstrated that the reduction in overall mortality due to newborn vitamin A dosing was driven primarily by a reduction in case fatality among infants.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. jtielsch@jhsph.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Rahmathullah
authors.forename: R D
authors.initials: RD
authors.lastname: Thulasiraj
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Christian
authors.initials: C
authors.lastname: Coles
authors.forename: S
authors.initials: S
authors.lastname: Sheeladevi
authors.forename: Rajeesh
authors.initials: R
authors.lastname: John
authors.forename: Karthik
authors.initials: K
authors.lastname: Prakash
mesh_terms: D002423:Cause of Death; D002648:Child; D003967:Diarrhea / Q000453:epidemiology; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D010919:Placebos; D011247:Pregnancy; D011897:Random Allocation; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010919:Placebos; D014801:Vitamin A