title: Efficacy of a high-dose in addition to daily low-dose vitamin A in children suffering from severe acute malnutrition with other illnesses.
abstract: BACKGROUND
  Efficacy of high-dose vitamin A (VA) in children suffering from severe acute malnutrition (SAM) has recently been questioned. This study compared the efficacy of a single high-dose (200,000 IU) in addition to daily low-dose (5000 IU) VA in the management of children suffering from SAM with diarrhea and/or acute lower respiratory tract infection (ALRI).
  
  
  METHODS
  In a randomized, double-blind, controlled clinical trial in icddr,b, Bangladesh during 2005-07, children aged 6-59 months with weight-for-height <-3 Z-score and/or bipedal edema (SAM) received either a high-dose VA or placebo on admission day. Both the groups received 5,000 IU/day VA in a multivitamins drop for 15 days and other standard treatment which is similar to WHO guidelines.
  
  
  RESULTS
  A total 260 children (130 in each group) were enrolled. All had diarrhea, 54% had concomitant ALRI, 50% had edema, 48.5% were girl with a mean±SD age of 16±10 months. None had clinical signs of VA deficiency. Mean±SD baseline serum retinol was 13.15±9.28 µg/dl, retinol binding protein was 1.27±0.95 mg/dl, and pre-albumin was 7.97±3.96 mg/dl. Median (inter quartile range) of C-reactive protein was 7.8 (2.1, 22.2) mg/L. Children of the two groups did not differ in any baseline characteristic. Over the 15 days treatment period resolution of diarrhea, ALRI, edema, anthropometric changes, and biochemical indicators of VA were similar between the groups. The high-dose VA supplementation in children with SAM did not show any adverse event.
  
  
  CONCLUSIONS
  Efficacy of daily low-dose VA compared to an additional single high-dose was not observed to be better in the management of children suffering from SAM with other acute illnesses. A single high-dose VA may be given especially where the children with SAM may leave the hospital/treatment center early.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00388921.
authors.affiliation: Clinical Sciences Division and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Samima
authors.initials: S
authors.lastname: Sattar
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.forename: Choudhury Habibur
authors.initials: CH
authors.lastname: Rasul
authors.forename: Debasish
authors.initials: D
authors.lastname: Saha
authors.forename: Mohammed Abdus
authors.initials: MA
authors.lastname: Salam
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Hossain
mesh_terms: D000208:Acute Disease; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D003967:Diarrhea / Q000188:drug therapy* / Q000453:epidemiology; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000188:drug therapy* / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D014815:Vitamins / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D014801:Vitamin A