Vitamin A Supplementation and Child Morbidity and Mortality in Developing Countries

A meta-analysis of eight mortality trials indicates that improving the vitamin A status of children aged six months to five years reduced mortality rates by about 23% in populations with at least low prevalence of clinical signs of vitamin A deficiency. The observed effect of supplementation, described in terms of relative risk (RR), was RR =0.77 (95% confidence interval 0.68–0.88; p < .001) and did not differ by sex or age. However, the number of lives saved was greater at younger ages because of higher mortality. A significant RR was shown for deaths attributed to diarrhoea and measles, but not for respiratory infection. Variability among the trials in effects was apparent, but attempts to explain it by descriptors of the population (baseline anthropometric status, prevalence of xerophthalmia, age profile, baseline mortality) were unsuccessful. Owing to the lack of data, firm conclusions could not be reached about effectiveness in children of less than six months and in settings where biochemical but not clinical evidence of vitamin A deficiency exists. Information about morbidity outcomes from about two dozen studies was reviewed. No consistent effects on frequency or prevalence of diarrhoeal and respiratory infections were found. Improvement in vitamin A status did appear to reduce severe morbidity, particularly in children with measles.