British Medical Journal – Vitamin A supplementation is associated with large reductions in mortality, morbidity, and vision problems in a range of settings, and these results cannot be explained by bias. Further placebo controlled trials of vitamin A supplementation in children between 6 and 59 months of age are not required. However, there is a need for further studies comparing different doses and delivery mechanisms (for example, fortification). Until other sources are available, vitamin A supplements should be given to all children at risk of deficiency, particularly in low and middle income countries.
43 trials with about 215 633 children were included.
Seventeen trials including 194 483 participants reported a 24% reduction in all cause mortality (rate ratio=0.76, 95% confidence interval 0.69 to 0.83).
Seven trials reported a 28% reduction in mortality associated with diarrhoea (0.72, 0.57 to 0.91).
Vitamin A supplementation was associated with a reduced incidence of diarrhoea (0.85, 0.82 to 0.87) and measles (0.50, 0.37 to 0.67) and a reduced prevalence of vision problems, including night blindness (0.32, 0.21 to 0.50) and xerophthalmia (0.31, 0.22 to 0.45). Three trials reported an increased risk of vomiting within the first 48 hours of supplementation (2.75, 1.81 to 4.19).
If the risk of death for 190 million vitamin A deficient children were reduced by 24%, over 600,000 lives would be saved each year and 20 million disability-adjusted life years (a measure of quantity and quality of life) would be gained.
Reported – BMJ 2011; 343:d5094 doi: 10.1136/bmj.d5094 (Published 25 August 2011)
Cite this as: BMJ 2011; 343:d5094
Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis
1. Evan Mayo-Wilson, departmental lecturer
2. Aamer Imdad, senior research officer
3. Kurt Herzer, Marshall scholar
4. Mohammad Yawar Yakoob, senior research officer
5. Zulfiqar A Bhutta, Noordin Noormahomed Sheriff endowed professor and founding chair
Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford OX1 2ER, UK
Division of Women and Child Health, Aga Khan University Hospital, Stadium Road, PO Box 3500, 74800 Karachi, Pakistan
Fine tuning the dose and delivery mechanism could further improve outcomes
Worldwide, nearly 8.8 million children die each year before they reach their 5th birthday. More than two thirds die from infectious diseases such as pneumonia, diarrhoea, and malaria. Although these are sobering figures, childhood mortality has been substantially reduced over the past decade partly as a result of the expansion of child survival interventions to prevent and treat major causes of childhood mortality.
Routine preventive treatment of all children 6-59 months of age with high dose vitamin A supplements is a core intervention to improve child survival supported by Unicef, the World Health Organization, governments, and donors in areas of high mortality and endemic vitamin A deficiency. Capsules are now distributed biannually in at least 60 countries, with average annual coverage rates nearing 80%. Initially launched as an initiative to prevent xerophthalmic blindness, universal vitamin A supplementation was expanded as a life saving intervention mainly on the basis of meta-analyses that showed average reductions in mortality and illness.