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