Abstract
Malaria is a leading cause of mortality in Uganda accounting for 25% of deaths among children. Hitherto no adjunct therapy has been identified to improve outcome of cerebral malaria. Retinol suppresses growth of P.falciparum, scavenges free radicals, and exhibits synergistic action with quinine in parasite clearance. To determine the effect of vitamin A supplementation on treatment outcome of cerebral malaria In this randomised double-blind placebo controlled clinical trial we studied 142 children aged 6-59 months admitted with cerebral malaria in Mulago Hospital, Kampala. Children were randomised to either vitamin A or placebo and followed for 7 days. The main outcome measures were coma recovery time, time for convulsions to stop, and parasite and fever clearance. Secondary outcomes were overall mortality and time taken to start oral feeds. There was no difference in the coma recovery time (p=0.44), resolution of convulsions (p=0.37), fever clearance (p=0.92), parasite clearance (p=0.12), and starting oral feeds between the two treatment groups. Mortality was higher (16.2%) in the placebo than in the vitamin A group (8.1%): RR 1.4; 95% CI 1.0-2.1. Vitamin A as adjunct therapy did not significantly reduce coma duration but there were fewer deaths in the vitamin A arm.
Highlights
Malaria is responsible for up to 2.7 million deaths every year and remains the major cause of morbidity and mortality worldwide.[1, 2] Malaria is the leading cause of morbidity and mortality in Uganda and is endemic in 95% of the country, with the exception of mountainous areas in the southwest, west, and eastern parts
We report results of a randomized controlled trial of vitamin A as adjunct therapy for childhood cerebral malaria in Uganda
Four hundred and thirty six children with cerebral malaria were seen in the Acute Care Unit (ACU) of Mulago hospital
Summary
Malaria is responsible for up to 2.7 million deaths every year and remains the major cause of morbidity and mortality worldwide.[1, 2] Malaria is the leading cause of morbidity and mortality in Uganda and is endemic in 95% of the country, with the exception of mountainous areas in the southwest, west, and eastern parts. Malaria accounts for 30-50% of all the outpatient visits at health facilities, 30% of hospital admissions as well as 25-30% of deaths among children less than five years of age in highly endemic areas.[3]. Malaria is a leading cause of mortality in Uganda accounting for 25% of deaths among children. Hitherto no adjunct therapy has been identified to improve outcome of cerebral malaria. Objective: To determine the effect of vitamin A supplementation on treatment outcome of cerebral malaria Methods: In this randomised double-blind placebo controlled clinical trial we studied 142 children aged 6-59 months admitted with cerebral malaria in Mulago Hospital, Kampala. Results: There was no difference in the coma recovery time (p=0.44), resolution of convulsions (p=0.37), fever clearance (p=0.92), parasite clearance (p=0.12), and starting oral feeds between the two treatment groups.
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