Efficacy of a High-Dose in Addition to Daily Low-Dose Vitamin A in Children Suffering from Severe Acute Malnutrition with Other Illnesses

Samima Sattar,Tahmeed Ahmed,Debasish Saha,Mohammed Abdus Salam,Choudhury Habibur Rasul,Md Iqbal Hossain,Zulfiqar A Bhutta

doi:10.1371/journal.pone.0033112

Samima Sattar, Tahmeed Ahmed + Show 5 more

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https://doi.org/10.1371/journal.pone.0033112

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Abstract

BackgroundEfficacy 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).MethodsIn 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.ResultsA 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.ConclusionsEfficacy 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.Trial RegistrationClinicalTrials.gov NCT00388921

Highlights

Diarrheal diseases, acute lower respiratory tract infection (ALRI), malnutrition, and vitamin A (VA) deficiency are common health problems in developing countries including Bangladesh
The World Health Organization (WHO) recommends giving high-doses of VA (200,000 IU for children more than one year old and half the dose to those aged 6–12 months) to children who suffer from severe protein-energy malnutrition (PEM) [2,3], measles, prolonged diarrhea, and to VA deficient populations [4,5]
Over the first 48 hours percent of children who had resolution of watery diarrhea, invasive diarrhea and ALRI, and over total 15 days treatment period time taken for cure/resolution of admission morbidities were similar between the groups (Table 2), as well as between the edematous and nonedematous children, whose baseline serum retinol and other biochemical characteristics were similar

Summary

Introduction

Acute lower respiratory tract infection (ALRI), malnutrition, and vitamin A (VA) deficiency are common health problems in developing countries including Bangladesh. Some studies [6,7,8,9,10,11] that have examined the effect of high-dose VA supplementation on diarrhea and respiratory infections in children showed no beneficial effect, and in few studies, high-dose VA was associated with adverse effects, in children with respiratory infection [9,10,12,13,14,15]. 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)

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