LESSONS FROM THE THIRD WORLD

Abstract

American pediatricians are often unaware of significant developments in international health, especially when they are reported in non-pediatric journals. A case in point is summarized by this abstract of a study from Java: In a controlled trial, fortification of commercially marketed monosodium glutamate (MSG) with vitamin A improved serum vitamin A levels of young children and the vitamin A content of breast milk of lactating women. These improvements in vitamin A indices were accompanied by dramatic changes in health and anthropometric status. During the course of the study, the prevalence of Bitot's spots among children in program villages fell progressively from 1.2% at base line to 0.2% 11 mo after introduction of the fortified product (p<0.001) xerophthalmia rates in control villages remained essentially unchanged. Linear growth was greater among program than among control children at every age. Hemoglobin levels among program children rose by ∼10 g, from 113 ± 16 g/L at base line to 123 ± 16 by 5 mo (p<0.0001); they remained essentially unchanged among children of control villages. Preschool children in control villages died at 1.8 times the rate of children in program villages. Am J Clin Nutr 1988;48:1271-6 These results are similar to those independently obtained in Sumatra, where Vitamin A capsules were given to preschool children at 6 month intervals (A. Sommer, et al: Impact of vitamin A supplementation on childhood mortality. Lancet 1986;1:1169) The data should stimulate inquiries into the mechanisms of the effect of Vitamin A on general health and mortality (in addition to its preventing xerophthalmia) and their relevance for nutritionally marginal children in the United States.