Letters to the Editor

Abstract

Although a preventive program has been in place in India since 1971 vitamin A deficiency and blinding malnutrition remain major public health problems for children under 6 years of age. Moreover there are indications that subclinical vitamin A deficiency and xerophthalmia are associated with measles acute lower respiratory infections and diarrhea. The impact of vitamin A prophylaxis on child morbidity and mortality was investigated in 2 slum areas outside of Bombay. The experimental group included 2217 children under 5 years of age 433 of whom were under the age of 1 year while the control group was comprised of 2060 children 416 of whom were under 1 year of age. The final sample was comprised of 195 children under age 1 year in the experimental group and 192 under-1s in the control group. A baseline survey was undertaken in 1985; the study period was from January 1985-June 1988 with the intervention consisting of 200000 IU of vitamin A in arachis oil. Throughout the study period in both the experimental and control groups the most common illnesses observed among children were fever respiratory tract infection diarrhea worm infestations in the gastrointestinal tract skin infection otitis media post-measles complications and malnutrition. Beginning in 1986 a significant decline was recorded in the experimental area in the number of children suffering from 4 or more episodes of these illnesses per year. By June 1988 the incidence of each of the above-cited illnesses was lower in the experimental area. Further confirmation of the efficacy of vitamin A administration was the lowering in under-5 mortality from 16.80/1000 in 1985 to 3.64/1000 in 1988 in the experimental group compared to relative stability of this rate (65.50/1000 in 1985 to 47.90/100 in 1988) in the control area.