Mortality In Preschool Children Research Articles

MANIFESTATIONS AND COMPLICATIONS OF ROTAVIRUS-POSITIVE GASTROENTERITIS AND ROTAVIRUS-NEGATIVE GASTROENTERITIS IN PRESCHOOL CHILDREN

Background. The cumulative annual statistics of rotavirus-associated gastroenteritis are about 25 million outpatient visits, 2 million hospitalizations, and 180,000–450,000 deaths in children under 5 years of age.
 Aim: To analyze the manifestations and complications of rotavirus compared with non-rotavirus gastroenteritis in UK children.
 Materials and methods. A retrospective hospital-based case-control study was conducted at three sites in East London, Great Britain. Cases were children aged 1 month to 16 years who were diagnosed with acute gastroenteritis between June 1, 2011, and December 31, 2013, and who were positive for rotavirus by PCR (polymerase chain reaction) on stool virology. They were compared by age, gender and month of referral to a control group with rotavirus-negative gastroenteritis.
 Results. Data were collected from 116 children (50 cases and 66 controls). Children with rotavirus gastroenteritis were more likely to have metabolic acidosis (pH 7.30 vs. 7.37) and fever (74% vs. 46%) and were more likely to require hospitalization compared with children with non-rotavirus gastroenteritis. (93% vs. 73%). Neurological complications were the most common extraintestinal manifestations, but did not differ significantly between children with rotavirus-positive gastroenteritis (RPG) and rotavirus-negative gastroenteritis (RNG) (24% vs. 15%, respectively). Encephalopathy occurred only in children with rotavirus infection.
 Conclusion. Therefore, rotavirus is an important cause of morbidity and mortality in preschool children. Seizures and milder neurologic signs were common and associated with multiple pathogens, but encephalopathy occurred only in children with rotavirus-positive gastroenteritis (RPG). Timely vaccination against rotavirus can prevent serious consequences.

Modelling the potential cost-effectiveness of food-based programs to reduce malnutrition

Poor quality diets contribute to malnutrition globally, but evidence is weak on the cost-effectiveness of food-based interventions that shift diets. This study assessed 11 candidate interventions developed through Delphi techniques to improve diets in India, Nigeria, and Ethiopia. A Markov simulation model incorporated time, individual-level, nutrition, and policy parameters to estimate health impacts and cost-effectiveness for reducing stunting, anaemia, diarrhea, and mortality in preschool children. At an assumed 80% coverage, interventions considered would potentially save between 0·16 and 3·20 years of life per child. The average cost-effectiveness ratio ranged from US$9 to US$2000 per life year saved. This approach, linking expert knowledge, known costs, and modelling, offers potential for estimating cost-effective investments for better informed policy choice where empirical evidence is limited.

Impact of Biannual Azithromycin on Anemia in Preschool Children in Kilosa District, Tanzania: A Cluster-Randomized Clinical Trial.

.A cluster-randomized clinical trial showed that biannual single-dose azithromycin reduced mortality in preschool children; we sought to determine the effect on anemia. A simple random sample of 30 communities from Kilosa district, Tanzania, were themselves randomized to receive either 6-monthly treatment of children aged 1–59 months with single-dose azithromycin or placebo. From each community, 40 preschool children were randomly selected at baseline, 12 months, and 24 months. At surveys, the children underwent hemoglobin testing; WHO definitions for anemia were applied. After adjusting for community clustering, the prevalence of anemia was not significantly different by treatment assignment at baseline, 12 months, and 24 months. In each of the cross-sectional surveys, anemia prevalence was associated with younger age; the odds of being anemic was highest in those aged < 12 months. There was also a general decrease in the prevalence of anemia during the study. Although azithromycin was not shown to affect anemia, significantly, the study highlights burden of anemia in rural, African communities.

Mass Administration of Azithromycin to Prevent Pre-school Childhood Mortality: Boon or Bane?

A group of American researchers funded by the Bill and Melinda Gates Foundation examined the effect of mass administration of azithromycin, on mortality in pre-school children. This was done through a community-based randomized controlled trial (RCT) designated MORDOR-I, conducted in Malawi, Niger, and Tanzania [1]. MORDOR is an acronym for the French title of the study. Community clusters of children (1 month to 5-year-old) were randomized to receive either azithromycin (single dose 20 mg/kg, administered twice a year for 2 years) or identical placebo (in the same dosage schedule). The overall mortality rate (expressed as deaths per 1000 person years) was 13.5% lower in the treatment arm, with 95% confidence interval 6.7% to 19.8% (hence statistically significant). However, detailed analysis showed that only communities in Niger had statistically significant mortality reduction to the extent of 18% (95% CI 10%, 25.5%), whereas those in Malawi and Tanzania did not. Thus, the overall mortality reduction was largely due to the reduction in Niger. This significant intercountry difference was partly attributed to higher baseline mortality in Niger, and stronger effect of mass azithromycin administration in such settings [2]. The investigators then evaluated the administration of two doses of azithromycin (6 months apart) in children from both groups of communities in Niger only. Thus, communities in the original Azithromycin group (in MORDOR-I) received a total of 6 doses, whereas those in the original placebo group received 2 doses. This part of the study has been designated MORDOR-II [3], and is examined in detail here. Communities in Malawi and Tanzania that did not show mortality decline were not evaluated any further. The primary outcome in MORDOR-II [3] was the same as in MORDOR-I viz. all-cause mortality at the community level. Secondary outcomes included intra-group comparison of mortality. Although safety data were mentioned in the manuscript [3], the data were not presented. The results showed a comparable mortality rate (expressed as deaths per 1000 person-years) among children who received 6 doses of azithromycin over three years versus those who received 2 doses over 1 year. In contrast, the mortality after administration of 2 doses and 4 doses of azithromycin (versus similar doses of placebo) was 16.0% and 20.3% lower respectively, in the azithromycin group. Intra-group comparison showed that mortality in the original placebo group was 26.3 at the end of year 1 of MORDOR-I, 28.0 at the end of year 2 of MORDOR-I, and 24.0 at the end of MORDOR-II. This translated to an overall (statistically significant) 13.5% reduction in mortality between pre-MORDOR-I and post-MORDOR-II. In contrast, the intra-group comparison in the azithromycin group showed a 3.6% higher mortality after MORDOR-II, compared to before MORDOR-I (although the difference was not statistically significant). The authors reiterated their original conclusion that mass administration of azithromycin reduced mortality among pre-school children in Niger [1,3], and additional administration of two doses did not appear to wane this effect. However, there was no additional benefit on mortality with the third year of mass azithromycin administration.

Biannual mass azithromycin distributions and malaria parasitemia in pre-school children in Niger: A cluster-randomized, placebo-controlled trial.

BackgroundMass azithromycin distributions have been shown to reduce mortality in preschool children, although the factors mediating this mortality reduction are not clear. This study was performed to determine whether mass distribution of azithromycin, which has modest antimalarial activity, reduces the community burden of malaria.Methods and findingsIn a cluster-randomized trial conducted from 23 November 2014 until 31 July 2017, 30 rural communities in Niger were randomized to 2 years of biannual mass distributions of either azithromycin (20 mg/kg oral suspension) or placebo to children aged 1 to 59 months. Participants, field staff, and investigators were masked to treatment allocation. The primary malaria outcome was the community prevalence of parasitemia on thick blood smear, assessed in a random sample of children from each community at study visits 12 and 24 months after randomization. Analyses were performed in an intention-to-treat fashion. At the baseline visit, a total of 1,695 children were enumerated in the 15 azithromycin communities, and 3,029 children were enumerated in the 15 placebo communities. No communities were lost to follow-up. The mean prevalence of malaria parasitemia at baseline was 8.9% (95% CI 5.1%–15.7%; 52 of 552 children across all communities) in the azithromycin-treated group and 6.7% (95% CI 4.0%–12.6%; 36 of 542 children across all communities) in the placebo-treated group. In the prespecified primary analysis, parasitemia was lower in the azithromycin-treated group at month 12 (mean prevalence 8.8%, 95% CI 5.1%–14.3%; 51 of 551 children across all communities) and month 24 (mean 3.5%, 95% CI 1.9%–5.5%; 21 of 567 children across all communities) than it was in the placebo-treated group at month 12 (mean 15.3%, 95% CI 10.8%–20.6%; 81 of 548 children across all communities) and month 24 (mean 4.8%, 95% CI 3.3%–6.4%; 28 of 592 children across all communities) (P = 0.02). Communities treated with azithromycin had approximately half the odds of parasitemia compared to those treated with placebo (odds ratio [OR] 0.54, 95% CI 0.30 to 0.97). Parasite density was lower in the azithromycin group than the placebo group at 12 and 24 months (square root–transformed outcome; density estimates were 7,540 parasites/μl lower [95% CI −350 to −12,550 parasites/μl; P = 0.02] at a mean parasite density of 17,000, as was observed in the placebo arm). No significant difference in hemoglobin was observed between the 2 treatment groups at 12 and 24 months (mean 0.34 g/dL higher in the azithromycin arm, 95% CI −0.06 to 0.75 g/dL; P = 0.10). No serious adverse events were reported in either group, and among children aged 1 to 5 months, the most commonly reported nonserious adverse events (i.e., diarrhea, vomiting, and rash) were less common in the azithromycin-treated communities. Limitations of the trial include the timing of the treatments and monitoring visits, both of which took place before the peak malaria season, as well as the uncertain generalizability to areas with different malaria transmission dynamics.ConclusionsMass azithromycin distributions were associated with a reduced prevalence of malaria parasitemia in this trial, suggesting one possible mechanism for the mortality benefit observed with this intervention.Trial registrationThe trial was registered on ClinicalTrials.gov (NCT02048007).

Efficacy of Mass Azithromycin Distribution for Reducing Childhood Mortality Across Geographic Regions.

.Mass azithromycin distribution has been shown to reduce all-cause mortality in preschool children in sub-Saharan Africa. However, substantial heterogeneity in the apparent effect has been noted across geographic settings, suggesting a greater relative benefit in higher mortality settings. Here, we evaluated the relationship between the underlying mortality rate and the efficacy of azithromycin for the prevention of child mortality using data from multiple sites in Ethiopia, Malawi, Niger, and Tanzania. Between regions, we find no strong evidence of effect modification of the efficacy of azithromycin distribution for the prevention of child mortality by the underlying mortality rate (P = 0.12), although a modest effect is consistent with our findings. Higher mortality settings could be prioritized, however, because of the larger number of deaths which could be averted with azithromycin distribution.

Hyperglycemia and Red Cell Distribution Width for Prediction of Mortality in Preschool Children with Community Acquired Pneumonia (CAP)

Background Community acquired pneumonia (CAP) is a major infectious cause of mortality in preschool children especially in developing countries. Red Cell Distribution Width (RDW) has been associated with poor outcomes of CAP. We aimed to determine whether admission stress hyperglycemia and RDW can predict mortality in preschool children with CAP for early identification of patients at risk of mortality. Materials and Methods This is a prospective cohort analysis of a single-center study conducted in the pediatric department and Pediatric Intensive Care Unit (PICU) of Minia Children’s University hospital, El-Minia, Egypt during the period from September 2016 to February 2017. The patients were 1-59 months old children, with community acquired pneumonia. Measurement of admission serum glucose and RDW in addition to complete blood picture was done to all participating children. Assessment of the severity of CAP was done using Pediatric Respiratory Severity Score. Results: The male gender consumes a high percentage in the Non survivors group (72.7%). The hyperglycemias patients had a statistically significant risk of developing septic shock and respiratory failure than the other groups (23.8%, p 17.4, sensitivity 90.9% and specificity 92.1%, followed by admission serum glucose at cutoff point >110 mg/dl, sensitivity 90.9%, and specificity 78.95 %. Conclusion According to the results, elevated RDW and admission hyperglycemia are reliable predictors of mortality in preschool children with community acquired pneumonia.

Iron Requirements for Infants with Cow Milk Protein Allergy

H istorically, cow milk has been used as a major source of protein and balanced nutrition for infants and children in resource-rich and resource-constrained countries. It is a rich source of energy, protein, and calcium. It is also an important source of fat; many of its fatty acids are readily metabolized to essential omega-3 fatty acids. Regular consumption of milk during childhood has been shown to enhance bone density later in life. However, reliance upon whole pasteurized cow milk as the sole or major source of nutrition for infants during the first year of life can increase the risk for iron deficiency and, in extreme cases, iron-deficient anemia (IDA) for a number of reasons. In 1972, Woodruff et al showed that 7 of 12 infants (ages 7-17 months) with IDA who ingested between 720 and 1920 mL whole milk daily had higher albumin turnover rates than a group of 5 normal infants. Parenteral iron had no effect on albumin turnover, but replacing whole milk with reconstituted evaporated milk or soy formula decreased the high albumin turnover rates to normal levels, suggesting that large amounts of cow milk protein could result in iron and protein loss in the gastrointestinal tract. Cow milk contains low levels of ascorbic acid, a factor that increases iron absorption, and certain proteins that negatively impact iron absorption. Cow milk contains about 4 times more calcium than human milk, and calcium negatively impacts iron absorption. Furthermore, cow milk has a higher protein concentration than human milk, and ingestion of large amounts can lead to metabolic and fluid imbalances, particularly in children with febrile illnesses. Thus, several entities have recommended against whole cow milk ingestion until 9-12 months and then, only when given in moderate amounts in conjunction with appropriate complementary foods.

Socio-Demographic and Behavioral Factors Related to Unintentional Injuries in Preschool Children Diagnosed to Have Attention-Deficit/Hyperactivity Disorder

Objective: Unintentional injuries are a significant cause of morbidity and mortality in preschool children. The purpose of this study was to investigate the factors related to unintentional injuries in preschool children diagnosed to have attention-deficit/hyperactivity disorder (ADHD). Method: This study included 237 preschool children diagnosed to have ADHD, aged 4–5 years, recruited from a child psychiatry outpatient clinic. Diagnoses of ADHD in the children were made by child psychiatrists, according to DSM-IV criteria. A form developed by the researchers was completed by receiving information from parents regarding unintentional injury histories of the children, their socio-demographic information, and a family history of psychiatric disorders, developmental problems, and the presence of chronic health conditions. Behavioral problems of the children were assessed using the Child Behavior Checklist/4-18 (CBCL). Results: Of the preschool children diagnosed to have ADHD examined in this study, 19.8% (n=47) had unintentional injuries; 17% (n=8) of the children who experienced unintentional injuries had multiple unintentional injuries; 68.1% of accidents occurred at home and 32.9% occurred outside of the home. The regression analysis conducted in this research revealed that male gender, higher CBCL externalizing scores, and separation of parents were associated with unintentional injuries in preschool children diagnosed to have ADHD. Conclusions: The results of this study indicate that prevention activities for unintentional injuries in children with ADHD should be initiated in the preschool period. Early implementation of protective measures regarding accidents may provide benefits for preschool children diagnosed to have ADHD that extend into adolescence and adulthood.

Effects of Zinc Supplementation on the Incidence of Mortality in Preschool Children: A Meta-Analysis of Randomized Controlled Trials

BackgroundPrevious trials have shown that zinc supplementation can decrease the risk of diarrhea, pneumonia, and malaria in children; however, the effects of zinc supplementation on mortality remain unclear. This study aimed at evaluating the benefits and risks of zinc supplementation on both total mortality and cause-specific mortality.Methodology and Principal FindingsWe searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials in preschool children reporting total mortality or cause-specific mortality. Relative risk (RR) was used as a measure of the effect of zinc supplementation on the risk of mortality using a random effect model. Of the 1,520 identified articles, we included 8 trials reporting data on 87,854 children. Overall, zinc supplementation had no effect on total mortality (RR, 0.76; 95% CI: 0.56–1.04; P = 0.084), diarrhea-related mortality (RR, 0.80; 95% CI: 0.53–1.20; P = 0.276), pneumonia-related mortality (RR, 0.52; 95% CI: 0.11–2.39; P = 0.399), malaria-related mortality (RR, 0.90; 95% CI: 0.77–1.06; P = 0.196), or other causes of mortality (RR, 0.98; 95% CI: 0.67–1.44; P = 0.917). Subgroup analysis indicated that zinc supplementation was associated with a reduction in total mortality risk if the participants were boys, aged greater than 12 months, and the duration of the follow-up period was less than 12 months.Conclusions/SignificanceZinc supplementation does not have an effect on total mortality, diarrhea-related mortality, pneumonia-related mortality, malaria-related mortality, or other causes of mortality. Subgroup analysis suggested that zinc supplementation can effectively reduce the risk of total mortality if the participants were boys, aged greater than 12 months, and the duration of the follow-up period was less than 12 months.

The comparison of the effects of hot milk and hot water scald burns and factors effective for morbidity and mortality in preschool children.

Scald burns are the leading cause of burns in children, especially in those younger than 5years of age, however, they are easily preventable. Our aim in this study was to emphasise the importance and impact of scald burns caused by hot milk. A total of 334 patients below sevenyears of age were included in this study. Of these, 252 were admitted with acquired hot water scald burns (Group 1) and 82 with hot milk scald burns (Group 2) between August 2009 and September 2010. Demographic data of the patients were retrospectively investigated. The depth of the burns was determined to be higher in Group 2 (p<0.001). The total burnt body surface area in Group 1 and Group 2 were 17.1±12.3 and 16.3±10.9 (p=0.99), respectively. Skin grafting was performed in 23 patients in Group 1 and 16 patients in Group 2 (p=0.01) and complications developed in three patients in Group 1 and in five patients in Group 2 (p=0.01). The mean length of hospital stay was 9.1±7.4days in Group 1 and 14.9±9.8days in Group 2 (p<0.001) and the mortality rates were similar between the two groups. More emphasis should be placed on the effects of hot milk scalding due to its ominous clinical course and the high healthcare costs associated with this type of scalding. We believe that taking simple precautions would help reduce the physical, psychological effects and financial consequences of hot milk scalds.

Ethnic variations in mortality in pre-school children in Denmark, 1973–2004

The objective of the study was to describe ethnic differences in under-five-years mortality in Denmark according to maternal country of origin. We conducted a large registry-linkage study of all singleton live-born children from mothers born in Denmark and from the ten largest migrant groups (n = 1,841,450). Study outcomes were death before the age of 5 years from all causes combined and the most frequent death causes. Results showed that children of mothers of Turkish, Pakistani, Somali and Iraqi origin had an elevated risk of dying before the age of five compared to offspring of mothers born in Denmark, with hazards ratios and 95% confidence intervals of 1.48 (1.31-1.67), 1.97 (1.68-2.32), 1.70 (1.29-2.25), and 1.92 (1.41-2.62), respectively. Ethnic differences were also observed in the underlying causes of death. Children of mothers born in Former Yugoslavia, Lebanon, Norway, Sweden, Iran, and Afghanistan did not differ in under-five-years mortality from ethnic Danish children. Adjustments for household income did not attenuate the risk estimates. In conclusion, we found excess child mortality in some migrant groups, but not in all. The differences could not be explained by socioeconomic status.

Estimation of risk ratio in a noncompliance randomized clinical trial with trichotomous dose levels

In randomized clinical trials (RCTs), we may come across the situation in which some patients do not fully comply with their assigned treatment. For an experimental treatment with trichotomous levels, we derive the maximum likelihood estimator (MLE) of the risk ratio (RR) per level of dose increase in a RCT with noncompliance. We further develop three asymptotic interval estimators for the RR. To evaluate and compare the finite sample performance of these interval estimators, we employ Monte Carlo simulation. When the number of patients per treatment is large, we find that all interval estimators derived in this paper can perform well. When the number of patients is not large, we find that the interval estimator using Wald’s statistic can be liberal, while the interval estimator using the logarithmic transformation of the MLE can lose precision. We note that use of a bootstrap variance estimate in this case may alleviate these concerns. We further note that an interval estimator combining interval estimators using Wald’s statistic and the logarithmic transformation can generally perform well with respect to the coverage probability, and be generally more efficient than interval estimators using bootstrap variance estimates when RR>1. Finally, we use the data taken from a study of vitamin A supplementation to reduce mortality in preschool children to illustrate the use of these estimators.

Nutritional Solutions to Major Health Problems of Preschool Children: How to Optimise Growth and Development

Significant opportunities to improve child health globally were provided in the second half of the 20th century. However malnutrition remains a major problem and in many countries the situation seems to have worsened. In a recent report about survival rate in childhood UNICEF remained that the United Nations first Millennium Goal was to eradicate extreme poverty and to reduce the proportion of people who suffer from hunger by half between 1990 and 2015 as measured by the percentage of children under five years of age who are underweight. The first Millennium Goal of the United Nations is to eradicate extreme poverty and to reduce the proportion of people who suffer from hunger by half between 1990 and 2015 as measured by the percentage of children under 5 y old who are underweight. (excerpt)

A Note on Hypothesis Test in Binary Data under the Single-Consent Randomized Design

When we compare an experimental treatment with the best standard therapy, Zelen first proposed use of the single-consent randomized design to increase the accrual rate of patients into trials. Under the single-consent randomized design, I developed two other simple test procedures to improve the power of the commonly used procedure for the intention-to-treat analysis in testing whether there is a difference in treatment effects in this article. Based on Monte Carlo simulation, I evaluated and compared these three test procedures with respect to type 1 error and power. I demonstrated that the two test procedures developed here outperformed the commonly employed test procedure in a variety of situations. Finally, I employed an example by studying the effect of vitamin A supplementation on reducing mortality in preschool children to illustrate the use of these test procedures.

Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial

Anaemia caused by iron deficiency is common in children younger than age 5 years in eastern Africa. However, there is concern that universal supplementation of children with iron and folic acid in areas of high malaria transmission might be harmful. We did a randomised, placebo-controlled trial, of children aged 1-35 months and living in Pemba, Zanzibar. We assigned children to daily oral supplementation with: iron (12.5 mg) and folic acid (50 mug; n=7950), iron, folic acid, and zinc (n=8120), or placebo (n=8006); children aged 1-11 months received half the dose. Our primary endpoints were all-cause mortality and admission to hospital. Analyses were by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN59549825. The iron and folic acid-containing groups of the trial were stopped early on Aug 19, 2003, on the recommendation of the data and safety monitoring board. To this date, 24 076 children contributed a follow-up of 25,524 child-years. Those who received iron and folic acid with or without zinc were 12% (95% CI 2-23, p=0.02) more likely to die or need treatment in hospital for an adverse event and 11% (1-23%, p=0.03) more likely to be admitted to hospital; there were also 15% (-7 to 41, p=0.19) more deaths in these groups. Routine supplementation with iron and folic acid in preschool children in a population with high rates of malaria can result in an increased risk of severe illness and death. In the presence of an active programme to detect and treat malaria and other infections, iron-deficient and anaemic children can benefit from supplementation. However, supplementation of those who are not iron deficient might be harmful. As such, current guidelines for universal supplementation with iron and folic acid should be revised.

Effect of routine prophylactic supplementation with iron and folic acid on preschool child mortality in southern Nepal: community-based, cluster-randomised, placebo-controlled trial

Iron deficiency is widespread in the developing world and is especially common in young children who live on the Indian subcontinent. Supplementation with iron and folic acid alleviates severe anaemia and enhances neurodevelopment in deficient populations, but little is known about the risks of mortality and morbidity associated with supplementation. We did a community-based, cluster-randomised, double-masked, placebo-controlled, 2x2 factorial trial in children aged 1-36 months and residing in southern Nepal. We randomly assigned children daily oral supplementation to age 36 months with: iron (12.5 mg) and folic acid (50 microg; n=8337), zinc alone (10 mg), iron, folic acid, and zinc (n=9230), or placebo (n=8683); children aged 1-11 months received half the dose. Our primary outcome measure was all-cause mortality, and our secondary outcome measures included cause-specific mortality and incidence and severity of diarrhoea, dysentery, and acute respiratory illness. Analyses were by intention to treat. This study is registered at , number NCT00109551. The iron and folic acid-containing groups of the study were stopped early in November, 2003, on the recommendation of the data and safety monitoring board; mortality in these groups did not differ from placebo and there was low power to detect positive or negative effects by the time enrollment was completed. We continued to enroll children to the placebo and zinc alone groups. 25,490 children participated and analyses are based on 29,097.3 person-years of follow-up. There was no difference in mortality between the groups who took iron and folic acid without or with zinc when compared with placebo (HR 1.03, 95% CI 0.78-1.37, and 1.00, 0.74-1.34, respectively). There were no significant differences in the attack rates for diarrhoea, dysentery, or respiratory infections between groups, although all the relative risks except one indicated modest, non-significant protective effects. Daily supplementation of young children in southern Nepal with iron and folic acid with or without zinc has no effect on their risk of death, but might protect against diarrhoea, dysentery, and acute respiratory illness.

Vitamin a administration and preschool child mortality

A double blind study conducted during January 90–March 91 in a rural part of Varanasi district in Uttar Pradesh state of India on 9987 and 5260 children under six years of age demonstrated that administration of vitamin A reduced overall mortality by 14.0%. The additional data collected from January 1991 to February 92 under similar settings on 1314 and 1200 children of same age in the experimental and control groups respectively and from all children suffering from xerophthalmia who received mega dose of vitamin A (200,000 I.U.), taken together, show that vitamin A supplementation results in 16.9% reduction in mortality. Mortality was reduced in unimmunized children by 22.0%, diarrhea by 18.8% and measles by 9.0%. However, significant reduction in mortality in vitamin A supplemented group was observed only for deaths due to severe malnutrition. No death was recorded in xerophthalmia children who received mega dose of vitamin A (200,000 I.U.). The child survival pattern remained unaltered and mortality pattern remained unchanged significantly even after one year of withdrawal, thus denying the possibility of any substantial change in the study area for births and deaths. Thus the finding that vitamin A supplementation protects against overall mortality and in particular deaths due to gastroenterits, severe malnutrition and in unimmunized children is of significance.

Vitamin A status: relationship to immunity and the antibody response.

Vitamin A (retinol and its derivatives) is essential for a variety of biologic processes, many of which are related to growth, cellular differentiation, and cell-cell or cell-substrate interactions. Within the last 5 years, there has been a renaissance of interest in vitamin A and immunity that is based largely on three important advances. First, a number of controlled, field-based or hospital-based, studies have demonstrated that vitamin A supplementation can decrease mortality in preschool children in populations at high risk for vitamin A deficiency. Although a mechanistic link between child survival and improved immunity has yet to be established, it seems quite probable that at least some of the benefit of vitamin A is due to restoration of epithelial barriers and improved resistance to respiratory and gastrointestinal infections. Second, vitamin A, either in the form of retinol or its metabolite, retinoic acid, has been shown to stimulate the rejection of certain immunogenic tumors; this effect may ...

Efficacy of vitamin A in reducing preschool child mortality in Nepal

Efficacy of vitamin A in reducing preschool child mortality in Nepal