Editorials

Vitamin A supplements and survival in children

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c977 (Published 09 March 2010) Cite this as: BMJ 2010;340:c977
  1. Andrew M Prentice, professor of international nutrition
  1. 1MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London WC1N 4AL and MRC Keneba, Gambia
  1. andrew.prentice{at}lshtm.ac.uk

    New evidence points to a differential effect in girls and boys

    In the linked randomised controlled trial (doi: 10.1136/bmj.c1101), Benn and colleagues assess the effect of giving high dose vitamin A supplements to low birthweight neonates in Guinea-Bissau. Overall, they found no effect on infant mortality, although the effect differed by sex; boys tended to benefit but a significantly harmful effect was seen on girls’ survival.1

    In 1983 it was reported that young Indonesian children with mild xerophthalmia, Bitot’s spots, and night blindness—the clinical symptoms of vitamin A deficiency—had a higher risk of death.2 A subsequent randomised controlled trial of vitamin A supplementation showed an impressive benefit on all cause mortality.3 This prompted further large scale trials elsewhere in Asia and Africa that confirmed the effect. A meta-analysis indicated that this cheap and simple intervention reduces child mortality by 30% in countries with evidence of at least marginal vitamin A deficiency.4 The World Health Organization subsequently recommended a protocol for universal vitamin A supplementation of children aged six to 60 months, and this has been adopted as government policy in more than 60 countries worldwide.

    If vitamin A supplementation is so effective at saving lives in later infancy and childhood, why not give supplements to newborn babies? Infant mortality is greatest in the first six months of life so it would be reasonable to expect an even greater benefit. The initial strategy was to supplement mothers postpartum in the hope …

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