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Impact of supplementing newborn infants with vitamin A on early infant mortality: community based randomised trial in southern India

BMJ 2003; 327 doi: (Published 31 July 2003) Cite this as: BMJ 2003;327:254

Rapid Response:

Impact of supplementing newborn infants with vitamin A on early infant mortality: community based randomised trial in southern India

The major conclusion of the present study that supplementing newborn
infants with vitamin A led to 22% reduction in total infant mortality
again highlights the importance of beneficial effects of Vitamin A
supplementation amongst children in different age4 groups . However , the
data on impact of supplementation of infants with Vitamin A on their
survival continues to be conflicting (1, 2, 3). In the present study,
investigators found that Vitamin A supplementation reduced the mortality
mainly amongst low birth weight infants it is contrary to the earlier
study documented from Indonesia which found greatest impact on infants
who weighed 2500 g and more at birth (4)

The major causes of infant mortality in developing countries
including India and particularly the districts in which the above study
was conducted are: diarrhoea, respiratory infections and low birth weight
(prematurity) . These causes contribute to more than 80% of the infant
mortality beyond first month of life (5). Also the existing scientific
evidence indicate that Vitamin A supplementation do not help in reduction
of morbidity and mortality due to diarrhoea and respiratory infections

Independent studies have documented that the deficiency of
individual micronutrient during pregnancy like Vitamin A, Iron, Iodine and
zinc, are associated with poor pregnancy outcome and high infant mortality
rate. In real life situation a pregnant woman in a rural area from low
income group suffers concurrently with deficiencies of Vitamin A, zinc,
iron and iodine. These micronutrients act synergistically on pregnancy
outcome and possibly on mortality amongst infant (8).

The aggressive approach to supplement pregnant mothers with only
Vitamin A requires serious debate in view of concurrent prevalence of
other micronutrient deficiencies and their impact on pregnancy outcome and
mortality in young children (9).

Amongst the four micronutrients the scientists are finding possibly
vitamin A as sexy, zinc as gorgeous, iodine as attractive and iron as
insipid and accordingly the priority is being accorded on their research
and beneficial effects of their supplementation.

There is a need of undertaking multi-centric and multi-country
studies on delivery of a package of Vitamin A, zinc, iron and iodine to
pregnant mothers to assess the impact on pregnancy outcome and infant
mortality so that scientific the evidence is available to the policy
planners and administrators of developing countries on "what" and "how
much" of micronutrients may be supplemented to the pregnant mothers to
improve pregnancy outcome and reduce infant mortality.

Dr. Umesh Kpail
Professor, Public Health Nutrition
Department of Human Nutrition,
All India Institute of Medical Sciences
Ansari Nagar, New Delhi, INDIA.


1. Stoltzfus RJ, Hakimi M, Miller KW, Rasmussen KM, Dawiesah S,
Habicht J-P, et al. High dose vitamin A supplementation of breast-feeding
Indonesian mothers: effects on the vitamin A status of mother and infant.
J Nutr 1993;123: 666-75.

2. Rice AL, Stoltzfus RJ, de Francisco A, Chakraborty J, Kjolhede CL,
Wahed MA. Maternal vitamin A or â-carotene supplementation in lactating
Bangladeshi women benefits mothers and infants but does not prevent
subclinical deficiency. J Nutr 1999;129: 356-65.
3. WHO/CHD immunization-linked Vitamin A supplementation study group.
Randomized trial to assess benefits and safety of vitamin A
supplementation linked to immunization in early infancy. Lancet

4. Humphrey JH, Agoestina T, Wu L, Usman A, Nurachim M, Subardja D,
et al. Impact of neonatal vitamin A supplementation on infant morbidity
and mortality. J Pediatr 1996;128: 489-96.

5. National Child Survival and Safe Motherhood Programme. Programme
Interventions - Child Survival. Maternal and Child Health Division,
Ministry of Health and Family Welfare, Government of India, New Delhi,
Government of India Press 1994;pp 79-84.

6. Villamor E and Fawzi WW. Vitamin A supplementation : Implications
for morbidity and mortality in children. J Infect Dis 2000;182:S122-S133.

7. Rahmathullah L, Underwood BA, Thulasiraj RD and Milton RC.
Diarrhoea, respiratory infections and growth are not affected by a weekly
low-dose Vitamin A supplement: A masked controlled field trial in children
of Southern India: Am J Clin Nutr 1991;54:568-577.

8. Kapil Umesh. Status of micronutrient malnutrition in India and
intervention strategies to combat them. Indian Journal of Pediatrics,

9. Priyali Pathak, Preeti Singh, Umesh Kapil and Rita Singh
Raghuvanshi. Prevalence of Iron, Vitamin A, and Iodine Deficiencies
amongst Adolescent Pregnant Mothers. Indian Journal of Pediatrics,

Competing interests:
None declared

Competing interests:
None declared

Competing interests: No competing interests

27 December 2003
Umesh Kapil
additional professor
Deparment of Human Nutrition, All India Institute of Medical Sciences, New Delhi-110 029