ABSTRACT
Objectives: Though VAS at vaccination contacts has been recommended for many years, the policy has never been evaluated for its effect on overall mortality in randomised controlled trials. We evaluated the effect of the WHO recommendation of vitamin A supplementation (VAS) at routine vaccination contacts after 6 months of age. Methods: We conducted a randomised controlled trial of VAS. Children aged 6-23 months were randomised 1:1 to VAS (100,000 IU if aged 6-11 months, 200,000 IU if aged 12-23 months) or placebo at vaccination contacts in Guinea-Bissau. Mortality rates were compared in Cox proportional-hazards models overall, and by sex and vaccine. Results: Between August 2007 and November 2010, 7587 children were enrolled. Within 6 months of follow-up there were 81 non-accident deaths (VAS: 39; placebo: 42). The mortality rate ratio (MRR) comparing VAS versus placebo recipients was 0.93 (95% CI: 0.60-1.44) and differed significantly between boys (MRR=1.92 (0.98-3.75)) and girls (MRR=0.49 (0.26-0.92)) (p=0.004 for interaction between VAS and sex). At enrolment 42% (3161/7587) received live measles vaccine, 29% (2154/7587) received inactivated diphtheria-tetanus-pertussis-containing vaccines and 21% (1610/7587) received both live and inactivated vaccines. The effect of VAS did not differ by vaccine group. Conclusions: This is the first randomised trial of the effect of VAS at routine vaccination contacts on mortality. VAS had no overall effect, but the effect differed significantly by sex. More trials to ensure an optimal evidence-based vitamin A policy are warranted.
ABSTRACT
A number of trials on maternal multi-micronutrient supplementation (MMS) have found a benefical effect on birth weight, but few have demonstrated a beneficial effect on infant survival. We examined the effect of two different preparations of antenatal MMS on fetal loss and under-2-years child mortality, as compared with iron-folic acid supplementation among 2,100 pregnant women in Guinea-Bissau. Women receiving a 1xRDA MMS preparation (consisting of 14 vitamins and minerals) had a marginally reduced risk of fetal loss (Relative risk (RR) 0.65, 95% CI 0.40; 1.05), and women receiving a 2xRDA MMS preparation had a similar effect (RR 0.67, 95% CI 0.42; 1.08), the pooled effect being 0.66 (95% CI 0.44; 0.99). None of the supplements reduced under-2-years mortality or the combination of fetal loss and under-2-years mortality. There was a marginally negative effect of both the 1xRDA (RR 2.10, 95% CI 0.99; 4.46) and the 2xRDA (RR 2.02, 95% CI 0.95; 4.32) MMS preparation on mortality specifically between 92365 days of age. (Afr. J. Reprod. Health 2010; 14[2]:17-26)