Vitamin A supplementation and increased prevalence of childhood diarrhoea and acute respiratory infections.

ABSTRACT

PIP: In the late 1980s, 11,124 children 6-83 months old, living in the sparsely populated northwest of Haiti participated in a double-blind, placebo-controlled trial of the effect of vitamin A supplementation on child morbidity. An ophthalmic assistant and a supervising ophthalmologist examined all children 2 years old. 30 children had vitamin A deficient related corneal disease (20 with corneal xerosis and 10 with corneal ulceration, keratomalacia, and/or corneal scarring). The children received either a capsule containing 200,000 IU of vitamin A and 40.6 mg vitamin E or a capsule containing only 40.6 mg vitamin E (placebo) every 4 months. Field workers interviewed caretakers 2-8 weeks after the children received their capsules to gather data on signs and symptoms of illness. Children in the vitamin A group were more likely to have a higher prevalence of diarrhea and of respiratory infections than the placebo group (e.g., 1st cycle, 42 vs. 36% for diarrhea and 18 vs. 15% for rapid breathing, rate ratios = 1.6 and 1.19, respectively). The risk of morbidity was highest 8-17 weeks after receiving the megadose of vitamin A. These findings indicate that prevalence of diarrhea and respiratory infections increased 2 weeks after vitamin A supplementation. Mortality rates of the 2 groups were essentially the same. The mortality rate of nonparticipants was higher than that of participants (52/1000 vs. 23/1000), however, suggesting that the supplements may have had some benefit.