Effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections in young children in Brazil

• Published in: The Lancet (British edition) Vol. 344; no. 8917; pp. 228 - 231
• Main Authors: Barreto, M.L, Farenzena, G.G, Fiaccone, R.L, Santos, L.M.P, Assis, A.M.O, Araújo, M.P.N, Santos, P.A.B
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 23.07.1994; Lancet; Elsevier Limited
• Subjects: Acute Disease; Biological and medical sciences; Brazil - epidemiology; Child, Preschool; Children & youth; Diarrhea; Diarrhea - epidemiology; Diarrhea - prevention & control; Diarrhea, Infantile - epidemiology; Diarrhea, Infantile - prevention & control; Double-Blind Method; Female; Humans; Infant; Male; Medical research; Medical sciences; Miscellaneous; Mortality; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Respiratory diseases; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - prevention & control; Vitamin A; Vitamin A - administration & dosage; South America; Brazil; America; Human; Pneumonia; Respiratory disease; Treatment efficiency; Diarrhea; Supplemented diet; Statistical study; Retinol; Infection; Prevention; Treatment; Digestive diseases; Child
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(94)92998-X

Summary A beneficial effect of periodic vitamin A supplementation on childhood mortality has been demonstrated, but the effect on morbidity is less clear. We investigated the effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections (ALRI) in children from northeastern Brazil in a randomised, double-blind, placebo-controlled community trial. 1240 children aged 6-48 months were assigned vitamin A or placebo every 4 months for 1 year. They were followed up at home three times a week, and data about the occurrence and severity of diarrhoea and ALRI were collected. Any child with cough and respiratory rate above 40 breaths per min was visited by a paediatrician. The overall incidence of diarrhoea episodes was significantly lower in the vitamin-A-supplemented group than in the placebo group (18·42 vs 19·58 × 10 -3 child-days; rate ratio 0·94 [95% Cl 0·90-0·9 8]). The benefit of supplementation was greater as regards severe episodes of diarrhoea; the incidence was 20% lower in the vitamin A group than in the placebo group (rate ratio 0·80 [0·65-0·98]). With the standard definition of diarrhoea (≥3 liquid or semi-liquid stools in 24 h) the effect of vitamin A on mean daily prevalence did not reach significance, but as the definition of diarrhoea was made more stringent (increasing number of stools per day), a significant benefit became apparent, reaching for diarrhoea with 6 or more liquid or semi-liquid stools in 24 h a 23% lower prevalence. We found no effect of vitamin A supplementation on the incidence of ALRI. The reduction in severity of diarrhoea may be the most important factor in the lowering of mortality by vitamin A supplementation.