Vitamin A supplements and diarrheal and respiratory tract infections
among children in Dar es Salaam, Tanzania.
Fawzi WW; Mbise R; Spiegelman D; Fataki M; Hertzmark E; Ndossi G
J Pediatr 2000 Nov;137(5):660-7
OBJECTIVE: To determine the effect
of vitamin A supplementation on the risk of diarrhea and of acute respiratory
infection. DESIGN: Double-blind, randomized, placebo-controlled trial.
SETTING: Dar-es-Salaam, Tanzania. SUBJECTS: Six hundred eighty-seven children,
6 to 60 months old, hospitalized with pneumonia, who received vitamin
A or placebo at baseline and at 4 and 8 months after discharge from hospital.Main
outcome variables: Incidence and duration of episodes of diarrhea and
respiratory tract infections during the year after discharge from the
hospital. RESULTS: Relative to those receiving placebo, children receiving
vitamin A had a significantly smaller risk of severe watery diarrhea (multivariate
odds ratio = 0.56, 95% CI = 0.32-0.99, P =.04) but a higher risk of cough
and rapid respiratory rate (multivariate odds ratio = 1.67, 95% CI = 1.17-2.36,
P =.004). Vitamin A supplementation was also associated with increased
risk of acute diarrhea among normally nourished children or children with
stunted growth but was relatively protective among children with wasting
disease (P value for interaction =.01). The apparently increased risk
of respiratory tract infection was limited to children who were seronegative
for human immunodeficiency virus (HIV) (P value for interaction =.07).
CONCLUSIONS: Vitamin A supplements provide a low-cost intervention
against morbidity in HIV-infected and undernourished children. Supplements
may also have serious non-lethal adverse outcomes in well-nourished individuals.
Whether these apparent detrimental effects of vitamin A are transient
or long-term needs to be examined.