KARACHI, Aug 25: An international study has come up with compelling evidence that vitamin A supplements is associated with large reductions in mortality, morbidity and vision problems, including night blindness, in children between six months and five years.

The inexpensive supplements with few side-effects were found to bring about particular benefits in reducing the incidence of diarrhoea and measles, according to the study posted on the online version of the British Medical Journal.

The research was conducted by the Centre for Evidence-Based Intervention, the University of Oxford and the Division of Women and Child Health, Aga Khan University and Hospital (AKUH).

“The study reaffirms the critical role vitamin A plays in saving children's lives. Diarrhoea, along with pneumonia, meningitis, is a major killer of children in Pakistan. Of the 450,000 under-five children dying of different diseases every year, diarrhoea claims about 100,000 lives while the number of children dying of measles runs into thousands,” said Prof Dr Zulfiqar Bhutta, the chair of the division of women and child health, AKUH, and the senior corresponding author of the study.

The provision of vitamin A supplements, according to Dr Bhutta, is already part of the government vaccination programme. But the measure has failed to bring about positive results.

“In fact, the research on the nutritional status of children has showed that the situation has worsened in recent years. Pakistan's health performance indicators are so poor that the country is now compared with Afghanistan. Even the northern part of Afghanistan is faring much better in health,” he said.

The state, he said, had abandoned its responsibility to look after the basic health needs of the masses, majority of whom had lost the power to purchase the food necessary for a healthy body.

“The poor surviving on lentils, onion and roti can't afford to buy the food rich in vitamin A that include sea food, eggs, minced meat, liver and mangoes,” he said.

One positive step could be fortifying food products with vitamin A. But in the absence of quality control checks by the government, there was little hope for improvement, he said.

Scientific evidence indicated that low levels of vitamin A could contribute to low response to polio vaccination, he added.

Findings

The findings were based on 43 trials in which some children were given vitamin A while others received no intervention. The sample included 215,633 healthy children between six months and five years in 19 countries, mostly in Asia. The average age of children was two and a half years when they were recruited for the trials and followed for about a year.

The study recorded a 24 per cent reduction in all cause mortality and 28 per cent reduction in mortality associated with diarrhoea.

The lead author, Dr Evan Mayo-Wilson from the Department of Social Policy and Intervention at the University of Oxford, said: “Our study shows that, until other sources are available, supplements should be given to all children who are at risk of vitamin A deficiency. After just one year, children who had taken supplements were less likely to have died than children who received a placebo. We estimate that by providing supplements to all children in countries where they are at risk, we could save up to 600,000 lives a year and prevent millions of serious infections. Vitamin A supplements are highly effective and cheap to produce and administer.”

He added that the study also showed that systematic literature reviews were cost-effective and ethically imperative. “Recent editorials criticising vitamin A programmes have received international attention, but the evidence taken as a whole leaves little doubt that vitamin A prevents early childhood mortality. The largest clinical trial ever conducted ran from 1999 to 2004 and assigned about 1,000,000 children to receive vitamin A or placebo. Since that trial began, only one relatively small trial has examined vitamin A for childhood mortality,” he added.

According to the study, vitamin is an essential nutrient that cannot be synthesised so it must be obtained through diet. Vitamin A deficiency is common during childhood in many developing countries, even among populations whose diets rely heavily on vegetables and fruits. The reasons are multiple and include widespread maternal undernutrition, poor dietary quality, and losses during diarrhoea.

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