The impact of vitamin A supplementation on the incidence of severe diarrhea and ARI in children in Nepal.

There is a growing body of knowledge on the relationship between vitamin A supplementation interventions and mortality reduction. However, the mechanism of mortality reduction is not fully understood. Several studies have failed to demonstrate mortality reduction. Vitamin A deficiency has been known to be associated with a high risk of morbidity and mortality, and vitamin A supplementation has been associated with a reduction in child mortality. Paradoxically, vitamin A supplementation has not reduced the prevalence of diarrhea and respiratory diseases. Many researchers have postulated that vitamin A reduced mortality not by reducing the incidence of these two conditions, but through reducing the severity of infection. This study aims to evaluate the impact of vitamin A supplementation on the severity of diarrhea and acute respiratory infection (ARI). Data used in this study were part of the data set of the second year evaluation of the Vitamin A Child Survival Project in Nepal. The analysis focused on those who suffered from diarrhea or ARI during the health examination by the study team in the second year of a three year study. While the project had three vitamin A interventions, only the vitamin A capsule and control groups were used in the analysis (a total of 889 children, of whom 695 suffered from diarrhea and 256 from ARI). The study found that supplementation with one capsule of vitamin A in a year was not associated with a reduction in the risk of severe diarrhea. However, children who received two capsules enjoyed a 56% reduction in the risk of diarrhea with dehydration and a 64% reduction on the risk of having diarrhea of duration of 5 days or more. Xerophthalmia was associated with a higher risk of having diarrhea with dehydration for 5 days or more. Stunting and wasting was associated with a higher risk of diarrhea with dehydration but not with having diarrhea for 5 days or more. The premonsoon period was associated with much higher risk for diarrhea of both types, compared to the period from August to November. The presence of a market in the ward was associated with a lower risk of diarrhea with dehydration as well as for diarrhea for 5 days and more. There was an indication that vitamin A supplementation was associated with a lower risk of severe ARI; however, the model was not sensitive. Further study is needed on the impact of vitamin A supplementation on persistent diarrhea and severe ARI in different nutritional and socieconomic conditions.PhDInternational HealthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/105061/1/9629606.pdfDescription of 9629606.pdf : Restricted to UM users only