Efficacy of a high-dose in addition to daily low-dose vitamin A in children
suffering from severe acute malnutrition with other illnesses.
Author(s): Sattar S, Ahmed T, Rasul CH, Saha D, Salam MA, Hossain MI.
Affiliation(s): Clinical Sciences Division and Centre for Nutrition and Food Security,
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka, Bangladesh.
Publication date & source: 2012, PLoS One. , 7(3):e33112
BACKGROUND: Efficacy of high-dose vitamin A (VA) in children suffering from
severe acute malnutrition (SAM) has recently been questioned. This study compared
the efficacy of a single high-dose (200,000 IU) in addition to daily low-dose
(5000 IU) VA in the management of children suffering from SAM with diarrhea
and/or acute lower respiratory tract infection (ALRI).
METHODS: In a randomized, double-blind, controlled clinical trial in icddr,b,
Bangladesh during 2005-07, children aged 6-59 months with weight-for-height <-3
Z-score and/or bipedal edema (SAM) received either a high-dose VA or placebo on
admission day. Both the groups received 5,000 IU/day VA in a multivitamins drop
for 15 days and other standard treatment which is similar to WHO guidelines.
RESULTS: A total 260 children (130 in each group) were enrolled. All had
diarrhea, 54% had concomitant ALRI, 50% had edema, 48.5% were girl with a mean±SD
age of 16±10 months. None had clinical signs of VA deficiency. Mean±SD baseline
serum retinol was 13.15±9.28 µg/dl, retinol binding protein was 1.27±0.95 mg/dl,
and pre-albumin was 7.97±3.96 mg/dl. Median (inter quartile range) of C-reactive
protein was 7.8 (2.1, 22.2) mg/L. Children of the two groups did not differ in
any baseline characteristic. Over the 15 days treatment period resolution of
diarrhea, ALRI, edema, anthropometric changes, and biochemical indicators of VA
were similar between the groups. The high-dose VA supplementation in children
with SAM did not show any adverse event.
CONCLUSIONS: Efficacy of daily low-dose VA compared to an additional single
high-dose was not observed to be better in the management of children suffering
from SAM with other acute illnesses. A single high-dose VA may be given
especially where the children with SAM may leave the hospital/treatment center
early.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00388921.
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