Department of International Health Newborn Vitamin A Supplementation and Early Infant Mortality:...
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Transcript of Department of International Health Newborn Vitamin A Supplementation and Early Infant Mortality:...
Department of International Health
Newborn Vitamin A Supplementation and Early Infant Mortality:
Current Evidence
James Tielsch, Ph.D.
Bangkok, March 2010
Newborn Vitamin A Supplementation
Background• Vitamin A supplementation well accepted intervention for children 6 – 72 months of age.• Evidence for children <6 m, suggested no impact on child mortality.• Newborn period (first few days) may be different:
• Almost all infants born with very low reserves.• Breastfeeding women often vitamin A deficient.• Trial in very preterm infants in US showed reduced rate of BPD.
Presenter’s Name
Date
Randomized Trials in South and SE Asia
Study Country DesignStudy Size(Live Births)
Age at Dosing
Humphrey et al. (1996)
IndonesiaHospital-based individually randomized trial
Vit. A: 1034Control:1033
Mean = 16.4hrs 88.2% within 24 hrs
Rahmathullah et al. (2003)
IndiaCommunity-based individually randomized trial
Vit. A: 5,786Control: 5,833
Median = 26hrs80% within 48 hrs
Klemm et al. (2009)
BangladeshCommunity-based cluster randomized trial
Vit. A:7.953 Control: 7,984
Median = 7hrs84% within 48 hrs
Bhutta et al.(unfinished)
PakistanCommunity-base cluster randomized trial
Vit. A: 180 clustersCont.: 180 clusters
Not completed
?(unfinished)
India ? ? ?
Presenter’s Name
Date
Randomized Trials in South and SE Asia
Study Country Results
Humphrey et al. (1996) Indonesia RR (IMR) =0.36
(0.16, 0.87)
Rahmathullah et al. (2003)
India RR (6m IMR) = 0.78 (0.63, 0.96)
Klemm et al. (2009) Bangladesh RR (6m IMR) =0.85 (0.73, 1.00)
POOLEDIndia &Bangladesh
RR = 0.83(0.72-0.94)
Presenter’s Name
Date
Randomized Trials in Africa
Two trials in Africa have shown no impact of newborn vitamin A supplementation on early infant mortality.• Zimbabwe (HIV neg infants)
• No maternal vitamin A deficiency.• Very low mortality rates.
• Guinea Bissau• Little vitamin A deficiency• Combined with BCG vaccination• Provided care for sick infants.• Other reasons ???
• Zambia trial just getting started.
• ? SHOULD DATA BE COMBINED WITH ASIAN TRIALS ?
Presenter’s Name
Date
Conclusions
• Trials from Asia provide strong evidence that supplementation with 50,000 IU vitamin A within the first few days after birth reduces early infant mortality in south & southeast Asian settings.
• Waiting until 2 or more weeks after birth will likely have little impact on mortality.
• Newborn vitamin A supplementation is unlikely to have an impact in settings with little maternal vitamin A deficiency and where early infant mortality rates are already low.
• Newborn vitamin A supplementation is a highly cost-effective intervention that can assist countries in meeting MDG-4.