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Vitamin A supplementation and child mortality. A meta-analysis.
Fawzi WW; Chalmers TC; Herrera MG; Mosteller F
JAMA 1993 Feb 17;269(7):898-903
two-part meta-analysis of studies examining the relationship of vitamin
A supplementation and child mortality. DATA SOURCES--We
identified studies by searching the MEDLARS database
from 1966 through 1992 and by scanning Current Contents and bibliographies
of pertinent articles. STUDY SELECTION--All 12 vitamin
A controlled trials with data on mortality identified in the search were
used in the analysis. DATA EXTRACTION--Data were independently
extracted by two investigators who also assessed the quality of each study
using a previously described method. DATA SYNTHESIS--We
formally tested for heterogeneity across studies. We pooled studies using
the Mantel-Haenszel and the DerSimonian and Laird methods and adjusted
for the effect of cluster assignment of treatment groups in community-based
studies. Vitamin A supplementation to hospitalized measles patients was
highly protective against mortality (DerSimonian and Laird odds ratio,
0.39; 95% confidence interval, 0.22 to 0.66; P = .0004) (part 1 of the
meta-analysis). Supplementation was also protective against overall mortality
in community-based studies (DerSimonian and Laird odds ratio, 0.70; clustering-adjusted
95% confidence interval, 0.56 to 0.87; P = .001) (part 2 of the meta-analysis).
CONCLUSIONS--Vitamin A supplements are associated with
a significant reduction in mortality when given periodically to children
at the community level. Factors that affect the bioavailability of large
doses of Vitamin A need to be studied further. Vitamin A supplements should
be given to all measles patients in developing countries whether or not
they have symptoms of vitamin A deficiency.