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. 1992;70(2):225–232.

Vitamin A deficiency and attributable mortality among under-5-year-olds.

J H Humphrey 1, K P West Jr 1, A Sommer 1
PMCID: PMC2393289  PMID: 1600583

Abstract

Reported are estimates of the prevalence in developing countries of physiologically significant vitamin A deficiency and the number of attributable deaths. The WHO classification of countries by the severity and extent of xerophthalmia was used to categorize developing countries by likely risk of subclinical vitamin A deficiency. Using vital statistics compiled by UNICEF, we derived population figures and mortality rates for under-5-year-olds. The findings of vitamin A supplementation trials were applied to populations at-risk of endemic vitamin A deficiency to estimate the potential impact of improved vitamin A nutriture in reducing mortality during preschool years. Worldwide, over 124 million children are estimated to be vitamin A deficient. Improved vitamin A nutriture would be expected to prevent approximately 1-2 million deaths annually among children aged 1-4 years. An additional 0.25-0.5 million deaths may be averted if improved vitamin A nutriture can be achieved during the latter half of infancy. Improved vitamin A nutriture alone could prevent 1.3-2.5 million of the nearly 8 million late infancy and preschool-age child deaths that occur each year in the highest-risk developing countries.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barclay A. J., Foster A., Sommer A. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed) 1987 Jan 31;294(6567):294–296. doi: 10.1136/bmj.294.6567.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Coutsoudis A., Broughton M., Coovadia H. M. Vitamin A supplementation reduces measles morbidity in young African children: a randomized, placebo-controlled, double-blind trial. Am J Clin Nutr. 1991 Nov;54(5):890–895. doi: 10.1093/ajcn/54.5.890. [DOI] [PubMed] [Google Scholar]
  3. Flores H., Campos F., Araujo R. C., Underwood B. A. Assessment of marginal vitamin A deficiency in Brazilian children using the relative dose response procedure. Am J Clin Nutr. 1984 Dec;40(6):1281–1289. doi: 10.1093/ajcn/40.6.1281. [DOI] [PubMed] [Google Scholar]
  4. Gebre-Medhin M., Vahlquist A. Vitamin A nutrition in the human foetus. A comparison of Sweden and Ethiopia. Acta Paediatr Scand. 1984 May;73(3):333–340. doi: 10.1111/j.1651-2227.1994.tb17744.x. [DOI] [PubMed] [Google Scholar]
  5. Katz J., Zeger S. L., Tielsch J. M. Village and household clustering of xerophthalmia and trachoma. Int J Epidemiol. 1988 Dec;17(4):865–869. doi: 10.1093/ije/17.4.865. [DOI] [PubMed] [Google Scholar]
  6. Keenum D. G., Semba R. D., Wirasasmita S., Natadisastra G., Muhilal, West K. P., Jr, Sommer A. Assessment of vitamin A status by a disk applicator for conjunctival impression cytology. Arch Ophthalmol. 1990 Oct;108(10):1436–1441. doi: 10.1001/archopht.1990.01070120084034. [DOI] [PubMed] [Google Scholar]
  7. Loerch J. D., Underwood B. A., Lewis K. C. Response of plasma levels of vitamin A to a dose of vitamin A as an indicator of hepatic vitamin A reserves in rats. J Nutr. 1979 May;109(5):778–786. doi: 10.1093/jn/109.5.778. [DOI] [PubMed] [Google Scholar]
  8. Mahalanabis D. Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case-control study. BMJ. 1991 Aug 31;303(6801):493–496. doi: 10.1136/bmj.303.6801.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Muhilal, Permeisih D., Idjradinata Y. R., Muherdiyantiningsih, Karyadi D. Vitamin A-fortified monosodium glutamate and health, growth, and survival of children: a controlled field trial. Am J Clin Nutr. 1988 Nov;48(5):1271–1276. doi: 10.1093/ajcn/48.5.1271. [DOI] [PubMed] [Google Scholar]
  10. Natadisastra G., Wittpenn J. R., West K. P., Jr, Muhilal, Sommer A. Impression cytology for detection of vitamin A deficiency. Arch Ophthalmol. 1987 Sep;105(9):1224–1228. doi: 10.1001/archopht.1987.01060090082033. [DOI] [PubMed] [Google Scholar]
  11. OOMEN H. A., MCLAREN D. S., ESCAPINI H. EPIDEMIOLOGY AND PUBLIC HEALTH ASPECTS OF HYPOVITAMINOSIS A. A GLOBAL SURVEY ON XEROPHTHALMIA. Trop Geogr Med. 1964 Dec;16:271–315. [PubMed] [Google Scholar]
  12. Rahmathullah L., Underwood B. A., Thulasiraj R. D., Milton R. C., Ramaswamy K., Rahmathullah R., Babu G. Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N Engl J Med. 1990 Oct 4;323(14):929–935. doi: 10.1056/NEJM199010043231401. [DOI] [PubMed] [Google Scholar]
  13. Solon F. S., Popkin B. M., Fernandez T. L., Latham M. C. Vitamin A deficiency in the Philippines: a study of xerophthalmia in Cebu. Am J Clin Nutr. 1978 Feb;31(2):360–368. doi: 10.1093/ajcn/31.2.360. [DOI] [PubMed] [Google Scholar]
  14. Sommer A., Hussaini G., Muhilal, Tarwotjo I., Susanto D., Saroso J. S. History of nightblindness: a simple tool for xerophthalmia screening. Am J Clin Nutr. 1980 Apr;33(4):887–891. doi: 10.1093/ajcn/33.4.887. [DOI] [PubMed] [Google Scholar]
  15. Sommer A., Katz J., Tarwotjo I. Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency. Am J Clin Nutr. 1984 Nov;40(5):1090–1095. doi: 10.1093/ajcn/40.5.1090. [DOI] [PubMed] [Google Scholar]
  16. Sommer A., Tarwotjo I., Djunaedi E., West K. P., Jr, Loeden A. A., Tilden R., Mele L. Impact of vitamin A supplementation on childhood mortality. A randomised controlled community trial. Lancet. 1986 May 24;1(8491):1169–1173. doi: 10.1016/s0140-6736(86)91157-8. [DOI] [PubMed] [Google Scholar]
  17. Sommer A., Tarwotjo I., Hussaini G., Susanto D. Increased mortality in children with mild vitamin A deficiency. Lancet. 1983 Sep 10;2(8350):585–588. doi: 10.1016/s0140-6736(83)90677-3. [DOI] [PubMed] [Google Scholar]
  18. Sommer A., Tarwotjo I., Hussaini G., Susanto D., Soegiharto T. Incidence, prevalence, and scale of blinding malnutrition. Lancet. 1981 Jun 27;1(8235):1407–1408. doi: 10.1016/s0140-6736(81)92581-2. [DOI] [PubMed] [Google Scholar]
  19. Tarwotjo I., Sommer A., West K. P., Jr, Djunaedi E., Mele L., Hawkins B. Influence of participation on mortality in a randomized trial of vitamin A prophylaxis. Am J Clin Nutr. 1987 Jun;45(6):1466–1471. doi: 10.1093/ajcn/45.6.1466. [DOI] [PubMed] [Google Scholar]
  20. Vijayaraghavan K., Radhaiah G., Prakasam B. S., Sarma K. V., Reddy V. Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet. 1990 Dec 1;336(8727):1342–1345. doi: 10.1016/0140-6736(90)92895-o. [DOI] [PubMed] [Google Scholar]
  21. West K. P., Jr, Howard G. R., Sommer A. Vitamin A and infection: public health implications. Annu Rev Nutr. 1989;9:63–86. doi: 10.1146/annurev.nu.09.070189.000431. [DOI] [PubMed] [Google Scholar]
  22. West K. P., Jr, Pokhrel R. P., Katz J., LeClerq S. C., Khatry S. K., Shrestha S. R., Pradhan E. K., Tielsch J. M., Pandey M. R., Sommer A. Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet. 1991 Jul 13;338(8759):67–71. doi: 10.1016/0140-6736(91)90070-6. [DOI] [PubMed] [Google Scholar]

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