for the main comparison.
| Vitamin A compared with placebo or no vitamin A for treating measles in children | ||||||
|
Patient or population: children with measles Settings: in hospital or in the community1 Intervention: vitamin A2 Comparison: placebo or no vitamin A | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo or no vitamin A | Vitamin A | |||||
| Mortality | Low‐risk population3 | RR 0.70 (0.42 to 1.15) | 2574 (8) | +++O moderate | Areas with case‐fatality > 10% Age two years or less |
|
| 98 per 1000 | 69 per 1000 (41 to 113) | |||||
| High‐risk population | ||||||
| 107 per 1000 | 75 per 1000 (45 to 123) | |||||
| Pneumonia‐specific mortality | 50 per 1000 | 28 per 1000 (12 to 68) | RR 0.57 (0.24 to 1.37) | 723 (4) | +++O moderate | |
| Duration of pneumonia | The mean duration of pneumonia ranged across control groups from of pneumonia from 5.7 to 12.37 days | The mean duration of pneumonia in the intervention groups was 3.69 days shorter (95% CI ‐7.53 to 0.16) | 249 (2) | +++O moderate | ||
| Duration of diarrhea in days | The mean duration of diarrhea in days ranged across control groups from 4.5 to 8.45 days | The mean duration of diarrhea in days in the intervention groups was 1.92 lower (95% CI ‐3.40 to ‐0.44) | 249 (2) | +++O moderate | ||
| Hospital stay in days | The mean days stay in hospital ranged across control groups from 5.9 to 15.24 | The mean stay in hospital in the intervention groups was 2.39 days less (95% CI ‐6.60 to 1.83 ) | 278 (2) | +++O moderate | ||
| Duration of fever in days | The mean duration of fever ranged across control groups from 4.2 to 8.3 days | The mean duration of fever in the intervention groups was 1.01 days less (95% CI ‐1.89 to ‐0.13) | 149 (2) | +++O moderate | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1. The evidence from these studies can only be generalized in relation to low‐income countries. There is limited information to permit a generalization in relation to high‐income countries. The only study carried out in a developed country (Japan) used one‐fourth of the recommended dose (100,000 IU), showed a reduced morbidity and did not report any toxicity. 2. All the Vitamin A supplements in the eight trials included in this review were administrated orally. Two studies used water‐based vitamin A formulations while the other three used an oil‐based formulation. Different doses of vitamin A were used in this review. 3. Three trials recruited high‐risk participants defined as those living in areas with case‐fatality > 10% or aged two years or less. The incidence for five trials that excluded high‐risk participants was 9.8% and the incidence for the two trials that recruited high‐risk participants (with at least one risk factor) was 10.7%. We have rounded these off to 98 and 107 per 1000 respectively.