VITAMIN-A SUPPLEMENTATION FAILS TO REDUCE INCIDENCE OF ACUTE RESPIRATORY ILLNESS AND DIARRHEA IN PRESCHOOL-AGE INDONESIAN CHILDREN

Vitamin A supplementation of populations of vitamin A-deficient presch ool-age children has been shown to reduce childhood mortality, but the primary preventive effects of such supplements on childhood infectiou s diseases have not been carefully evaluated. We conducted an individu ally randomized, placebo-controlled, double-masked trial among 1,407 I ndonesian preschool-age children, to measure the effects of high dose vitamin A on acute respiratory and diarrheal illnesses. Signs and symp toms of morbidity were monitored using every other day home surveillan ce by trained interviewers, High dose vitamin A supplements increased the incidence of acute respiratory illnesses (ARI) by 8%, and acute lo wer respiratory illnesses (ALRI) by 39%. These detrimental effects on acute lower respiratory illnesses were most marked in children with ad equate nutritional status (rate ratio 1.83, 95% confidence interval 1. 257-2.669). In contrast, vitamin A tended to be protective of ALRI in chronically malnourished children (rate ratio 0.71, 95% confidence int erval 0.375-1.331). There was no overall effect of high-dose vitamin A supplements on the incidence of diarrheal disease (rate ratio 1.06, 9 5% confidence interval 0.920-1.225). However, we found a significant i nteraction between supplementation and age: vitamin A increased the in cidence of diarrhea in children <30 mo of age, but tended to reduce th e incidence in older children. The finding of a significant adverse ef fect of vitamin A supplements in adequately nourished children highlig hts the need to review the criteria for selecting populations of presc hool-age children for vitamin A supplementation.