VITAMIN-A SUPPLEMENTATION IN NORTHERN GHANA - EFFECTS ON CLINIC ATTENDANCES, HOSPITAL ADMISSIONS, AND CHILD-MORTALITY

Although most studies on the effect of vitamin A supplementation have reported reductions in childhood mortality, the effects on morbidity a re less clear. We have carried out two double-blind, randomised, place bo-controlled trials of vitamin A supplementation in adjacent populati ons in northern Ghana to assess the impact on childhood morbidity and mortality. The Survival Study included 21 906 children aged 6-90 month s in 185 geographical clusters, who were followed for up to 26 months. The Health Study included 1455 children aged 6-59 months, who were mo nitored weekly for a year. Children were randomly assigned either 200 000 IU retinol equivalent (100 000 IU under 12 months) or placebo ever y 4 months; randomisation was by individual in the Health Study and by cluster in the Survival Study. There were no significant differences in the Health Study between the vitamin A and placebo groups in the pr evalence of diarrhoea or acute respiratory infections; of the symptoms and conditions specifically asked about, only vomiting and anorexia w ere significantly less frequent in the supplemented children. Vitamin- A-supplemented children had significantly fewer attendances at clinics (rate ratio 0.88 [95% CI 0.81-0.95], p=0.001), hospital admissions (0 .62 [0.42-0.93], p=0.02), and deaths (0.81 [0.68-0.98], p=0.03) than c hildren who received placebo. The extent of the effect on morbidity an d mortality did not vary significantly with age or sex. However, the m ortality rate due to acute gastroenteritis was lower in vitamin-A-supp lemented than in placebo clusters (0.66 [0.47-0.92], p=0.02); mortalit y rates for all other causes except acute lower respiratory infections and malaria were also lower in vitamin A clusters, but not significan tly so. Improving the vitamin A intake of young children in population s where xerophthalmia exists, even at relatively low prevalence, shoul d be a high priority for health and agricultural services in Africa an d elsewhere.