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It has been little more than a decade since the initial observation of the dose dependent relation between the severity of vitamin A deficiency and childhood mortality,1 quickly followed by the publication of a controlled trial in which children of preschool age, randomised to receive large doses of vitamin A every six months, died at only two thirds (or less) the rate of control subjects.2 3 In the short interval since this trial, an initially sceptical scientific community has declared control of vitamin A deficiency a major international goal4-6 and potentially one of the most cost effective of all health interventions.7
Key messages
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Vitamin A deficiency increases the severity of and mortality from measles and diarrhoea
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Increased infectious morbidity and mortality is apparent even before the appearance of xerophthalmia
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Improving the vitamin A status of deficient children aged 6 months to 6 years can dramatically reduce their morbidity and mortality from infection
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Prompt administration of large doses of vitamin A to children with moderate to severe measles, particularly if they may be vitamin A deficient, can reduce individual mortality by 50% and prevent or moderate the severity of complications
The story did not begin in the 1980s. A host of animal studies and anecdotal clinical reports during the first third of the century, soon after vitamin A was discovered, suggested a close, potentially causal relation between vitamin A status and morbidity and mortality from infection. These are detailed elsewhere.8
Vitamin A prophylaxis and mortality
For ethical and logistic reasons the observational study1 has never been repeated, though a large number of intervention trials have been carried out. Eight were initially considered to be suitably rigorous for inclusion in an independently commissioned meta-analysis (table 1).9 The results were remarkably similar, particularly given the wide differences in culture, dietary …