Milk lactoferrin (LF), lysozyme (LZ), and secretory IgA (sIgA) were measured cross-sectionally in 127 Zaïrean mothers, lactating greater than or equal to 18 mo. The 54 urban mothers were of marginal nutrition status [body mass index (BMI) 22.6 +/- 2.6 kg/m2 and albumin 33.1 +/- 4.5 g/L]. The neighboring rural mothers were of significantly (P less than 0.001) poorer nutrition status (BMI 20.5 +/- 2.2 kg/m2 and albumin 27.7 +/- 5.4 g/L). In both urban and rural mothers, as lactation progressed LF decreased by 33% and 55% whereas sIgA remained unchanged and LZ steadily increased. There was more LZ and sIgA in rural milk, contrasting with the poorer maternal nutrition. As calculated from individual milk yields, the urban infants were fed daily with twice as much LF and sIgA but with similar amounts of LZ as were the rural infants. In the early stage of lactation, the milk of both groups of Zaïrean mothers contains more sIgA than that of a group of west European (Belgian) mothers (n = 20), but the LF and LZ contents were rather similar.

Community-acquired bacteremia caused by multiresistant Enterobacteriacea is an important problem of hospitalized well-nourished and malnourished children in central Africa. Fever on admission is a sensitive diagnostic sign, even in malnourished children.

A randomized controlled trial was conducted in eastern Zaire to assess the effects of high dose vitamin A supplementation and regular deparasitation on the growth of 358 moderately malnourished preschool children, discharged from the hospital. The treatment groups received either vitamin A (60 mg of oily solution of retinyl palmitate, 30 mg if aged õ12 mo) every 6 mo or mebendazole (500 mg) every 3 mo; the control group received no supplementation. Anthropometric data were gathered at baseline and after 6 and 12 mo of followup. Serum retinol concentrations were measured at baseline and after 3 mo. The three groups did not differ in sociodemographic indicators, age and sex composition, nutritional status and serum retinol concentrations at baseline. In children who were vitamin A deficient at baseline, adjusted mean weight and mid-upper arm circumference (MUAC) increments were higher in the vitamin A-supplemented group than in the control group [annual increment in weight and MUAC in vitamin A vs. control group: 2.088 vs. 1.179 kg (P Å 0.029) and 2.24 vs. 0.95 cm (P Å 0.012), respectively], whereas growth increment did not differ between the dewormed group and the control group. In children who were not vitiamin A deficient at baseline, growth increment did not differ between the vitamin A-supplemented and control groups, whereas weight gain was lower in the dewormed group than in the control group. Vitamin A-supplemented boys gained more weight and height than control boys, whereas vitamin A-supplemented girls gained less height than control girls. Dewormed boys and girls gained less weight than control boys and girls. Programs to improve vitamin A status by high dose vitamin A supplementation may improve growth of preschool children who are vitamin A deficient, whereas deworming does not.

The effect of high-dose vitamin A supplementation on recovery from morbidity and on recovery from nosocomial morbidity of hospitalized children has been poorly studied and results are conflicting. The effect of daily, low doses has never been assessed. We investigated the effect of a single high dose and daily, low doses of vitamin A on diarrhea, acute lower respiratory tract infections (ALRIs), and all-cause fevers in 900 hospitalized preschool-age children in the Democratic Republic of Congo in a randomized, double-blind, placebo-controlled clinical trial. The high-dose treatment group received 200 000 IU vitamin A (100 000 IU if aged < 12 mo) orally on the day of admission, the low-dose treatment group received 5000 IU vitamin A/d until discharge. Data on all-cause morbidity were collected daily. Mortality rates were not significantly different among the 3 groups. High-dose vitamin A supplementation had no significant effect on the duration of moderate or severe diarrhea nor on the duration and incidence of ALRIs and all-cause fevers. Children in the high-dose group with no edema had an increased risk of severe nosocomial diarrhea (relative risk: 2.42; 95% CI: 1.15, 5.11). Low-dose vitamin A supplementation significantly reduced the incidence of severe diarrhea in severely malnourished children (relative risk: 0.21; 95% CI: 0.07, 0.62) but showed no significant effect on the duration of moderate or severe diarrhea or on the duration and incidence of ALRIs and all-cause fevers. Supplementation with high doses of vitamin A did not reduce morbidity in this population of malnourished and subclinically vitamin A-deficient children; daily, low doses appeared more beneficial for severely malnourished children.