Efficacy of vitamin A in reducing preschool child mortality in Nepal

West, Keith P.; Katz, Joanne; LeClerq, Steven C.; Pradhan, Elizabeth Kimbrough; Tielsch, James M.; Sommer, Alfred; Pokhrel, Ram Prasad; Sk, Khatry; Shrestha, Sharada Ram; Pandey, Madhav

doi:10.1016/0140-6736(91)90070-6

Cited by 309 publications

(97 citation statements)

References 17 publications

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“…The apparently discrepant results in some other reports [5][6][7][8] may relate, in part, to whether adjunctive retinol is given prophylactically or in the acute phase of the illness. Although supplementary retinol may act to inhibit the spread of infection rather than contributing to initial defensive barriers [2,9], there is a decrease in levels of serum retinol and its binding proteins in acutely ill patients even with normal prior vitamin A status [10].…”

Section: Introductionmentioning

confidence: 67%

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

et al. 2000

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Retinol (vitamin A alcohol) is an accepted adjunctive treatment in infections such as measles. There is also indirect evidence from in vitro, animal and human studies that retinol supplementation may be beneficial in severe malaria. There have, however, been no studies that have examined the pharmacokinetics of acute retinol supplementation in severe illness. To establish whether mobilization of intramuscular retinyl palmitate (RP) and its availability as retinol are adequate in complicated falciparum malaria, we administered a single dose of 400000 i.u. of RP to six Vietnamese adults with severe malaria. Another 28 patients were not given RP. All patients had blood samples taken over 96 h for RP and retinol assay using HPLC, and received conventional anti-malarial and supportive therapy. Admission serum retinol concentrations were below the lower limit of the reference range (<1.0 micromol/l) in 74% of the 34 patients. In supplemented patients, analysis of serum RP between 0 and 96 h using a multi-compartmental model revealed a median (range) delay in mobilization of 6.9 h (0.7-15.1 h), a bioavailability of 55% (19-100%) and an elimination half-life of 13.5 h (4.2-23.7 h). The area under the serum retinol curve expressed as an absolute or percentage change from baseline was greater in supplemented than in unsupplemented patients (P<0.05). The separation in median serum retinol concentrations in the two groups was maximal at 48 h. The model-derived retinol half-life [1.5 (0.7-15.8) h] suggested rapid uptake, metabolism and/or excretion. In conclusion, there is variable RP bioavailability in severe malaria, but a significant if delayed increase in serum retinol over that associated with recovery from the infection. In severe infections, RP supplementation appears simple, well tolerated and of potential benefit once anti-microbial and supportive therapy have been established.

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Section: Introductionmentioning

confidence: 67%

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

et al. 2000

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“…A preselected systematic sample of 819 (22%) subjects underwent nonverbal intelligence testing, of whom 55 were excluded because of missing data (10 related to hearing, 44 for education, and 1 for SES). A total of 764 subjects were used in the final analysis, 397 (52%) from the vitamin A and 367 (48%) from the placebo groups of the original vitamin A trial (22). …”

Section: Resultsmentioning

confidence: 99%

“…This subcohort had participated as preschoolers in a placebo-controlled vitamin A supplementation trial in 1989–91 (22) and were followed in an ear health and hearing survey from 2006–2008 (23). …”

Section: Methodsmentioning

confidence: 99%

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Hearing Loss Is Associated With Decreased Nonverbal Intelligence in Rural Nepal

Emmett¹,

Schmitz²,

Pillion³

et al. 2015

Otology &Amp; Neurotology

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Objective Evaluate the association between adolescent and young adult hearing loss and nonverbal intelligence in rural Nepal Study Design Cross-sectional assessment of hearing loss among a population cohort of adolescents and young adults Setting Sarlahi District, southern Nepal Patients 764 individuals aged 14–23 years Intervention Evaluation of hearing loss, defined by WHO criteria of pure-tone average (PTA) >25 decibels (0.5, 1, 2, 4 kHz), unilaterally and bilaterally Main Outcome Measure Nonverbal intelligence, measured by the Test of Nonverbal Intelligence, 3rd Edition (TONI-3) standardized score (mean 100; standard deviation (SD) 15) Results Nonverbal intelligence scores differed between participants with normal hearing and those with bilateral (p =0.04) but not unilateral (p =0.74) hearing loss. Demographic and socioeconomic factors including male sex, higher caste, literacy, education level, occupation reported as student, and ownership of a bicycle, watch, and latrine were strongly associated with higher nonverbal intelligence scores (all p <0.001). Subjects with bilateral hearing loss scored an average of 3.16 points lower (95% CI: −5.56, −0.75; p =0.01) than subjects with normal hearing after controlling for socioeconomic factors. There was no difference in nonverbal intelligence score based on unilateral hearing loss (0.97; 95% CI: −1.67, 3.61; p =0.47). Conclusions Nonverbal intelligence is adversely affected by bilateral hearing loss, even at mild hearing loss levels. Social and economic well being appear compromised in individuals with lower nonverbal intelligence test scores.

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“…The four interventions that appear to be most responsible for the decline in mortality include maternal tetanus toxoid vaccination (3-6), measles vaccination (7,8), and a reduction in diarrhoea fatalities due to oral rehydration solution (ORS) (9) and vitamin A capsules (10,11). …”

Section: Introductionmentioning

confidence: 99%

Infectious Diseases and Vaccine Sciences: Strategic Directions

Luby

Brooks

Zaman

et al. 2009

J Health Popul Nutr

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Despite substantial progress, infectious diseases remain important causes of ill-health and premature deaths in Bangladesh. Bangladesh has experienced a >90% reduction in the incidence of deaths due to childhood diarrhoea over the last 25 years. Further reductions can be achieved through the introduction of effective vaccines against rotavirus and improvements in home hygiene, quality of drinking-water, and clinical case management, including appropriate use of oral rehydration solution and zinc. Pneumonia is now the leading cause of childhood deaths in Bangladesh, and the pneumonia-specific child mortality is largely unchanged over the last 25 years. Reductions in mortality due to pneumonia can be achieved through the introduction of protein conjugate vaccines against Haemophilus influenza type b and Streptococcus pneumoniae, improvements in case management, including efforts to prevent delays in providing appropriate treatment, and the wider use of zinc. Tuberculosis is responsible for an estimated 70,000 deaths each year in Bangladesh. Although services for directly-observed therapy have expanded markedly, improved case finding and involvement of private practitioners will be important to reduce the burden of disease.

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Efficacy of vitamin A in reducing preschool child mortality in Nepal

Cited by 309 publications

References 17 publications

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

Pharmacokinetics of retinyl palmitate and retinol after intramuscular retinyl palmitate administration in severe malaria

Hearing Loss Is Associated With Decreased Nonverbal Intelligence in Rural Nepal

Infectious Diseases and Vaccine Sciences: Strategic Directions

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