Vitamin A Supplementation but Not Deworming Improves Growth of Malnourished Preschool Children in Eastern Zaire

Donnen, Philippe; Brasseur, Daniel; Dramaix, Michèle; Vertongen, Françoise; Zihindula, Mweze; Mbasha, Muhamiriza; Hennart, Philippe

doi:10.1093/jn/128.8.1320

Cited by 59 publications

(54 citation statements)

References 22 publications

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“…30 Donnen et al found that although vitamin A supplementation improved the growth of malnourished pre-school children, de-worming had no impact. 41 Our study results re ect this mixed picture. While previous studies have shown improvement in school achievement and cognitive tests following de-worming programmes, 3,39 de-worming 7-12-year-old rural Guatemalan children with high parasite loads failed to affect their school performance.…”

Section: Discussionmentioning

confidence: 51%

A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children

Jinabhai

Taylor

Coutsoudis

et al. 2001

Annals of Tropical Paediatrics

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Single interventions for helminthic infections and micronutrient deficiencies are effective, but it is not clear whether combined interventions will provide equal, additive or synergistic effects to improve children's health. The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children. A double-blind, randomized, placebo-controlled trial in 11 rural South African primary school randomly allocated 579 children aged between 8 and 10 years into six study groups, half of whom received antihelminthic treatment at baseline. The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits, either unfortified or fortified with vitamin A and iron or with vitamin A only, given daily for 16 weeks. The outcome measures were anthropometric, micronutrient and parasite status, and scholastic and cognitive test scores. There was a significant treatment effect of vitamin A on serum retinol (p < 0.01), and the suggestion of an additive effect between vitamin A fortification and de-worming. Fortified biscuits improved micronutrient status in rural primary school children; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection. The burden of micronutrient deficiency (anaemia, iron and vitamin A) and stunting in this study population was low and, coupled with the restricted duration of the intervention (16 weeks), might have limited the impact of the interventions.

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Section: Discussionmentioning

confidence: 51%

A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children

Jinabhai

Taylor

Coutsoudis

et al. 2001

Annals of Tropical Paediatrics

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“…Only one trial included children with SAM exclusively [19]. The remaining 14 included non-malnourished and malnourished children [20-33]. VA dosing also varied; only five trials administered the recommended high-dose on day 1 [19,26,30,31,33], while the remaining administered VA doses in varying quantities and forms.…”

Section: Resultsmentioning

confidence: 99%

Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutrition

Iannotti

Trehan

Manary

2013

Nutr J

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BackgroundWorld Health Organization (WHO) guidelines recommend for children with severe acute malnutrition (SAM), high-dose vitamin A (VA) supplements be given on day 1 of admission, and on days 2 and 14 in the case of clinical signs of vitamin A deficiency (VAD). Daily low-dose VA follows, delivered in a premix added to F-75 and F-100. This study aimed to systematically review the evidence for safety and effectiveness of high-dose VA supplementation (VAS) in treatment of children with SAM.MethodsA comprehensive literature review was undertaken for all relevant randomized controlled trials (RCT) and observational studies from 1950 to 2012. Studies identified for full review were evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology using a set of pre-defined criteria: indirectness; inconsistency; imprecision; and study limitations. A quality rating of high, moderate, or low was then assigned to each study, and only those attaining moderate to high were considered in making recommendations.ResultsOf the 2072 abstracts screened, 38 met criteria for full review, and 20 were rated moderate to high quality. Only one study replicated the WHO VA protocol in children with SAM. Indirectness was a critical limitation, as studies were not exclusive to children with SAM. There was inconsistency across trials for definitions of malnutrition, morbidities, and ages studied; and imprecision arising from sub-group analyses and small sample sizes. Evidence showed improved outcomes associated with low-dose compared to high-dose VAS, except in cases presenting with signs of VAD, measles, and severe diarrhea or shigellosis. Adverse outcomes related to respiratory infection, diarrhea, and growth were associated with high-dose VAS in children who were predominantly adequately nourished. No adverse effects of the high dose were found in children with SAM in the trial that replicated the WHO VA guideline.ConclusionThis is the first systematic review of the safety and efficacy of high-dose VAS in treatment of SAM. We recommend a low-dose VAS regimen for children with SAM, except in cases presenting with measles, severe diarrhea (shigellosis), and any indication of VAD. Further research is needed in exclusively malnourished children and to explore alternate delivery strategies.

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“…An additional four multiple dose trials recorded data after their first treatment dose, and these data were included in the single dose analysis 19 22 40 45. A subsequent sensitivity analysis that excluded data from these four multiple dose trials did not show any change in effect trends.…”

Section: Resultsmentioning

confidence: 99%

Effects of treatment for intestinal helminth infection on growth and cognitive performance in children: systematic review of randomised trials

Dickson

Awasthi²,

Williamson³

et al. 2000

BMJ

188

131

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Objective To summarise the effects of anthelmintic drug treatment on growth and cognitive performance in children. Results Thirty randomised controlled trials in more than 15 000 children were identified. Effects on mean weight were unremarkable, and heterogeneity was evident in the results. There were some positive effects on mean weight change in the trials reporting this outcome: after a single dose (any anthelmintic) the pooled estimates were 0.24 kg (95% confidence interval 0.15 kg to 0.32 kg; fixed effects model assumed) and 0.38 kg (0.01 kg to 0.77 kg; random effects model assumed). Results from trials of multiple doses showed mean weight change in up to one year of follow up of 0.10 kg (0.04 kg to 0.17 kg; fixed effects) or 0.15 kg (0.00 to 0.30; random effects). At more than one year of follow up, mean weight change was 0.12 kg (−0.02 kg to 0.26 kg; fixed effects) and 0.43 (−0.61 to 1.47; random effects). Results from studies of cognitive performance were inconclusive. Conclusions There is some limited evidence that routine treatment of children in areas where helminths are common has effects on weight gain, but this is not consistent between trials. There is insufficient evidence as to whether this intervention improves cognitive performance. Data sources

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Vitamin A Supplementation but Not Deworming Improves Growth of Malnourished Preschool Children in Eastern Zaire

Cited by 59 publications

References 22 publications

A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children

A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children

Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutrition

Effects of treatment for intestinal helminth infection on growth and cognitive performance in children: systematic review of randomised trials

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