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Vitamin A with vaccines after 6 months does not improve survival

WHO recommends utilizing vaccination contacts to deliver high-dose vitamin A supplementation to children aged 6-59 months. The effect of this policy on overall child mortality has not been assessed. We found no overall benefit of this policy in a randomised trial in Guinea-Bissau, but a strong sex-differential effect; vitamin A was beneficial for gorls, bur associated with increased mortality for boys.

We conducted the first randomized controlled trial assessing the effect of VAS at routine vaccination contacts after 6 months of age. Among 7587 children VAS had no overall effect on mortality, but was associated with reduced female mortality and increased male mortality. Given the lack of an overall effect, more randomized trials are warranted to justify the WHO policy. We need to examine whether the beneficial effect of VAS has waned over time and to identify when VAS is beneficial. Importantly we need to ensure that we do not give VAS when it might be harmful.