Article type
Year
Abstract
Introduction: Measles is a leading cause of childhood morbidity and mortality in developing countries and vitamin A deficiency is a recognised risk factor for severe measles. The review aims to determine whether vitamin A given to children after measles has been diagnosed is beneficial in preventing morbidity and mortality.
Objectives:
Methods: The search strategy used was developed for the Acute Respiratory Infections Group, which included The Cochrane Library, Issue 1, 1999. Twenty eight studies were assessed independently by two reviewers using the Jadad method for assessing the quality of trials ie randomisation, blinding and intention to treat in the analysis. In the meta-analysis administration of vitamin A was compared with placebo. Summary estimates of effect (using Peto odds ratios) were calculated across studies for morbidity (incidence of pneumonia, diarrhoea, croup) and mortality. Five of the 28 studies met the selection criteria and were included in the review. Data was extracted from each trial for analysis by intention to treat. Trialists have been contacted for missing data.
Results: Vitamin supplementation reduced mortality by almost 50% when given to patients hospitalised with measles in addition to routine treatment 0.51 (95% CI 0.27, 0.97). When the one study of non-hospitalised patients is included, the mortality reduction is 40% but not statistically significant 0.61 (95% CI 0.35, 1.07). Vitamin A supplementation had a significant effect (62% reduction on mortality) in areas where the case fatality rate was greater than 10%, 0.38 (95% CI 0.18, 0.80). The effect of vitamin A supplementation was more pronounced on children under two years of age 0.23 (95% CI 0.09, 0.57). Of the 39 deaths in 4 studies in which the cause of death was known, 29 (74%) were due to pneumonia. Even though pneumonia was the leading cause of death and there was reduction in the number of pneumonia deaths in the treatment group this was not statistically significant (0.51, 95% CI 0.26, 1.15). The development of complications like croup was lower in the vitamin A group 0.52 (95% CI 0.29, 0.95). The severity of illness was also less in the vitamin A group as the duration of pneumonia decreased by 2 days and duration of diarrhoea decreased by 1.4 days. Further information on incidence of diarrhoea and pneumonia has been requested from authors.
Discussion: Evidence of reduction in mortality in children with measles supplemented with vitamin A was seen only in hospitalised patients and in children under the age of two years. Vitamin A supplementation also reduced the incidence of complications like croup and the severity of illness as seen in the decreased duration of pneumonia and diarrhoea.
Objectives:
Methods: The search strategy used was developed for the Acute Respiratory Infections Group, which included The Cochrane Library, Issue 1, 1999. Twenty eight studies were assessed independently by two reviewers using the Jadad method for assessing the quality of trials ie randomisation, blinding and intention to treat in the analysis. In the meta-analysis administration of vitamin A was compared with placebo. Summary estimates of effect (using Peto odds ratios) were calculated across studies for morbidity (incidence of pneumonia, diarrhoea, croup) and mortality. Five of the 28 studies met the selection criteria and were included in the review. Data was extracted from each trial for analysis by intention to treat. Trialists have been contacted for missing data.
Results: Vitamin supplementation reduced mortality by almost 50% when given to patients hospitalised with measles in addition to routine treatment 0.51 (95% CI 0.27, 0.97). When the one study of non-hospitalised patients is included, the mortality reduction is 40% but not statistically significant 0.61 (95% CI 0.35, 1.07). Vitamin A supplementation had a significant effect (62% reduction on mortality) in areas where the case fatality rate was greater than 10%, 0.38 (95% CI 0.18, 0.80). The effect of vitamin A supplementation was more pronounced on children under two years of age 0.23 (95% CI 0.09, 0.57). Of the 39 deaths in 4 studies in which the cause of death was known, 29 (74%) were due to pneumonia. Even though pneumonia was the leading cause of death and there was reduction in the number of pneumonia deaths in the treatment group this was not statistically significant (0.51, 95% CI 0.26, 1.15). The development of complications like croup was lower in the vitamin A group 0.52 (95% CI 0.29, 0.95). The severity of illness was also less in the vitamin A group as the duration of pneumonia decreased by 2 days and duration of diarrhoea decreased by 1.4 days. Further information on incidence of diarrhoea and pneumonia has been requested from authors.
Discussion: Evidence of reduction in mortality in children with measles supplemented with vitamin A was seen only in hospitalised patients and in children under the age of two years. Vitamin A supplementation also reduced the incidence of complications like croup and the severity of illness as seen in the decreased duration of pneumonia and diarrhoea.