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Children in developing countries who have
HIV, malaria or diarrhea-causing ailments can end up with
stunted growth. But according to new research, supplementing
the diets of these children with high doses of vitamin A every
4 months can help them grow properly.
The findings point to a low-cost way to
improve the health of HIV-infected children in nations where
antiviral medication may be unavailable or prohibitively expensive.
Although the ideal way to prevent vitamin
A or any other nutrient deficiency is guaranteeing that all
the population have sustained access to a complete diet, supplementation
is a useful public health intervention in many cases.
The study included 554 Tanzanian children
aged 6 months to 5 years who were hospitalized with pneumonia.
Patients received 200,000 international units (IU) of vitamin
A if they were older than 1 year or 100,000 IU if they were
under 1 year, or an inactive pill (placebo) on the day they
checked into the hospital. The following day, children received
a second dose, followed by a third and fourth dose 4 and 8
months after leaving the hospital.
While the levels of vitamin A given to
sick children in the study are extremely high, a single dose
is unlikely to cause the headache, vomiting, skin and bone
abnormalities or liver damage associated with sustained intake
of such doses.
The researchers recorded the children's
height, weight and arm circumference, a measure of body fat,
at the beginning of the study and at monthly intervals over
a year.
HIV-infected children younger than 18
months who received vitamin A grew significantly more in height,
compared with their peers who took the placebo. After 4 months,
vitamin-supplemented infants had grown an average of nearly
3 centimeters (cm) more than infants who had taken the placebo.
Similarly, vitamin A-supplemented infants with malaria younger
than 12 months gained significantly more weight than their
peers who did not receive vitamin A.
The vitamin supplements had no discernible
effects on children without malaria, however. Additionally,
vitamin A nearly eliminated the risk of stunting associated
with persistent diarrhea lasting at least 14 days.
Vitamin A supplementation every 4 months
to children younger than 5 years of age is likely to improve
the pattern of growth in populations with high incidence of
infectious diseases including HIV, malaria, persistent diarrhea,
and dysentery.
Requirements for vitamin A in infants
and children may vary according to underlying medical conditions
and nutrient deficiencies. Among healthy infants, the recommended
dietary allowance is about 375 micrograms or 1250 IUs.
The administration of a single dose at
4 monthly intervals is very well tolerated in children and
is within the safety range recommended by international agencies
for supplementation programs.
Pediatrics
Online January 2002;109:e6
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