Randomized controlled safety and efficacy trial of 2 vitamin A supplementation schedules in Tanzanian infants

Abstract

Background: Vitamin A supplementation reduces morbidity and mortality in children living in areas endemic for vitamin A deficiency. Routine vitamin A supplementation usually starts only at age 9 mo, but high rates of illness and mortality are seen in the first months of life. Objective: The objective of the study was to evaluate the safety and efficacy of vitamin A supplementation at the same time as routine vaccination in infants aged 1-3 mo. Design: We recruited 780 newborn infants and their mothers to a randomized double-blind controlled trial in Ifakara in southern Tanzania. In one group, mothers received 60 000 μg vitamin A palmitate shortly after delivery, and their infants received 7500 μg at the same time as vaccinations given at ≈1, 2, and 3 mo of age. In the other group, mothers received a second 60 000-μg dose when their infant was aged 1 mo, and their infants received 15 000 μg at the same time as the routine vaccinations. VAD was defined as a modified relative dose-response test result of ≥0.060. Results: High-dose vitamin A supplementation was well tolerated. The relative risk of VAD at 6 mo in the high-dose group compared with the lower dose group was 0.91 (95% CI: 0.76, 1.09; P = 0.32). Serum retinol and incidence of illness did not differ significantly between the 2 groups. Some vitamin A capsules degraded toward the end of the study. Conclusions: Doubling the doses of vitamin A to mothers and their young infants is safe but unlikely to reduce short-term morbidity or to substantially enhance the biochemical vitamin A status of infants at age 6 mo. The stability of vitamin A capsules merits further investigation. © 2007 American Society for Nutrition.