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Summary of article findings: Is routine Vitamin A supplementation still justified for children in Nepal? Trial synthesis findings applied to Nepal national mortality estimates

Shreshta et al. PLoS One 2022 May 18;17(5):e0268507.  

doi: 10.1371/journal.pone.0268507. eCollection 2022

https://pubmed.ncbi.nlm.nih.gov/35584136/

Preventing child deaths by giving Vitamin A in countries of Africa and Asia has been a routine for over twenty years, but has the time come when we can safely stop this? Nepal has been distributing large amounts of supplements to children since its start in 1993 covering approximately 2.7 million children twice a year. The country spending is high to procure distribution of Vitamin A, and researchers at the Birat Nepal Medical Trust, working with colleagues from the Centre for Evidence Synthesis in Global Health at the Liverpool School of Tropical Medicine, decided to look at this more closely to see if continuation of the population-wide programme is still justified. When routine vitamin A supplementation was started in Nepal in 1993, the country was a lot poorer and the health, nutrition, vaccination coverage and access to healthcare of the population was very low, and so vitamin A supplementation was needed. However, Nepal has developed substantially in the last two decades and it is now time to consider if the population-wide supplementation is still a good use of health spending.

The authors meta-analysed 6 high quality trials, which carefully compared groups of children receiving vitamin A with those who did not. These studies showed that there was a 9% reduction in child mortality, but this fell to 4% when the problems for studies that had not been published was corrected for. The researchers analysed this effect in the context of Nepal today, with the dramatically reduced under five death rate. This analysis suggested routine vitamin A supplementation prevents between 1 and 4 deaths in every 1,000 children supplemented during childhood.

The authors conclude that in Nepal routine Vitamin A supplementation to every child is no longer the most effective way to reduce child mortality and that it could be stopped. This doesn’t mean areas that have high rates are not supplemented, said Khem Pokhrel, senior author on the report, or children that clearly are deficient: it just means we don’t have to give it to all children every year. This will free up resources, time and energy for other things that do make a difference to children’s lives.

This publication is associated with the Research, Evidence and Development Initiative (READ-It). READ-It (project number 300342-104) is funded by UK Aid from the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies.

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