Does single mega-dose vitamin A in early neonatal period reduce mortality during infancy in low- and middle-income countries?

Background: Suboptimal nutritional status of a newborn is a risk factor for short- and long-term morbidity and mortality. The objectives of this review were to assess the efficacy and effectiveness of neonatal synthetic vitamin A supplementation, dextrose gel and probiotic supplementation for prevention of morbidity and mortality during infancy in low and middle-income countries. Methods: We included randomized trials. Primary outcome was all-cause mortality. We conducted electronic searches on multiple databases. Data were meta-analyzed to obtain relative risk (RR) and 95% confidence interval (CI). Studies for vitamin A and Probiotics were analyzed separately. No studies were found for dextrose gel supplementation during neonatal period. The overall rating of evidence was determined by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Sixteen studies assessed the effect of vitamin A supplementation during the neonatal period. Based on pooled data from community-based studies only, there was no significant effect of vitamin A on all-cause mortality at age 1 month (RR 0.99, 95% CI 0.90, 1.08), 6 months (RR 0.98; 95% CI 0.89–1.08) and 12 months (RR 1.04, 95% CI 0.94, 1.14) but increased risk of bulging fontanelle (RR 1.53, 95% CI 1.12, 2.09). The overall quality of evidence was high for the above outcomes. Thirty-three studies assessed the effect of probiotic supplementation during the neonatal period and were mostly conducted in the hospital setting. Probiotics reduced the risk of all-cause mortality (RR 0.80, 95% CI 0.66, 0.96), necrotizing enterocolitis (RR 0.46, 95% CI 0.35, 0.59) and neonatal sepsis (RR 0.78, 95% CI 0.70, 0.86). The grade ratings for the above three outcomes were high. Conclusions: Vitamin A supplementation during the neonatal period does not reduce all-cause neonatal or infant mortality in low and middle-income countries in the community setting. Probiotic supplementation during the neonatal period seems to reduce all-cause mortality, NEC, and sepsis in babies born low birth weight and/or preterm in the hospital setting.

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Potential of pumpkin to combat vitamin A deficiency during complementary feeding in low and middle income countries: variety, provitamin A carotenoid content and retention, and dietary reference intakes

Critical Reviews in Food Science and Nutrition ◽

10.1080/10408398.2021.1896472 ◽

2021 ◽

pp. 1-10

Author(s):

Edward Buzigi ◽

Kirthee Pillay ◽

Muthulisi Siwela

Keyword(s):

Vitamin A ◽

Complementary Feeding ◽

Vitamin A Deficiency ◽

Provitamin A ◽

Carotenoid Content ◽

Middle Income ◽

Middle Income Countries ◽

Dietary Reference Intakes ◽

Low And Middle Income

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Maximising benefits and minimising adverse effects of micronutrient interventions in low- and middle-income countries

Proceedings of The Nutrition Society ◽

10.1017/s0029665119000557 ◽

2019 ◽

Vol 78 (4) ◽

pp. 540-546 ◽

Cited By ~ 1

Author(s):

Kaleab Baye

Keyword(s):

Adverse Effects ◽

Vitamin A ◽

Iron Concentration ◽

Iodine Intake ◽

Micronutrient Deficiencies ◽

Nutrient Deficiencies ◽

Middle Income ◽

Middle Income Countries ◽

Excessive Intake ◽

Low And Middle Income

Micronutrient deficiencies are widespread and disproportionately affect women and children in low- and middle-income countries (LMIC). Among various interventions, food fortification and supplementation with micronutrients have been proven to be cost-effective. The aim of the present paper is to review existing literature to assess risks of excessive intake in LMIC to then highlight programmatic changes required to maximise benefits of micronutrient interventions while minimising risks of adverse effects. While very few LMIC have national food consumption surveys that can inform fortification programmes, many more are implementing mandatory fortification programmes. The risks of inadequate micronutrient intakes were common, but risks of excessive intakes were also present for iodine, vitamin A, folic acid and iron. Excessive salt consumption, high concentrations of iodine in ground-water and excessive levels of iodisation were linked with excessive iodine intake. For vitamin A, overlapping interventions were the main risk for excessive intake; whereas for iron, contamination with iron from soil and screw-wares of millers and high iron concentration in drinking-water increased the risk of excessive intake, which could be further exacerbated with fortification. Before implementing micronutrient interventions, adherence to the basic principles of documenting evidence confirming that the deficiency in question exists and that fortification will correct this deficiency is needed. This can be supported with dietary intake assessments and biochemical screening that help diagnose nutrient deficiencies. Targeting micronutrient interventions, although programmatically challenging, should be considered whenever possible. Moreover, closer monitoring of appropriate fortification of foods and overlapping interventions is needed.

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Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd006980.pub3 ◽

2017 ◽

Cited By ~ 11

Author(s):

Batool A Haider ◽

Renee Sharma ◽

Zulfiqar A Bhutta

Keyword(s):

Vitamin A ◽

Vitamin A Supplementation ◽

Middle Income ◽

Term Neonates ◽

Mortality And Morbidity ◽

Middle Income Countries ◽

Low And Middle Income

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Consumption of Vitamin-A-Rich Foods and Vitamin A Supplementation for Children under Two Years Old in 51 Low- and Middle-Income Countries

Nutrients ◽

10.3390/nu14010188 ◽

2021 ◽

Vol 14 (1) ◽

pp. 188

Author(s):

Omar Karlsson ◽

Rockli Kim ◽

Andreas Hasman ◽

S. V. Subramanian

Keyword(s):

Vitamin A ◽

Dietary Diversity ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

Vitamin A Supplementation ◽

Middle Income ◽

Persistent Problem ◽

Middle Income Countries ◽

Minimum Dietary Diversity ◽

Low And Middle Income

Vitamin A supplementation for children 6–59 months old is an important intervention that boosts immune function, especially where children do not consume enough vitamin-A-rich foods. However, the low coverage of vitamin A supplementation is a persistent problem in low- and middle-income countries. We first estimated the percentage of children 6–23 months old receiving the minimum dietary diversity, vitamin-A-rich foods, and vitamin A supplementation, and second, the difference in the percentage receiving vitamin A supplementation between children 6–23 months old and children 24–59 months old using nationally representative cross-sectional household surveys, namely, the Demographic and Health Surveys, conducted from 2010 to 2019 in 51 low- and middle-income countries. Overall, 22% (95% CI: 22, 23) of children received the minimum dietary diversity, 55% (95% CI: 54, 55) received vitamin-A-rich foods, 59% (95% CI: 58, 59) received vitamin A supplementation, and 78% (95% CI: 78, 79) received either vitamin-A-rich foods or supplementation. A wide variation across countries was observed; for example, the percentage of children that received either vitamin-A-rich foods or supplementation ranged from 53% (95% CI: 49, 57) in Guinea to 96% (95% CI: 95, 97) in Burundi. The coverage of vitamin A supplementation should be improved, especially for children 6–23 months old, in most countries, particularly where the consumption of vitamin-A-rich foods is inadequate.

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