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The impact of different doses of vitamin A supplementation on male and female mortality. A randomised trial from Guinea-Bissau.

ABSTRACT: Vitamin A supplementation (VAS) given to children between 6 months and 5 years of age is known to reduce mortality in low-income countries. We have previously observed that girls benefit more from a lower dose of VAS than the one recommended by WHO, the effect being strongest if diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccination. We aimed to test these observations.During national immunisations days in Guinea-Bissau, West Africa, combining oral polio vaccination and VAS, we randomised 8626 children between 6 months and 5 years of age to receive the dose of VAS recommended by WHO or half this dose. Mortality rate ratios (MRRs) were assessed after 6 and 12 month.The overall mortality rate among participants was lower than expected. There was no significant difference in mortality at 6 months and 12 months of follow up between the low dose VAS group and the recommended dose VAS group. The MRRs were 1.23 (0.60-2.54) after 6 months and 1.17 (0.73-1.87) after 12 months. This tendency was similar in boys and girls. The low dose was not associated with lower mortality in girls if the most recent vaccine was DTP (MRR = 0.60 (0.14-2.50) after 6 months).Our sample size does not permit firm conclusions since mortality was lower than expected. We could not confirm a beneficial effect of a lower dose of VAS on mortality in girls.The study was registered under clinicaltrials.gov, number NCT00168636.

SUBMITTER: Yakymenko D

PROVIDER: S-EPMC3175170 | biostudies-literature | 2011 Sep

REPOSITORIES: biostudies-literature

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The impact of different doses of vitamin A supplementation on male and female mortality. A randomised trial from Guinea-Bissau.

Yakymenko Dorthe D Benn Christine S CS Martins Cesario C Diness Birgitte R BR Fisker Ane B AB Rodrigues Amabelia A Aaby Peter P

BMC pediatrics 20110901

<h4>Background</h4>Vitamin A supplementation (VAS) given to children between 6 months and 5 years of age is known to reduce mortality in low-income countries. We have previously observed that girls benefit more from a lower dose of VAS than the one recommended by WHO, the effect being strongest if diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccination. We aimed to test these observations.<h4>Methods</h4>During national immunisations days in Guinea-Bissau, West Africa, combini ...[more]

PMID: 21884606

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Project description:OBJECTIVE:In Guinea-Bissau, West Africa, we observed that having a smallpox vaccination scar was associated with lower HIV-1 prevalence, more strongly for women than men. If this represents a causal effect, the female/male HIV-1 prevalence ratio would increase for birth cohorts no longer receiving smallpox vaccination due to the phase-out of this vaccine. DESIGN:An ecological design using HIV surveys and information about smallpox vaccination coverage. SETTING:Urban and rural Guinea-Bissau. PARTICIPANTS:Participants in HIV surveys were grouped into an age group with decreasing smallpox vaccination coverage (15-34 years) and an age group with steady smallpox vaccination coverage (?35 years). INTERVENTIONS:The exposure of interest was the phase-out of the smallpox vaccine in Guinea-Bissau. PRIMARY AND SECONDARY OUTCOME MEASURES:HIV-1 prevalence. RESULTS:At both sites, the female/male HIV-1 prevalence ratio increased by calendar time for the age group with decreasing smallpox vaccination coverage; the combined female/male HIV-1 prevalence ratio among people aged 15-34 years was 1.00 (95% CI 0.17 to 5.99) in 1987-1990, 1.16 (95% CI 0.69 to 1.93) in 1996-1997, 2.32 (95% CI 1.51 to 3.56) in 2006-2007 (p value for no trend=0.04). There was no increase in the female-to-male HIV-1 prevalence ratio for the age group >35 years with steady smallpox vaccination coverage; 1.93 (95% CI 0.40 to 9.25) in 1987-1990, 1.32 (95% CI 0.83 to 2.10) in 1996-1997, 0.81 (95% CI 0.56 to 1.16) in 2006-2007 (p value for no trend=0.07). CONCLUSIONS:Thus, data was compatible with the deduction that the phase-out of smallpox vaccination may have increased the susceptibility to HIV-1 relatively more for women than men. Hence, phasing out smallpox vaccination may have contributed to the global increase in the female/male HIV-1 prevalence ratio among young individuals. Due to the potential fallacies of ecological studies, the results should be interpreted carefully, and this hypothesis needs further assessment. If the hypothesis is true, studies of smallpox vaccination could inform HIV-1 vaccine research.

Dataset Information

The impact of different doses of vitamin A supplementation on male and female mortality. A randomised trial from Guinea-Bissau.

Publications

The impact of different doses of vitamin A supplementation on male and female mortality. A randomised trial from Guinea-Bissau.

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