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Presentation by Emily Smith and Jessica Stevens

Newborn Vitamin A Supplementation Reduced Infant Mortality in Rural Bangladesh Rolf D. W. Klemm, Alain B. Labrique, Parul Christian, Mahbubur Rashid, Abu Ahmed Shamim, Joanne Katz, Alfred Sommer, Keith P. West, Jr. Pediatrics. 2008 Jul;122(1): e242-e250.

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Presentation by Emily Smith and Jessica Stevens

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  1. Newborn Vitamin A Supplementation Reduced Infant Mortality in Rural BangladeshRolf D. W. Klemm, Alain B. Labrique, Parul Christian, Mahbubur Rashid, Abu Ahmed Shamim, Joanne Katz, Alfred Sommer, Keith P. West, Jr. Pediatrics. 2008 Jul;122(1): e242-e250. Presentation by Emily Smith and Jessica Stevens

  2. “Vitamin A deficiency affects about 19 million pregnant women and 190 million preschool- age children, mostly from the World Health Organization (WHO) regions of Africa and South East Asia. Infants and children have increased vitamin A requirements to support rapid growth and to help them combat infections.” WHO, 2011

  3. What is known? “Previous evidence from South Asia has shown that providing vitamin A to infants at or near birth in deficient populations can reduce infant mortality.” • Humphrey et al. 1996 & Rahmathullah et al, 2003 • Gaibandha and Rangpur regions of Bangladesh is an area identified with a high prevalence of maternal night blindness • Purpose: add to current literature

  4. About JitVitA-2 • Nested into another supplementation trial among pregnant women underway since 2001, to evaluate effects on pregnancy-related mortality • Infants born to consenting mothers from the earlier trial were eligible for inclusion in this study • Community-based, double-blind, cluster- randomized, placebo controlled trial • Goal: Enroll ~20,000 infants; dose newborns with 50,000 IU of vitamin A or placebo oil as soon as possible after birth

  5. JiVitA-2: The Approach • 9 weeks: Interview related to household socio-demographics, etc. • 28 weeks: Seek consent to dose newborn with vitamin A or a placebo; give mother a health card with recommended newborn care practices • 32 weeks: Maternal health assessment • Birth: Live-born infants visited by field staff (median age of 7 hrs) and administered oral 50,000 IU dose of vitamin A or placebo. • Female anthropometrist visited newborns (median age of 18 hrs) to gather anthropometric data and ask about fontanelle bulge (sign of toxicity). • 3 months post-partum: maternal health assessment • Vital stats and risk factors (e.g. breastfeeding) assessed weekly for first 12 weeks, then once more at 24 weeks of life

  6. Results • In total, 15,937 infants were included in the study's findings (n vitamin A = 7953; n placebo = 7984) • Maternal factors (age, parity, upper arm circumference, serum retinol concentrations, SES status, etc.) and birth factors (weight, place of birth, term, etc.) were all measured and evaluated • Parent self-reporting of infant status throughout 24wk was also assessed

  7. Results, cont. • Total of 666 infants died by 24wk of age; presenting mortality rates of 38.5 and 45.1 per 1000 live births in vitamin A-supplemented and placebo-supplemented, respectively • Relative Risk (RR) for mortality in the vitamin A supplemented group was 0.85 (95% CI: 0.73-1.00; P = 0.45), indicating a protective effect • Survival probabilities in the 2 infant groups were significantly different (P = 0.37)

  8. Infant survival through 24 weeks

  9. Conclusions & Implications • Newborn vitamin A supplementation of 50,000 IU may reduce infant mortality by ~15% or more • Adds to the growing evidence in current literature about the possible causes of high infant mortality in many southern Asian regions, and the consequences of vitamin A deficiency • Research benefits global health intervention in developing countries

  10. Limitations & Further Research • Klemm et al unable to distinguish any risk factor strata from the collected SES or birth data (birth weight, gender, place of birth, etc.) on the effects of vitamin A and infant survival • "Nested" study design within maternal supplementation trial • Self-reported data collection from mothers/parents on infant's health status through 24wk • Other factors should be further researched to evaluate effects on varying population's responsiveness to vitamin A supplementation

  11. Question • What 2 protective functions of vitamin A might play a role in reducing infant mortality in developing countries? • Maintenance of epithelial integrity • Immune competence

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