Vitamin A supplementation during war-emergency in Guinea-Bissau 1998-1999

Acta Trop. 2005 Mar;93(3):275-82. doi: 10.1016/j.actatropica.2004.11.007.


Background: Vitamin A supplementation is recommended by WHO in emergency situations.

Objective: To evaluate the impact of Vitamin A supplementation on childhood mortality in an emergency situation.

Design: Since this was not a randomised study, we evaluated the impact in different ways; we used the variation in the delay of provision of Vitamin A in a step-wedged design, compared wartime with pre-wartime mortality and examined whether Vitamin A as a free commodity reduced cultural and social-economic inequalities in childhood mortality.

Subjects: 5926 children 6 months to 5 years of age, resident in four suburbs in the capital of Guinea-Bissau between October 1, 1998 and March 31, 1999.

Interventions: From October 1, 1998 until the end of the war in 1999 all children present in the study area were offered Vitamin A at regular three-monthly visits to their homes.

Results: Using the variation in the provision of Vitamin A, we found a slight non-significant reduction in mortality for children between 6 months and 5 years of age (mortality ratio (MR) 0.49; 95% CI 0.09-2.70). Comparing with a three-year period before the war, children offered Vitamin A at home during the war had a 12% reduction in mortality (MR 0.88; 0.41-1.87), whereas the overall impact of the war was an 89% increase in mortality (MR 1.89; 1.32-2.71). Vitamin A supplementation was associated with a reduction in cultural and socio-economic inequalities.

Conclusions: Vitamin A supplementation may have a beneficial impact on childhood mortality in an emergency situation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Altruism
  • Child Mortality*
  • Child, Preschool
  • Emergencies
  • Guinea-Bissau
  • Humans
  • Infant
  • Malnutrition / drug therapy*
  • Social Class
  • Vitamin A / therapeutic use*
  • Warfare*


  • Vitamin A