Efficacy of vitamin A in reducing preschool child mortality in Nepal

Lancet. 1991 Jul 13;338(8759):67-71. doi: 10.1016/0140-6736(91)90070-6.


Community trials of the efficacy of vitamin A supplementation in reducing preschool childhood mortality have produced conflicting results. To resolve the question, a randomised, double-masked, placebo-controlled community trial of 28,630 children aged 6-72 months was carried out in rural Nepal, an area representative of the Gangetic flood plain of South Asia. Randomisation was carried out by administrative ward; the vitamin-A-supplemented children received 60,000 retinol equivalents every 4 months and placebo-treated children received identical capsules containing 300 retinol equivalents. After 12 months, the relative risk of death in the vitamin-A-supplemented compared with the control group was 0.70 (95% confidence interval 0.56-0.88), equivalent to a 30% reduction in mortality. The trial, which had been planned to last 2 years, was discontinued. The reduction in mortality was present in both sexes (relative risk for boys 0.77; for girls 0.65), at all ages (range of relative risks 0.83-0.50), and throughout the year (0.76-0.67). The reduction in mortality risk was not affected by acute nutritional status, as measured by arm circumference. Thus, periodic vitamin A delivery in the community can greatly reduce child mortality in developing countries.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Capsules
  • Cause of Death*
  • Child, Preschool
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Evaluation
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Nepal
  • Nutritional Status / drug effects
  • Risk Factors
  • Rural Health
  • Survival Analysis
  • Vitamin A / administration & dosage
  • Vitamin A / therapeutic use*
  • Vitamin A Deficiency / mortality
  • Vitamin A Deficiency / prevention & control*


  • Capsules
  • Vitamin A