Vitamin A supplementation and child mortality. A meta-analysis

JAMA. 1993 Feb 17;269(7):898-903.


Objective: A two-part meta-analysis of studies examining the relationship of vitamin A supplementation and child mortality.

Data sources: We identified studies by searching the MEDLARS database from 1966 through 1992 and by scanning Current Contents and bibliographies of pertinent articles.

Study selection: All 12 vitamin A controlled trials with data on mortality identified in the search were used in the analysis.

Data extraction: Data were independently extracted by two investigators who also assessed the quality of each study using a previously described method.

Data synthesis: We formally tested for heterogeneity across studies. We pooled studies using the Mantel-Haenszel and the DerSimonian and Laird methods and adjusted for the effect of cluster assignment of treatment groups in community-based studies. Vitamin A supplementation to hospitalized measles patients was highly protective against mortality (DerSimonian and Laird odds ratio, 0.39; 95% confidence interval, 0.22 to 0.66; P = .0004) (part 1 of the meta-analysis). Supplementation was also protective against overall mortality in community-based studies (DerSimonian and Laird odds ratio, 0.70; clustering-adjusted 95% confidence interval, 0.56 to 0.87; P = .001) (part 2 of the meta-analysis).

Conclusions: Vitamin A supplements are associated with a significant reduction in mortality when given periodically to children at the community level. Factors that affect the bioavailability of large doses of Vitamin A need to be studied further. Vitamin A supplements should be given to all measles patients in developing countries whether or not they have symptoms of vitamin A deficiency.

Publication types

  • Clinical Trial
  • Meta-Analysis
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant Mortality*
  • Male
  • Measles / mortality*
  • Measles / therapy
  • Vitamin A / administration & dosage*
  • Vitamin A / therapeutic use
  • Vitamin A Deficiency / mortality
  • Vitamin A Deficiency / prevention & control


  • Vitamin A