Xerophthalmia: a study among malnourished children of West Mednipur District

To study the correlation of stages of xerophthalmia in different grades of malnutrition, having 200 children clinically diagnosed having malnutrition as per criteria laid down by the Indian Academy of Pediatrics (IAP) were examined to detect the dinical stages of xerophthalmia as proposed by World Health Organisation (WHO). Out of 200 cases with different grades of malnutrition 81 (40.5%), 78 (39.0%), 22 (11.0%) and 19 (9.5%) were found malnourished in grades I, II, III, and IV respectively. Night blindness was earliest feature and seen in 97 cases (48.5%). All the 97 cases of night blindness fell in group of X(N) in which one case had corneal scar and falls in the group of X(S) in clinical staging of xerophthalmia. Thirty-nine (40.2%), 35 (36.1%), 19 (19.6%), 3 (3.1%) and (1.1%) were in clinical stages of xerophthalmia of X(1A), X(1B), X2, X(3A), X(3B)respectively. Severity of xerophthalmia was found directly proportional to severity of malnutrition.

Vitamin A deficiency and child mortality in Mozambique

BACKGROUND

In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average.

OBJECTIVES

To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations.

METHODS

The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD=1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births).

RESULTS

In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30,000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group.

DISCUSSION

Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers' training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.

One-time vitamin A supplementation of lactating sows enhances hepatic retinol in their offspring independent of dose size

BACKGROUND

Single megadoses of vitamin A between 200,000 and 400,000 IU have been administered to lactating mothers to improve the vitamin A status of both mothers and breastfeeding infants. However, the most beneficial dosing regimen is not known.

OBJECTIVE

The effect of megadoses of vitamin A supplements given to lactating sows on hepatic vitamin A concentrations in their nursing offspring was examined.

DESIGN

Lactating sows were given a high (2.1 mmol), low (1.05 mmol), or control (0 mmol) dose of retinyl acetate in oil (n=3 sows per treatment). Piglets nursed for 3 or 14 d, consumed a vitamin A-free diet for the next 4 d, and were then killed. Liver and serum samples were analyzed for vitamin A.

RESULTS

After 3 d, piglets of the control, low-dose, and high-dose sows had different (P=0.034) hepatic vitamin A concentrations, ie, 0.078+/-0.004, 0.14+/-0.053, and 0.13+/-0.026 micromol/g, respectively. Liver vitamin A concentrations on day 18 were 0.069+/-0.004, 0.14+/-0.044, and 0.11+/-0.026 micromol/g in the control, low-dose, and high-dose piglets, respectively (P=0.017). Liver vitamin A concentrations in piglets of the low- and high-dose sows were not significantly different (day 3: P=0.97; day 18: P=0.59). Serum retinol concentrations were higher (P=0.02) at early kill (0.95+/-0.22 micromol/L) than at late kill (0.76+/-0.24 micromol/L) but were not significantly different between groups.

CONCLUSIONS

Maternal vitamin A supplementation enhances liver vitamin A concentrations in offspring. Larger one-time doses are not more effective than are smaller doses. Additional research is needed to determine the most effective maternal dosing regimens for improving infant vitamin A status.

Effect of postpartum maternal or neonatal vitamin A supplementation on infant mortality among infants born to HIV-negative mothers in Zimbabwe

BACKGROUND

Young infants are at risk of vitamin A deficiency. Supplementation of breastfeeding mothers improves the vitamin A status of their infants, but there are no data regarding its effect on infant mortality, and data on the effect of directly supplementing infants during the first few weeks of life are conflicting.

OBJECTIVE

The objective was to measure the effect on infant mortality of supplementing neonates and their HIV-negative mothers with single, large doses of vitamin A during the immediate postpartum period.

DESIGN

A randomized, placebo-controlled, 2-by-2 factorial design trial was conducted in 14,110 mothers and their infants; 9208 of the mothers were HIV-negative at delivery, remained such during the postpartum year, and were retained in the current analysis. The infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A (Aa), mothers received vitamin A and infants received placebo (Ap), mothers received placebo and infants received vitamin A (Pa), and both mothers and infants received placebo (Pp). The vitamin A dose in the mothers was 400,000 IU and in the infants was 50,000 IU. The mother-infant pairs were followed to 12 mo.

RESULTS

Hazard ratios (95% CI) for 12 mo mortality among infants in the maternal-supplemented and infant-supplemented groups were 1.17 (0.87, 1.58) and 1.08 (0.80, 1.46), respectively. Hazard ratios (95% CI) for the Aa, Ap, and Pa groups compared with the Pp group were 1.28 (0.83, 1.98), 1.27 (0.82, 1.97), and 1.18 (0.76, 1.83), respectively. These data indicate no overall effect. Serum retinol concentrations among a subsample of women were similar to reference norms.

CONCLUSION

Postpartum maternal or neonatal vitamin A supplementation may not reduce infant mortality in infants of HIV-negative women with an apparently adequate vitamin A status.

[Revalence of vitamin deficiency in Tajik children]

A research of estimating the prevalence og vitamin A deficiency in Tajik children was made. At revealed that 51.8% of children of age 6-59 months suffer from vitamin A defficiency. 97.4% of the examined pregnant women have no information at all about vitamin A and didnit take any vitamins including vitamin A.

The National Vitamin A Supplementation Program and Subclinical Vitamin A Deficiency among Preschool Children in the Philippines

The prevalence of vitamin A deficiency (serum retinol [SR] < 20 μg/dl) in children from one to five years of age in the Philippines rose from 35.8% to 38% between 1993 and 1998, despite a twice-yearly universal vitamin A capsule distribution program. The Philippines 1998 National Nutrition Survey, with one-time SR measurements from 11,620 children from one to four years of age, collected over an eight-month period from one month to more than six months after distribution of vitamin A capsules, was an opportunity to examine the impact of the program on the children's vitamin A status, using post hoc analysis. Overall, a detectable impact of vitamin A capsules on SR was limited to groups with the highest prevalence of vitamin A deficiency and lasted up to four months after dose administration. In highly urban cities in Visayas, where very high prevalences of deficient SR (SR < 10 μg/dl) were found, the prevalence of deficient SR was reduced from 27% to 9% one to two months after distribution of vitamin A capsules, and to 16% at three to four months. In Mindanao, a statistically significant reduction from 38% to 32% was seen in the prevalence of deficient to low SR (SR < 20 μg/dl) one to four months after distribution of vitamin A capsules. There was no overall reduction in the prevalence of vitamin A deficiency or deficient and low SR (SR < 20 μg/dl) in Luzon, but a significant interaction with stunting was observed in Luzon non-highly urbanized cities. Two aspects are of concern. First, the magnitude of the effect of high-dose vitamin A capsules on SR, and hence on the extent of reduction in deficiency, is limited. Second, the effect does not persist for six months, which is the interval between doses. Thus there is no decrease in the prevalence of deficiency over time. With more frequent dosing (especially to those most deficient in SR), a progressive reduction in vitamin A deficiency could, however, be expected; this hypothesis could be tested. The policy implication arising from these results is that a shift in resources is warranted. In areas of low prevalence of vitamin A deficiency, distribution of vitamin A capsules should be targeted to stunted children. In areas of high prevalence, vitamin A capsules should be distributed to children one to five years old at least three times a year.

Vitamin A deficiency as a preventable cause of maternal mortality in undernourished societies: plausibility and next steps

Maternal vitamin A deficiency is a public health problem in the developing world. Recent evidence from Nepal suggests that supplementing populations of rural, poor, and undernourished women with a recommended dietary amount of vitamin A--or its equivalent as beta-carotene--can lower mortality risk related to pregnancy and childbirth, presumably by reducing the severity of conditions such as sepsis, tuberculosis, and diarrheal diseases. An adequate intake of beta-carotene may also reduce some maternal health risks related to oxidative stress. These findings reveal the potential for vitamin A and other micronutrient interventions to improve maternal and infant health and survival. They also present important implementation challenges for the developing world.

Effectiveness of weekly vitamin A (10,000 IU) and iron (60 mg) supplementation for adolescent boys and girls through schools in rural and urban East Java, Indonesia

OBJECTIVE

High prevalences of vitamin A deficiency and anaemia among adolescents warrant interventions. This study evaluated the effectiveness of school-based supplementation to reduce anaemia and improve vitamin A status.

DESIGN

School-based, grade-randomized, intervention.

SUBJECTS AND SETTING

In all, 1757 girls and 1859 boys, aged 12-15 y, in 24 Junior High Schools.

INTERVENTIONS

Weekly supplementation for 14 weeks with 60 mg iron and 250 microg folate (Fe group; n=978), 10 000 IU vitamin A (VA group; n=970) or both (VAFe group; n=1042) to subjects in 15 schools, compared to subjects in nine other schools not receiving supplements (control; n=626).

RESULTS

The baseline anaemia prevalence (Hb <120 g/l) in girls was 20% (prepubertal) and 26% (pubertal), and in boys 24% (pre-pubertal) and 11% (pubertal). Serum retinol concentrations were low (<1.05 micromol/l) in 41% of boys and 45% of girls. The interventions did not increase haemoglobin concentrations. Serum retinol concentration of boys, but not girls, in the VA group increased (0.33 vs 0.07 micromol/l in controls; P<0.01). The risk factors for low serum retinol concentration were lower baseline serum retinol concentration (OR 0.02-0.03) with, for girls, nightblindness at baseline (OR 5.88), and for boys, not receiving vitamin A (OR control: 1.00; VA: 0.37; Fe: 0.77; VAFe: 0.34) and maternal illiteracy (OR mother never attended school 1.00, mother received any formal education 0.17-0.33).

CONCLUSIONS

Supplementation with vitamin A increased serum retinol concentration of boys. Iron supplementation did not change Hb. This appeared to be due to poor compliance, and partly related to side effects.

Daily consumption of Indian spinach (Basella alba) or sweet potatoes has a positive effect on total-body vitamin A stores in Bangladeshi men

BACKGROUND

Recent evidence suggests that the vitamin A equivalency of beta-carotene from plant sources is lower than previously estimated.

OBJECTIVE

We assessed the effect of 60 d of daily supplementation with 750 microg retinol equivalents (RE) of either cooked, puréed sweet potatoes; cooked, puréed Indian spinach (Basella alba); or synthetic sources of vitamin A or beta-carotene on total-body vitamin A stores in Bangladeshi men.

DESIGN

Total-body vitamin A stores in Bangladeshi men (n = 14/group) were estimated by using the deuterated-retinol-dilution technique before and after 60 d of supplementation with either 0 microg RE/d (white vegetables) or 750 microg RE/d as sweet potatoes, Indian spinach, retinyl palmitate, or beta-carotene (RE = 1 microg retinol or 6 microg beta-carotene) in addition to a low-vitamin A diet providing approximately 200 microg RE/d. Mean changes in vitamin A stores in the vegetable and beta-carotene groups were compared with the mean change in the retinyl palmitate group to estimate the relative equivalency of these vitamin A sources.

RESULTS

Overall geometric mean (+/-SD) initial vitamin A stores were 0.108 +/- 0.067 mmol. Relative to the low-vitamin A control group, the estimated mean changes in vitamin A stores were 0.029 mmol for sweet potato (P = 0.21), 0.041 mmol for Indian spinach (P = 0.033), 0.065 mmol for retinyl palmitate (P < 0.001), and 0.062 mmol for beta-carotene (P < 0.002). Vitamin A equivalency factors (beta-carotene:retinol, wt:wt) were estimated as approximately 13:1 for sweet potato, approximately 10:1 for Indian spinach, and approximately 6:1 for synthetic beta-carotene.

CONCLUSION

Daily consumption of cooked, puréed green leafy vegetables or sweet potatoes has a positive effect on vitamin A stores in populations at risk of vitamin A deficiency.

Children Aged 6 to 60 Months in Nepal May Require a Vitamin A Supplement Regardless of Dietary Intake from Plant and Animal Food Sources

The purpose of this survey was to explore the relationship between the prevalence of the health indicators of malnutrition, diarrhea, and acute respiratory infection and the consumption of vitamin A–rich food and the supplementation status of three groups of children in Nepal (supplemented, supplemented only once, and never supplemented). A trained female community health worker interviewed mothers about vitamin A–rich food feeding practices to children aged 6 to 60 months using a standardized questionnaire and then estimated the nutritional status of the children using mid-upper-arm circumference measurements and recording the incidence of diarrhea and acute respiratory infection from mothers’ interviews. Regardless of the amount of vitamin A–rich foods consumed, children who were regularly supplemented with high doses of vitamin A were protected against malnutrition, diarrhea, and acute respiratory infection at a higher rate than children who were supplemented only once or were never supplemented. Regularly providing a high-dose (200,000 IU) capsule of vitamin A to children aged 6 to 60 months, including those who eat vitamin A–rich foods, may be effective in decreasing the prevalence of morbidity from malnutrition, diarrhea, and acute respiratory infection.

Undernutrition as an underlying cause of malaria morbidity and mortality in children less than five years old

Undernutrition is highly prevalent in many areas in which morbidity and mortality from malaria is unacceptably high. That undernutrition exacerbates diarrhea and respiratory infections is widely demonstrated; however, research suggests that it may exacerbate, palliate, or have little effect on malaria outcomes. This review examines the global burden of malaria associated with various nutrient deficiencies as well as underweight status in children 0-4 years of age. Although the association is complex and requires additional research, improved nutritional status lessens the severity of malaria episodes and results in fewer deaths due to malaria. Deficiencies in vitamin A, zinc, iron, folate, as well as other micronutrients are responsible for a substantial proportion of malaria morbidity and mortality. It is recommended that nutrition programs be integrated into existing malaria intervention programs.

Aflatoxin-induced toxicity and depletion of hepatic vitamin A in young broiler chicks: protection of chicks in the presence of low levels of NovaSil PLUS in the diet

Aflatoxin contamination of foods and livestock feeds is an ongoing problem. In this research, NovaSil PLUS (NSP), a calcium montmorillonite clay that is commonly used as an anticaking agent in feeds, was evaluated for its ability to bind aflatoxin B1 (AfB1) in vitro and to prevent the onset of aflatoxicosis and vitamin A depletion in broiler chicks in vivo. Isothermal analyses were conducted with NSP and AfB1 to quantitate and characterize critical sorption parameters at equilibrium, i.e., ligand saturation capacities, affinity constants, and thermodynamics of the sorption process. In vitro results indicated that AfB1 was tightly sorbed onto the surface of NSP, which provided a high capacity and high affinity for the ligand. Thermodynamics favored sorption of AfB1 to NSP. The process was exothermic and spontaneous with a mean heat of sorption equal to approximately -50 kJ/mol, suggesting chemisorption (or tight binding). In addition to the in vitro studies, the effectiveness of NSP as an aflatoxin enterosorbent to attenuate the onset of aflatoxicosis in broiler chicks was determined at 3 different inclusion levels in the diet (0.5, 0.25, and 0.125%). NSP alone was not toxic to chicks at a level as high as 0.5% in the total diets (based on body and organ weights, feed intake, and hepatic vitamin A levels). NSP in the diet significantly protected chicks from the effects of highlevel exposure to aflatoxins (i.e., 5 mg/kg) and preserved hepatic vitamin A levels, even at lower dietary intake of clay.

Diffusion of innovations: a world tour

This contribution to the 40th Anniversary celebration of the Diffusion of Innovations Theory discusses three health communication projects which applied the tenets of Diffusion of Innovation Theory with differing results: Using voodoo practitioners to pave the way for HIV/AIDS education in Haiti. A food-based approach to improving Vitamin A nutrition in Nepal. Diffusion at the horizon of life: The difficulties of communicating reproductive health to youth in Mali. The article illustrates a spectrum of circumstances in which diffusion theory has been applied, in order to show the application of the theory with different populations or target groups, in different sectors, and in different regions of the world.

Vitamin A status of pregnant Nigerian women: relationship to dietary habits and morbidity

Vitamin A status of pregnant Nigerian women has been determined by measurement of retinol concentration in plasma samples obtained from pregnant subjects, using a spectrophotometric method. The relationship between vitamin A status, dietary habits and morbidity pattern was also examined. Two hundred (200) consecutive pregnant women registered for antenatal clinic at the Obafemi Awolowo University Teaching Hospitals Complex within a period of eight (8) weeks were recruited as subjects. The subjects were aged 15-43 years (mean 27.2 years), and were at different stages of pregnancy. Semi-structured questionnaires were administered on the subjects to obtain data on dietary habits, present health status and obstetric history. Vitamin A deficiency (plasma retinol concentration < 0.35 micromol/L) is found in 17.5% of the subjects, while 37% and 45.5% have borderline (plasma retinol concentration 0.35-0.70 micromol/L) and normal (plasma retinol concentration > 0.70 micromol/L) vitamin A status respectively. There is a significant relationship between frequent micturition and vitamin A status (chi-square = 0.39: P < 0.05). There is no relationship between maternal age and vitamin A status. Although about 80% of the subjects consumed red palm oil daily, about 64% would heat the oil to smoking for at least 10 minutes, before adding to stew during cooking. Green vegetables were also boiled in hot water before adding to sauce, while liver is consumed on just about three days per month. The findings reported in this study have further strengthened the claim that vitamin A deficiency is fairly prevalent in pregnant Nigerian women, underlining the need for prompt and effective intervention.

Vitamin A deficiency disorders: international efforts to control a preventable "pox"

Visual symptoms (night blindness) of vitamin A deficiency (VAD) were among the earliest diet-related deficiencies documented. Knowledge of vitamin A chemistry, metabolism and deficiency consequences accrued rapidly during the first eight decades of the 20th century. A series of disorders were described in animals, including impaired growth, reproduction, epithelial integrity, and disease resistance that were relieved by consumption of both animal and plant sources of the vitamin. Identification of the intestinal beta-carotene cleavage enzyme in the laboratory of James Allen Olson was seminal to understanding the mechanism for formation of vitamin A from ingested carotenoids. WHO's 1990 estimate of about 40 million children annually with clinical eye signs of VAD was revised upward to 140-250 million at risk of vitamin A deficiency disorders (VADD) when epidemiological and clinical trials demonstrated morbidity and mortality risk even in the absence of ocular signs. Alternative methods for VAD status assessment and more reliable analytical techniques were developed, several in Dr. Olson's laboratory. The last decade has seen global progress in VADD control by expanding distribution of medicinal supplements, fortification of foods and dietary diversification through horticulture and education programs. Experience shows that achievements gained through narrowly focused interventions are fragile and vulnerable to national political and economic instability. Contextually relevant, community-centered strategies that improve household food and nutrition security and self-reliance are critical to sustaining international efforts to control the VADD "pox."

Vitamin A deficiency alters the bioelectric parameters and RNA content of rat gastric mucosa in vitro

The present study was aimed to investigate the mechanisms by which vitamin A plays a role in maintaining the efficiency of gastric mucosal barrier. Particularly, we measured electrical parameters and the RNA/DNA ratio of gastric mucosa isolated in vitro from the stomach of rats in which vitamin A-deficiency was induced by means of a vitamin A-free diet and then abolished by means of a massive vitamin A supplementation. Pair-fed vitamin A-nondepleted rats and normal rats fed ad libitum on a standard diet served as controls. Vitamin A status was assayed for each group of rats by measuring the hepatic content of vitamin A. We found that in gastric mucosa vitamin A-deficiency induced: 1) a decrease in both transmucosal potential difference and short-circuit current; 2) an increase in transmucosal electrical resistance; 3) a decrease in RNA content resulting in a decreased RNA/DNA ratio. Abolishment of vitamin A-deficiency restored both electrical parameters and RNA content of rat gastric mucosa. Our results stress the role of vitamin A in maintaining the efficiency of the gastric mucosal barrier. Vitamin A seems to act by stabilizing gastric electrical parameters and by controlling the protein synthesis/turnover in the surface gastric mucosal cells.

Pacific pandanus fruit: an ethnographic approach to understanding an overlooked source of provitamin A carotenoids

Commonly recommended plant sources of provitamin A, such as dark green leafy vegetables, are not acceptable in many population groups. The objective of this study was to identify other indigenous foods that may be effectively promoted to alleviate vitamin A deficiency (VAD) and to gather information relevant to identification, production, acquisition, and consumption of foods relevant to a food-based VAD prevention strategy in the Federated States of Micronesia. An ethnographic study on edible pandanus cultivars, involving key informant interviews and observation was carried out. Analyses revealed a great range in carotenoid content. Several orange-coloured pandanus cultivars, all highly acceptable, contained high levels of carotenoid, almost meeting daily requirements in usual consumption patterns, whereas light yellow-coloured cultivars contained low levels. Availability has decreased substantially in recent years due to increased consumption of imported foods and general neglect of indigenous foods. High-carotenoid pandanus should be promoted for general enjoyment and health benefits.

Hypothesis: Vitamin A supplementation and childhood mortality: amplification of the non-specific effects of vaccines?

Most areas of health research will have accepted data and a dominating interpretation. If the interpretation is not correct, contradictions will accumulate, and it will eventually become clear that the current interpretation is untenable. In this situation, the best hypothesis is the one that accounts for all of the known data as well as the apparent contradictions. The area of vitamin A supplementation and childhood mortality in developing countries is afflicted with many contradictions and there is a need for a new hypothesis. We propose that the effect of vitamin A supplementation may depend on the amplification of non-specific effects of vaccines on childhood mortality.

Vitamin A and sudden infant death syndrome in Scandinavia 1992-1995

AIM

To assess the effect of vitamin supplementation on the risk of sudden infant death syndrome (SIDS).

METHODS

The analyses are based on data from the Nordic Epidemiological SIDS Study, a case-control study in which parents of SIDS victims in the Scandinavian countries were invited to participate together with parents of four matched controls between 1 September 1992 and 31 August 1995. The odds ratios presented are computed by conditional logistic regression analysis.

RESULTS

The crude odds ratio in Scandinavia for not giving vitamin substitution was 2.8 (95% CI (1.9, 4.3)). This effect was statistically significant in Norway and Sweden, which use A and D vitamin supplementation, but not in Denmark, where only vitamin D supplementation is given. The odds ratios remained significant in Sweden when an adjustment was made for confounding factors (OR 28.4, 95% CI (4.7, 171.3)).

CONCLUSION

We found an association between increased risk of sudden infant death syndrome and infants not being given vitamin supplementation during their first year of life. This was highly significant in Sweden, and the effect is possibly connected with vitamin A deficiency. This effect persisted when an adjustment was made for potential confounders, includingsocioeconomic factors.

Single megadose vitamin A supplementation of Indian mothers and morbidity in breastfed young infants

BACKGROUND AND OBJECTIVE

In developing countries low maternal vitamin A stores combined with increased demands of pregnancy and lactation may lead to its deficiency in breastfed infants. This study evaluates the effects of maternal supplementation with a high dose of vitamin A on the serum retinol levels of exclusively breastfed infants, and their morbidity in the first six months of life.

SETTING

Hospital based.

STUDY DESIGN

Randomised controlled trial.

SUBJECTS AND METHODS

Mothers of the test group (n=150) were orally supplemented with a single dose of retinol (209 micro mol) soon after delivery and were advised exclusive breastfeeding for six months. Before supplementation retinol levels were estimated in the mothers' and newborns' blood, and in colostrum. On follow up, breastmilk and infants' serum retinol contents were assessed monthly for six months. Retinol level <0.7 micro mol/l indicated vitamin A deficiency. Morbidity patterns like vitamin A deficiency, diarrhoea, febrile illnesses, acute respiratory infection, measles, and ear infection were also studied and compared between the two groups.

RESULTS

Presupplement mean maternal serum retinol levels were 0.98 and 0.92 micro mol/l and mean breastmilk levels were 3.85 and 3.92 micro mol/l in the test and control groups respectively (p>0.05). Mean cord blood retinol levels were also comparable (0.68 v 0.64 micro mol/l). After supplementation, the test group showed a rise in mean breastmilk retinol content (12.08 v 2.96 micro mol/l) which remained significantly higher for four months. The infants' mean serum retinol level, initially 322.06% of the baseline value, was significantly higher for five months. In the control group, significant numbers of mothers and infants showed deficient breastmilk and serum retinol throughout the follow up (p<0.01). Decreased incidence and duration of various diseases were also found in the test group suggesting lesser morbidity.

CONCLUSION

Maternal supplementation with single megadose vitamin A is an effective strategy for vitamin A prophylaxis of exclusively breastfed infants of 0-6 months.