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Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys

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Title: Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys
Authors: Stevens, GA
Bennett, JE
Hennocq, Q
Lu, Y
De-Regil, LM
Rogers, L
Danaei, G
Li, G
White, RA
Flaxman, SR
Oehrle, S-P
Finucane, MM
Guerrero, R
Bhutta, ZA
Then-Paulino, A
Fawzi, W
Black, RE
Ezzati, M
Item Type: Journal Article
Abstract: Background: Vitamin A deficiency is a risk factor for blindness and for mortality from measles and diarrhoea in children aged 6–59 months. We aimed to estimate trends in the prevalence of vitamin A deficiency between 1991 and 2013 and its mortality burden in low-income and middle-income countries. Methods: We collated 134 population-representative data sources from 83 countries with measured serum retinol concentration data. We used a Bayesian hierarchical model to estimate the prevalence of vitamin A deficiency, defined as a serum retinol concentration lower than 0·70 μmol/L. We estimated the relative risks (RRs) for the effects of vitamin A deficiency on mortality from measles and diarrhoea by pooling effect sizes from randomised trials of vitamin A supplementation. We used information about prevalences of deficiency, RRs, and number of cause-specific child deaths to estimate deaths attributable to vitamin A deficiency. All analyses included a systematic quantification of uncertainty. Findings: In 1991, 39% (95% credible interval 27–52) of children aged 6–59 months in low-income and middle-income countries were vitamin A deficient. In 2013, the prevalence of deficiency was 29% (17–42; posterior probability [PP] of being a true decline=0·81). Vitamin A deficiency significantly declined in east and southeast Asia and Oceania from 42% (19–70) to 6% (1–16; PP>0·99); a decline in Latin America and the Caribbean from 21% (11–33) to 11% (4–23; PP=0·89) also occurred. In 2013, the prevalence of deficiency was highest in sub-Saharan Africa (48%; 25–75) and south Asia (44%; 13–79). 94 500 (54 200–146 800) deaths from diarrhoea and 11 200 (4300–20 500) deaths from measles were attributable to vitamin A deficiency in 2013, which accounted for 1·7% (1·0–2·6) of all deaths in children younger than 5 years in low-income and middle-income countries. More than 95% of these deaths occurred in sub-Saharan Africa and south Asia. Interpretation: Vitamin A deficiency remains prevalent in south Asia and sub-Saharan Africa. Deaths attributable to this deficiency have decreased over time worldwide, and have been almost eliminated in regions other than south Asia and sub-Saharan Africa. This new evidence for both prevalence and absolute burden of vitamin A deficiency should be used to reconsider, and possibly revise, the list of priority countries for high-dose vitamin A supplementation such that a country's priority status takes into account both the prevalence of deficiency and the expected mortality benefits of supplementation.
Issue Date: 28-Aug-2015
Date of Acceptance: 1-Aug-2015
URI: http://hdl.handle.net/10044/1/48910
DOI: https://dx.doi.org/10.1016/S2214-109X(15)00039-X
ISSN: 2214-109X
Publisher: Elsevier
Start Page: e528
End Page: e536
Journal / Book Title: Lancet Global Health
Volume: 3
Issue: 9
Copyright Statement: © 2015 World Health Organization; licensee Elsevier. This is an Open Access article published without any waiver of WHO’s privileges and immunities under international law, convention, or agreement. This Article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted.
Sponsor/Funder: Bill & Melinda Gates Foundation
Medical Research Council (MRC)
Grand Challenges Canada
Funder's Grant Number: OPP1008028
MR/K005901/1
0073-03
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
SYSTEMATIC ANALYSIS
RISK-FACTORS
REPRESENTATIVE DATA
GLOBAL BURDEN
SUPPLEMENTATION
PREVALENCE
RETINOL
WOMEN
UNDERNUTRITION
METAANALYSIS
Bayes Theorem
Child
Child Mortality
Child, Preschool
Developing Countries
Female
Humans
Infant
Prevalence
Vitamin A Deficiency
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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