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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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
Author: Stevens, Gretchen A; Bennett, James E; Hennocq, Quentin; Lu, Yuan ORCID  0000-0001-5264-2169 ; De-Regil, Luz Maria; Rogers, Lisa; Danaei, Goodarz; Li, Guangquan; White, Richard A; Flaxman, Seth R; Oehrle, Sean-Patrick; Finucane, Mariel M; Guerrero, Ramiro; Bhutta, Zulfiqar A; Then-Paulino, Amarilis; Fawzi, Wafaie W.; Black, Robert E; Ezzati, Majid

Note: Order does not necessarily reflect citation order of authors.

Citation: Stevens, Gretchen A, James E Bennett, Quentin Hennocq, Yuan Lu, Luz Maria De-Regil, Lisa Rogers, Goodarz Danaei, et al. 2015. “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.” The Lancet Global Health 3 (9) (September): e528–e536. doi:10.1016/s2214-109x(15)00039-x.
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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.
Published Version: doi:10.1016/S2214-109X(15)00039-X
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:26835980
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