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dc.contributor.authorStevens, Gretchen A
dc.contributor.authorBennett, James E
dc.contributor.authorHennocq, Quentin
dc.contributor.authorLu, Yuan
dc.contributor.authorDe-Regil, Luz Maria
dc.contributor.authorRogers, Lisa
dc.contributor.authorDanaei, Goodarz
dc.contributor.authorLi, Guangquan
dc.contributor.authorWhite, Richard A
dc.contributor.authorFlaxman, Seth R
dc.contributor.authorOehrle, Sean-Patrick
dc.contributor.authorFinucane, Mariel M
dc.contributor.authorGuerrero, Ramiro
dc.contributor.authorBhutta, Zulfiqar A
dc.contributor.authorThen-Paulino, Amarilis
dc.contributor.authorFawzi, Wafaie W.
dc.contributor.authorBlack, Robert E
dc.contributor.authorEzzati, Majid
dc.date.accessioned2016-04-26T19:05:38Z
dc.date.issued2015
dc.identifier.citationStevens, 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.en_US
dc.identifier.issn2214-109Xen_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:26835980
dc.description.abstractBACKGROUND: 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.en_US
dc.language.isoen_USen_US
dc.publisherElsevier BVen_US
dc.relation.isversionofdoi:10.1016/S2214-109X(15)00039-Xen_US
dash.licenseLAA
dc.titleTrends 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 surveysen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalThe Lancet Global Healthen_US
dash.depositing.authorFawzi, Wafaie W.
dc.date.available2016-04-26T19:05:38Z
dc.identifier.doi10.1016/S2214-109X(15)00039-X*
dash.authorsorderedfalse
dash.identifier.orcid0000-0001-5264-2169en_US
dash.contributor.affiliatedLu, Yuan
dash.contributor.affiliatedEzzati, Majid
dash.contributor.affiliatedFawzi, Wafaie
dc.identifier.orcid0000-0001-5264-2169


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