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Efficacy of a single oral dose of 200,000 iu of oil-soluble vitamin A in measles-associated morbidity.
AMERICAN JOURNAL OF EPIDEMIOLOGY. 1996 Mar 1; 143(5):413-22.In 1991, in Ndola, Zambia, staff at urban health centers randomly allocated children with acute measles who did not require hospitalization to receive either a single oral dose of 200,000 IU of oil-soluble vitamin A (90 children) or a placebo (110 children). (A single oral administration of vitamin A at this dose is recommended by the World Health Organization [WHO]). This double-blind placebo-controlled clinical study aimed to determine whether or not a single oral dose of vitamin A would minimize measles-associated morbidity in children who do not require hospitalization. The cross-sectional analysis revealed that at week 4 the vitamin A group was more likely than the placebo group to have no symptoms of acute respiratory infection (ARI) (93% vs. 78%) and less likely to have pneumonia (0 vs. 12%) (p = 0.005). It did not find any significant association prior to week 4, however. None of the three longitudinal analyses found vitamin A to have a significant benefit on morbidity. These analyses considered the effect of treatment on the movement of individual patients between ARI health states. The odds ratio for pneumonia in children with measles-associated cough and for measles-associated cough or pneumonia in asymptomatic measles patients suggested that vitamin A minimized morbidity (0.73 and 0.52, respectively). Yet vitamin A failed to improve pneumonia (odds ratio = 1.23, in favor of placebo). These findings suggest that a single oral dose of 200,000 IU of oil-soluble vitamin A is not as effective at preventing measles complications as that indicated earlier for two 200,000 IU doses of water-miscible vitamin A. Thus, the WHO recommendations need to be reconsidered.