Is routine Vitamin A supplementation still justified for children in Nepal? Trial synthesis findings applied to Nepal national mortality estimates

Shrestha, Samjhana, Thapa, Saki, Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941, Caws, Maxine ORCID: https://orcid.org/0000-0002-9109-350X, Gurung, Suman Chandra, Fox, Tilly, Kirubakaran, Richard and Pokhrel, Khem Narayan (2022) 'Is routine Vitamin A supplementation still justified for children in Nepal? Trial synthesis findings applied to Nepal national mortality estimates'. PLoS ONE, Vol 17, Issue 5, e0268507.

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Abstract

Background
The World Health Organization has recommended Vitamin A supplementation for children in low- and middle-income countries for many years to reduce child mortality. Nepal still practices routine Vitamin A supplementation. We examined the potential current impact of these programs using national data in Nepal combined with an update of the mortality effect estimate from a meta-analysis of randomized controlled trials.

Methods
We used the 2017 Cochrane review as a template for an updated meta-analysis. We conducted fresh searches, re-applied the inclusion criteria, re-extracted the data for mortality and constructed a summary of findings table using GRADE. We applied the best estimate of the effect obtained from the trials to the national statistics of the country to estimate the impact of supplementation on under-five mortality in Nepal.

Results
The effect estimates from well-concealed trials gave a 9% reduction in mortality (Risk Ratio: 0.91, 95% CI 0.85 to 0.97, 6 trials; 1,046,829 participants; low certainty evidence). The funnel plot suggested publication bias, and a meta-analysis of trials published since 2000 gave a smaller effect estimate (Risk Ratio: 0.96, 95% CI 0.89 to 1.03, 2 trials, 1,007,587 participants), with the DEVTA trial contributing 55.1 per cent to this estimate. Applying the estimate from well-concealed trials to Nepal’s under-five mortality rate, there may be a reduction in mortality, and this is small from 28 to 25 per 1000 live births; 3 fewer deaths (95% CI 1 to 4 fewer) for every 1000 children supplemented.

Conclusions
Vitamin A supplementation may only result in a quantitatively unimportant reduction in child mortality. Stopping blanket supplementation seems reasonable given these data.

Item Type:	Article
Subjects:	QU Biochemistry > Vitamins > QU 145 Nutrition. Nutritional requirements QU Biochemistry > Vitamins > QU 160 Vitamins. Vitamin requirements WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 115 Nutritional requirements. Nutrition disorders
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pone.0268507
Depositing User:	Christianne Esparza
Date Deposited:	24 May 2022 10:14
Last Modified:	24 May 2022 10:14
URI:	https://archive.lstmed.ac.uk/id/eprint/20457

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