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

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. We collated 1...

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Vydáno v:	The Lancet global health Ročník 3; číslo 9; s. e528 - e536
Hlavní autoři:	Stevens, Gretchen A, Bennett, James E, Hennocq, Quentin, Lu, Yuan, 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, Black, Robert E, Ezzati, Majid
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England Elsevier Ltd 01.09.2015 Elsevier
Témata:	Bayes Theorem Child Child Mortality - trends Child, Preschool Developing Countries - statistics & numerical data Female Humans Infant Internal Medicine Prevalence Vitamin A Deficiency - epidemiology Vitamin A Deficiency - mortality
ISSN:	2214-109X, 2214-109X
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Abstract	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. 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. 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. 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. Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council.
AbstractList	BACKGROUNDVitamin 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.METHODSWe 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.FINDINGSIn 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.INTERPRETATIONVitamin 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.FUNDINBill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council. 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. 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. 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. 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. Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council. 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. Fundin: Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council. Summary 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. Fundin Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council.
Author	Oehrle, Sean-Patrick Danaei, Goodarz Hennocq, Quentin White, Richard A Black, Robert E Bhutta, Zulfiqar A Ezzati, Majid Rogers, Lisa Flaxman, Seth R Finucane, Mariel M Lu, Yuan Then-Paulino, Amarilis Guerrero, Ramiro Li, Guangquan Fawzi, Wafaie Bennett, James E Stevens, Gretchen A De-Regil, Luz Maria
Author_xml	– sequence: 1 givenname: Gretchen A surname: Stevens fullname: Stevens, Gretchen A organization: Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland – sequence: 2 givenname: James E surname: Bennett fullname: Bennett, James E organization: MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK – sequence: 3 givenname: Quentin surname: Hennocq fullname: Hennocq, Quentin organization: MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK – sequence: 4 givenname: Yuan surname: Lu fullname: Lu, Yuan organization: Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA – sequence: 5 givenname: Luz Maria surname: De-Regil fullname: De-Regil, Luz Maria organization: Micronutrient Initiative, Ottawa, Ontario, Canada – sequence: 6 givenname: Lisa surname: Rogers fullname: Rogers, Lisa organization: Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland – sequence: 7 givenname: Goodarz surname: Danaei fullname: Danaei, Goodarz organization: Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA – sequence: 8 givenname: Guangquan surname: Li fullname: Li, Guangquan organization: MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK – sequence: 9 givenname: Richard A surname: White fullname: White, Richard A organization: Department of Infectious Disease Epidemiology, Division of Infectious Disease Control and Department of Health Statistics, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway – sequence: 10 givenname: Seth R surname: Flaxman fullname: Flaxman, Seth R organization: School of Computer Science & Heinz College, Carnegie Mellon University, Pittsburgh, PA, USA – sequence: 11 givenname: Sean-Patrick surname: Oehrle fullname: Oehrle, Sean-Patrick organization: Independent Consultant, Geneva, Switzerland – sequence: 12 givenname: Mariel M surname: Finucane fullname: Finucane, Mariel M organization: Mathematica Policy Research, Cambridge, MA, USA – sequence: 13 givenname: Ramiro surname: Guerrero fullname: Guerrero, Ramiro organization: PROESA-Research Center for Social Protection and Health Economics, Universidad Icesi, Cali, Colombia – sequence: 14 givenname: Zulfiqar A surname: Bhutta fullname: Bhutta, Zulfiqar A organization: Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan – sequence: 15 givenname: Amarilis surname: Then-Paulino fullname: Then-Paulino, Amarilis organization: Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic – sequence: 16 givenname: Wafaie surname: Fawzi fullname: Fawzi, Wafaie organization: Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA – sequence: 17 givenname: Robert E surname: Black fullname: Black, Robert E organization: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA – sequence: 18 givenname: Majid surname: Ezzati fullname: Ezzati, Majid email: majid.ezzati@imperial.ac.uk organization: MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
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Snippet	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... Summary 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... 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... BACKGROUNDVitamin 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... 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...
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SubjectTerms	Bayes Theorem Child Child Mortality - trends Child, Preschool Developing Countries - statistics & numerical data Female Humans Infant Internal Medicine Prevalence Vitamin A Deficiency - epidemiology Vitamin A Deficiency - mortality
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
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