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New Delhi, March 18: Neither vitamin A nor deworming tablets administered on a mass scale result in significant reductions in child mortality, the world’s largest clinical study conducted in India has suggested, contradicting earlier claims of big health benefits.
Medical researchers have said they could not find any significant differences in the death rates between children aged under five who received vitamin A and the deworming tablets called albendazole every six months and those who did not.
The study, led by a team of doctors at the King George Medical University, Lucknow, and the University of Oxford in the UK, tracked more than 1 million children in 8,338 government-supported childcare centres in villages across Uttar Pradesh for five years. The researchers have just published their findings in a medical journal, The Lancet, more than five years after completing their study.
Sections of paediatricians and nutrition experts in India who were familiar with its findings had been questioning the long delay in the publication of the results, as reported in The Telegraph in April 2008.
They say the findings raise questions about the wisdom of continuing with current government policies that encourage the mass administration of vitamin A and deworming tablets to all young children.
Several studies since the 1980s had indicated that vitamin A supplementation can reduce childhood mortality by 20 to 30 per cent, and deworming to eliminate intestinal worms can help bolster weight gain in children.
But the Uttar Pradesh study has shown that the childhood mortality reduction “is not as great as” what the earlier studies had suggested. The overall child mortality was four per cent lower in the children who received vitamin A compared with those who did not.
The study has also shown little effect on weight gain after deworming. After two years of treatment, the average weight gain in the children who received albendazole was 12.72 kg. It was 12.68 kg in those who did not.
“I think these long-awaited results cast doubts on the benefits of what have been promoted as two magic bullets,” said Harsh Pal Singh Sachdev, a senior consultant paediatrician at the Sitaram Bhartia Institute in New Delhi, who was not associated with the study.
“Both (vitamin A and deworming) have important roles in childhood care, but should be used only in individuals who need them,” Sachdev told The Telegraph. “This is important to ensure that our scarce resources are used with wisdom.”
Under the existing Union government policy, children between six months and five years of age receive vitamin A through government health centres across India. And several states, including Bihar, have initiated deworming campaigns in recent years.
Experts from organisations campaigning for vitamin A and deworming were not immediately available for comment on the findings from the Uttar Pradesh study. Public health specialists who have been campaigning for vitamin A have long cited research that suggests that vitamin A deficiency that does not have overt symptoms might impact the immune system and put children at risk of life-threatening infections.
Similarly, proponents of deworming have long argued that there is ample evidence to show that heavy worm infestations can hamper the growth of young children and that periodic deworming improves weight gain.
“We’re going to leave it to others to interpret these findings for policy guidance,” said Shally Awasthi, a senior paediatrician at the King George Medical University, Lucknow, a principal investigator of the study from Uttar Pradesh.
Awasthi and her colleagues point out that when the results of their study and earlier studies from the 1980s on vitamin A are combined, the reduction in child mortality is about 5 to 15 per cent, which is only about a quarter or half as great as suggested earlier.
However, some doctors believe that given the improvements in the overall health conditions in India since the 1980s, it would be inappropriate to combine the results of studies in the 1980s with those from the 2000s.
“In the 1980s, we had far higher figures for childhood mortality from diarrhoea and other infections than we have now — they could have contributed to high mortality documented earlier,” said a senior doctor not associated with the study.
“We should not combine the data sets of studies from the 1980s and a study from 2006,” said Umesh Kapil, professor of human nutrition at the All India Institute of Medical Sciences, New Delhi.
Sachdev and Kapil had been questioning the delay in the publication of the results, contending that only a formal publication would force policy makers to take its findings into account.
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