Mortality Clinical Trial
Official title:
Evaluation of the Impact on Mortality and Morbidity of the WHO Recommended Vitamin A Supplementation at First Immunisation Contact After 6 Months of Age
High-dose vitamin A to children above 6 months of age reduces all-cause mortality by 23-30%.
The WHO recommends vitamin A supplementation (VAS) with the first vaccine after 6 months of
age. However, the effect of providing VAS with vaccines has never been investigated. We have
hypothesised that the effect of VAS depends on the immune stimulus at the time of
supplementation. Hence, the effect might vary depending on which type of vaccine it is given
with. In particular, we hypothesised that VAS might be beneficial when given with measles
vaccine but not when given with DTP vaccine. Normally the first vaccine after 6 months of
age would be a measles vaccine, but many children come late for their DTP vaccinations and
receive DTP alone or together with measles vaccine. Hence, it is important to study whether
the effect of VAS is the same irrespective of the vaccine(s) administered at the same time.
Guinea-Bissau has not yet implemented the WHO vitamin A policy of providing VAS with
vaccines, but plans to do so within the next years. Together with the Ministry of Health in
Guinea-Bissau, the Bandim Health Project (BHP) in Guinea-Bissau will investigate the effect
on mortality and morbidity of implementing the WHO vitamin A policy in Guinea-Bissau. This
will be done in a large randomised trial.
BHP has a demographic surveillance system (DSS) which has followed a population of now more
than 150,000 individuals for almost 30 years. Children will be randomised to receive VAS or
placebo with their first vaccine after 6 months of age, and will be followed through the DSS
to assess mortality and morbidity. Based on previous observations, the effects of VAS might
differ according to sex and season. The interaction between VAS, sex, and season will also
be studied in the present trial. By identifying situations where VAS may be beneficial,
ineffective, or even harmful the study may contribute importantly to optimising the VAS
policy for low-income countries.
n/a
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention
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