Lifesavers · No. 17

Vitamin A supplementation

Two cheap doses of vitamin A a year cut a young child's overall risk of dying by about 12%, one of the best-evidenced nutrition measures in child health.

12% lives — reduction in all-cause mortality among children aged 6 months to 5 years given vitamin A, versus control (Cochrane, risk ratio 0.88)

A relative reduction in the risk of death, not a cumulative lives-saved count. Pooled from 19 trials of over 1.2 million children.

Credited to: Vitamin A was identified in 1913; its power to prevent child deaths was established by field trials from the 1980s onward, notably by Alfred Sommer.
When: 1913; child-survival trials from the 1980s

How it saves lives

Vitamin A is essential for the immune system and for the surfaces that line the eyes, gut and lungs. In children who do not get enough, infections like measles and diarrhoea turn deadly more often, and severe deficiency also causes blindness. A large dose every four to six months tops up the body's stores and restores those defences, which is why it lowers deaths across several diseases at once rather than just one.

The story

In the 1980s the ophthalmologist Alfred Sommer noticed that children with even mild vitamin A deficiency were far more likely to die, not just to go blind. The claim met scepticism until trial after trial confirmed it. Pooling the strongest of them, a Cochrane review found that vitamin A supplementation cut all-cause death in young children by about 12%, rated high-certainty evidence. The doses cost pennies, which is why twice-yearly vitamin A campaigns now reach hundreds of millions of children in the countries where deficiency is common.

From the record

At longest follow-up, there was a 12% observed reduction in the risk of all-cause mortality for VAS compared with control using a fixed-effect model (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83 to 0.93; high-certainty evidence).

Cochrane (Imdad et al.) Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age, 2022

Asked often

Does vitamin A supplementation reduce child deaths?

Yes. A Cochrane review pooling 19 trials of more than a million children found that vitamin A supplementation reduced all-cause mortality in children aged six months to five years by about 12%, rated high-certainty evidence.

How is vitamin A given to children?

Usually as a large oral dose every four to six months, delivered through child-health campaigns in countries where vitamin A deficiency is common. It is one of the cheapest child-survival measures available.

How it saves lives

The story

Asked often

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