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维生素A补充剂对印度儿童贫血和人体测量指标不达标的估计影响。

Estimated effect of vitamin A supplementation on anaemia and anthropometric failure of Indian children.

作者信息

Rai Rajesh Kumar

机构信息

Society for Health and Demographic Surveillance, Suri, West Bengal, India.

Department of Global Health and Population, Harvard T H Chan School of Public Health, Cambridge, MA, USA.

出版信息

Pediatr Res. 2022 Apr;91(5):1263-1271. doi: 10.1038/s41390-022-01969-1. Epub 2022 Feb 9.

Abstract

BACKGROUND

India has an unacceptably high burden of vitamin A deficiency (VAD) among children aged 6-59 months. To mitigate VAD and its adverse effects on child health, the Indian government runs a nationwide vitamin A supplementation (VAS) programme. However, the effect of VAS in reducing child morbidity and mortality remains inconclusive and has been debated globally. In this paper, we estimate the effect of VAS on two indicators of child nutrition-anaemia (categorized into any anaemia, and mild/moderate anaemia) and anthropometric failure (categorized into stunting, wasting, and underweight) among children aged 6-59 months.

METHODS

Using the nationally representative 2015-2016 National Family Health Survey data set from India, we set up a quasi-experimental study design and estimated household and mother fixed-effects of VAS on select types of child anaemia and anthropometric failure.

RESULTS

Findings from both the household fixed-effects and mother fixed-effects analysis showed that VAS does not influence any types of childhood anaemia and anthropometric failure in India. We discussed the findings considering existing literature and possible limitations of the study.

CONCLUSIONS

The infirm effect of Vitamin A on anaemia and anthropometric failure is probably indicative of targeted VAS intervention, as opposed to a universal VAS programme.

IMPACT

Effects of vitamin A supplementation (VAS) in treating child morbidity and mortality remain inconclusive, which calls for further rigorous studies. This study set up a quasi-experimental research design and estimated the null effect of VAS on child anaemia and childhood anthropometric failure. While the cautious interpretation of findings is urged, this study reliably supports targeted intervention of VAS, instead of the universal VAS programme. The use of nationally representative data and robust research protocol are the primary strengths of this study.

摘要

背景

在印度,6至59个月大的儿童中维生素A缺乏症(VAD)的负担高得令人无法接受。为了减轻维生素A缺乏症及其对儿童健康的不利影响,印度政府实施了一项全国性的维生素A补充(VAS)计划。然而,维生素A补充计划在降低儿童发病率和死亡率方面的效果仍无定论,且在全球范围内一直存在争议。在本文中,我们估计了维生素A补充计划对6至59个月大儿童的两项营养指标——贫血(分为任何贫血以及轻度/中度贫血)和人体测量指标不良(分为发育迟缓、消瘦和体重不足)的影响。

方法

利用来自印度具有全国代表性的2015 - 2016年全国家庭健康调查数据集,我们建立了一个准实验研究设计,并估计了维生素A补充计划对特定类型儿童贫血和人体测量指标不良的家庭和母亲固定效应。

结果

家庭固定效应和母亲固定效应分析的结果均表明,在印度,维生素A补充计划不会影响任何类型的儿童贫血和人体测量指标不良。我们结合现有文献和该研究可能存在的局限性讨论了这些发现。

结论

维生素A对贫血和人体测量指标不良的效果不明显,这可能表明是有针对性的维生素A补充干预,而非普遍的维生素A补充计划。

影响

维生素A补充(VAS)在治疗儿童发病率和死亡率方面的效果仍无定论,这需要进一步进行严谨的研究。本研究建立了一个准实验研究设计,并估计了维生素A补充计划对儿童贫血和儿童人体测量指标不良的无效作用。虽然敦促对研究结果进行谨慎解读,但本研究可靠地支持了维生素A补充计划的针对性干预,而非普遍的维生素A补充计划。使用具有全国代表性的数据和稳健的研究方案是本研究的主要优势。

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