Vitamin D₃supplementation and childhood diarrhea: a randomized controlled trial.

OBJECTIVE: To investigate the effect of vitamin D3 supplementation on the incidence and risk for first and recurrent diarrheal illnesses among children in Kabul, Afghanistan. METHODS: This double-blind placebo-controlled trial randomized 3046 high-risk 1- to 11-month-old infants to receive 6 quarterly doses of oral vitamin D3 (cholecalciferol 100000 IU) or placebo in inner city Kabul. Data on diarrheal episodes (≥ 3 loose/liquid stools in 24 hours) was gathered through active and passive surveillance over 18 months of follow-up. Time to first diarrheal illness was analyzed by using Kaplan-Meier plots. Incidence rates and hazard ratios (HRs) were calculated by using recurrent event Poisson regression models. RESULTS: No significant difference existed in survival time to first diarrheal illness (log rank P = .55). The incidences of diarrheal episodes were 3.43 (95% confidence interval [CI], 3.28-3.59) and 3.59 per child-year (95% CI, 3.44-3.76) in the placebo and intervention arms, respectively. Vitamin D3 supplementation was found to have no effect on the risk for recurrent diarrheal disease in either intention-to-treat (HR, 1.05; 95% CI, 0.98-1.17; P = .15) or per protocol (HR, 1.05; 95% CI, 0.98-1.12; P = .14) analyses. The lack of preventive benefit remained when the randomized population was stratified by age groups, nutritional status, and seasons. CONCLUSIONS: Quarterly supplementation with vitamin D3 conferred no reduction on time to first illness or on the risk for recurrent diarrheal disease in this study. Similar supplementation to comparable populations is not recommended. Additional research in alternative settings may be helpful in elucidating the role of vitamin D3 supplementation for prevention of diarrheal diseases

The effects of vitamin D supplementation on the incidence of pneumonia in infants and young children in Kabul, Afghanistan: a double blind randomized controlled trial

Afghanistan has one of the highest infant mortalities in the world, and pneumonia is one of the main killers. Moreover, Dietary intake of vitamin D is low and exposure to sunlight is limited due to widespread use of Burqa by women. Two studies in Ethiopia and India suggest that vitamin D deficiency may substantially increase the risk of severe pneumonia among children under-5. Thus a randomized controlled trial was conducted to assess effects ofvitamin Don the incidence of pneumonia. The study was conducted on 3046 children aged 1-11 months (approximately 1500 per arm), in Kabul, Afghanistan. Intervention group was given quarterly 100.000 IU vitamin D (6 doses in total), and control arm received placebo (olive oil). Active and passive surveillance of pneumonia was done for 18 months. Time to the first episode in the Vitamin D group was compared to that in the placebo group using log rank tests and proportional hazards models. The incidence rate ratio for the episodes of pneumonia was calculated using Cox proportional hazard models. Vitamin D had no effect on the incidence of first or only episode of x-ray confirmed pneumonia (RR= 1.06, 95% CI: 0.89- 1.27; p=0.47). The incidence of repeat episodes of xray confirmed pneumonia was higher in the vitamin D group (RR=1.68; 95% CI: 1.28 - 2.21; p <0.00 1 ). Infants 6-12 months old had a higher incidence of pneumonia compared to those <6 months old (RR=2.01; 95% CI: 1.12- 3.63). Children of fathers without any formal education had a higher incidence of repeat episodes of pneumonia compared to children of fathers having any formal education (RR=1.67, 95% CI: 1.20- 2.29). Vitamin D supplementation is not useful to reduce the incidence of pneumonia in children. The effective implementation of measles, OPT, Hib, and pneumococcal vaccines, and IMCI guidelines remain the key strategy to reduce the burden of pneumonia in Afghanistan

The effectiveness of display screen user training

Project report submitted in partial fulfilment of the requirements for the degree of M.Sc. in Occupational Psychology at Hull UnivAvailable from British Library Document Supply Centre- 3278.6522(CCRI-Z--91) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Multivariate analysis for risk of diarrheal illness.

<p><i>a</i>. Impoverished household defined as households that reported living on less than 1.25 US dollars per person per day.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0116342#pone.0116342.ref021" target="_blank">21</a>]</p><p>Multivariate analysis for risk of diarrheal illness.</p

Estimated hazards for diarrheal illness by season^a. a.

<p>Hazards estimates are adjusted for child age.</p

Study population.

<p>Study population.</p

Univariate analysis for risk of diarrheal illness.

<p><i>a</i>. Impoverished household defined as households that reported living on less than 1.25 US dollars per person per day.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0116342#pone.0116342.ref021" target="_blank">21</a>]</p><p>Univariate analysis for risk of diarrheal illness.</p

Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul: a randomised controlled superiority trial

BACKGROUND: Vitamin D has a role in regulating immune function, and its deficiency is a suggested risk factor for childhood pneumonia. Our aim was to assess whether oral supplementation of vitamin D(3) (cholecalciferol) will reduce the incidence and severity of pneumonia in a high-risk infant population. METHODS: We did a randomised placebo-controlled trial to compare oral 100,000 IU (2·5 mg) vitamin D(3) with placebo given to children aged 1-11 months in Kabul, Afghanistan. Randomisation was by use of a computer-generated list. Vitamin D or placebo was given by fieldworkers once every 3 months for 18 months. Children presenting at the study hospital with signs of pneumonia had their diagnosis confirmed radiographically. Our primary outcome was the first or only episode of radiologically confirmed pneumonia. Our analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00548379. FINDINGS: 1524 children were assigned to receive vitamin D(3) and 1522 placebo. There was no significant difference between the incidence of first or only pneumonia between the vitamin D (0·145 per child per year, 95% CI 0·129-0·164) and the placebo group (0.137, 0·121-0·155); the incidence rate ratio was 1·06 (95% CI 0·89-1·27). From 652 children during five separate periods of testing serum calcifediol, only one child in each of two testing periods had results greater than 375 nmol/L in the intervention group--a toxic level. INTERPRETATIONS: Quarterly bolus doses of oral vitamin D(3) supplementation to infants are not an effective intervention to reduce the incidence of pneumonia in infants in this setting. FUNDING: Wellcome Trust and British Council