Heterogeneous effects on child survival in neonatal vitamin A supplementation trials.

摘要

Our report of increased female mortality in recipients of neonatal vitamin A supplementation (VAS) in two trials in Guinea-Bissau has raised concerns in relation to three WHO-sponsored neonatal VAS trials in Ghana, Tanzania, and India, which are in progress to inform global policy. Betty Kirkwood and colleagues (Nov 13, p 1643) did a meta-analysis of the sex-specific effects in the neonatal VAS trials, including previously unpublished data from Zimbabwe, and conclude that there is no differential effect of VAS in boys and girls. We disagree. The meta-analysis shows that the effect of VAS was significantly heterogeneous for boys (p=0.004) and overall (p=0.005). The interactions between VAS and sex in Guinea-Bissau and Zimbabwe were significantly different (p=0.002). This finding indicates that the effect of VAS is modified by factors that differ between sites. These apparent heterogeneous results might be due to the trial design and the higher HIV prevalence in Zimbabwe.