The latest report from a Tanzanian study on giving vitamin supplements to breastfeeding women has found that providing multivitamins (B, C and E) to the women raised CD4 counts in their babies, regardless of HIV status, reducing the babies’ risk of diarrhoeal disease. The findings are published in the latest edition of Clinical Infectious Diseases
Previous reports of the same study found that providing vitamins B, C and E to these mothers significantly reduced both HIV transmission to the babies and mortality in the first two years of life, when the mothers’ immunological or nutritional status was poor. In contrast, providing vitamin A to the mothers appeared to increase HIV transmission rates and was therefore discontinued, although it now seems it reduced the risk of pneumonia among the babies whose mothers were given vitamin A.
Breast-feeding HIV positive mothers were given either vitamin A (combined vitamin A and beta carotene) or multivitamins (B, C and E) or both or placebo tablets in a Tanzanian study that enrolled 1078 women in the city of Dar es Salaam in the two years beginning April 1995. The children’s health was monitored in terms of CD4 count, diarrhoeal disease, respiratory infections, and HIV status.
The vitamin supplementation arms were:
- Vitamin A: daily 30mg beta carotene plus 1500 IUs (international units) of preformed vitamin A PLUS 200,000 IUs as a single dose after giving birth
- Multivitamins without vitamin A: daily 20mg B1, 20mg B2, 25mg B6, 100mg niacin, 50 micrograms B12, 500mg C, 30mg E, 0.8mg folic acid
- Multivitamins (as above) plus vitamin A (as above)
- Placebo
Women were randomly allocated to the four arms of the study.
During the course of the study, it became apparent that there were higher rates of HIV transmission to babies whose mothers were being given vitamin A, so the vitamin A supplementation was discontinued. However, all children were given 100,000 IUs of vitamin A at six months of age and 200,000 IUs every six months after that, in line with standard Tanzanian practice. The researchers observe that the positive effects of giving supplements to the mothers support other evidence of greater advantages when smaller vitamin A supplements are given to children at more frequent intervals.
B, C, E multivitamin supplementation reduced the diarrhoea rate by around 17% overall. Vitamin A supplementation reduced the incidence of coughing with high respiratory rate (a measure of pneumonia) by around 30%. Although these reductions may be modest, they were statistically significant and the intervention was inexpensive.
In this and similar settings where there is clear evidence of widespread malnutrition among pregnant women, mothers and children, there are clearly benefits to be obtained from providing vitamin supplements. Ideally, vitamin A supplements should be targeted to women who are HIV negative, although this would not in itself be a sufficient justification for an HIV testing programme. Especially if vitamin A supplements are not being given to all mothers, then it may be worth increasing the frequency of provision of vitamin A supplements to babies and young children.
Fawzi WW et al. Effect of providing vitamin supplements to human immunodeficiency virus-infected, lactating mothers on the child’s morbidity and CD4+ cell counts. Clinical Infectious Diseases 36 (published electronically 2 April) 2003.