The impact of vitamin A supplementation on mortality inequalities among children in Nepal

David M Bishai, K. C Samir Kumar, Hugh Waters, Michael Koenig, Joanne Katz, Subarna K. Khatry, Keith West

Research output: Contribution to journalArticle

Abstract

Objective: This paper examines gender, caste and economic differentials in child mortality in the context of a cluster-randomized trial of vitamin A distribution, in order to determine whether or not the intervention narrowed these differentials. Design: The study involved secondary analysis of data from a placebo-controlled randomized field trial of vitamin A supplements. The study took place between 1989-1991 in rural Sarlahi District of Nepal, with 30 059 children age 6 to 60 months. The main outcome measures were differences in mortality between boys and girls, between highest Hindu castes and others, and between the poorest quintile and the four other quintiles. Results: Without vitamin A, girls in rural Nepal experience 26.1 deaths per 1000, which is 8.3 deaths more than the comparison population of boys. With vitamin A the mortality disadvantage of girls is nearly completely attenuated, at only 1.41 additional deaths per 1000 relative to boys. Vitamin A supplementation also narrowed mortality differentials among Hindu castes, but did not lower the concentration of mortality across quintiles of asset ownership. The vitamin A-related attenuation in mortality disadvantage from gender and caste is statistically significant. Conclusions: We conclude that universal supplementation with vitamin A narrowed differentials in child death across gender and caste in rural Nepal. Assuring high-coverage vitamin A distribution throughout Nepal could help reduce inequalities in child survival in this population.

Original languageEnglish (US)
Pages (from-to)60-66
Number of pages7
JournalHealth Policy and Planning
Volume20
Issue number1
DOIs
StatePublished - 2005

Fingerprint

Nepal
Vitamin A
caste
mortality
Social Class
Mortality
death
gender
secondary analysis
Child Mortality
supplement
Ownership
assets
coverage
district
Population
Randomized Controlled Trials
Placebos
Economics
Outcome Assessment (Health Care)

Keywords

  • Child mortality
  • Health equity
  • Nepal
  • Vitamin A

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Health(social science)
  • Health Professions(all)
  • Public Health, Environmental and Occupational Health

Cite this

The impact of vitamin A supplementation on mortality inequalities among children in Nepal. / Bishai, David M; Kumar, K. C Samir; Waters, Hugh; Koenig, Michael; Katz, Joanne; Khatry, Subarna K.; West, Keith.

In: Health Policy and Planning, Vol. 20, No. 1, 2005, p. 60-66.

Research output: Contribution to journalArticle

Bishai, David M ; Kumar, K. C Samir ; Waters, Hugh ; Koenig, Michael ; Katz, Joanne ; Khatry, Subarna K. ; West, Keith. / The impact of vitamin A supplementation on mortality inequalities among children in Nepal. In: Health Policy and Planning. 2005 ; Vol. 20, No. 1. pp. 60-66.
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