Vitamin A supplementation during war-emergency in Guinea-Bissau 1998–1999

Background: Vitamin A supplementation is recommended by WHO in emergency situations. Objective: To evaluate the impact of Vitamin A supplementation on childhood mortality in an emergency situation. Design: Since this was not a randomised study, we evaluated the impact in different ways; we used the variation in the delay of provision of Vitamin A in a step-wedged design, compared wartime with pre-wartime mortality and examined whether Vitamin A as a free commodity reduced cultural and social-economic inequalities in childhood mortality. Subjects: 5926 children 6 months to 5 years of age, resident in four suburbs in the capital of Guinea-Bissau between October 1, 1998 and March 31, 1999. Interventions: From October 1, 1998 until the end of the war in 1999 all children present in the study area were offered Vitamin A at regular three-monthly visits to their homes. Results: Using the variation in the provision of Vitamin A, we found a slight non-significant reduction in mortality for children between 6 months and 5 years of age (mortality ratio (MR) 0.49; 95% CI 0.09–2.70). Comparing with a three-year period before the war, children offered Vitamin A at home during the war had a 12% reduction in mortality (MR 0.88; 0.41–1.87), whereas the overall impact of the war was an 89% increase in mortality (MR 1.89; 1.32–2.71). Vitamin A supplementation was associated with a reduction in cultural and socio-economic inequalities. Conclusions: Vitamin A supplementation may have a beneficial impact on childhood mortality in an emergency situation.