There are conflicting reports on the role of high dose of vitamin A supplementation in the management of ALRI and pneumonia in malnourished children [31], [15]. Even sub-clinical vitamin A deficiency in non-malnourished children is associated with increased risk of ARI [32], [33]. Meta-analysis of community-based studies of high dose vitamin A supplementation to children aged 6 months to 5 years did not observe any protective or detrimental effects of vitamin A supplementation on pneumonia-specific mortality according to the vitamin A and pneumonia working group [34]. In fact, some studies have reported an increase in the incidence of ALRI in children with adequate nutritional status receiving vitamin A supplementation [35]. In a placebo-controlled study, high dose vitamin A supplementation did neither influence recovery nor the duration of hospitalization in Guatemalan children with ALRI [31]. A higher dose of vitamin A was evaluated in studies in Brazil [36], Vietnam [37], Chile [38] and Tanzania [39], and none of them had observed any beneficial effect, and in fact had observed a negative effect in adequately nourished children [40]. Another clinical trial conducted in Peru not only observed high dose vitamin A supplements to be ineffective in improving recovery from pneumonia in hospitalized children, but actually observed prolonged duration of the clinical signs, higher requirements of oxygen support, and higher nursing time and patient care cost in high-dose supplemented group [41]. On the other hand, in a population based, controlled clinical trial in Ecuadorian urban slum children, weekly supplementation of low dose vitamin A (10,000 IU) for 40 weeks was associated with a strong protective effect on ALRI in malnourished under-five children [42].