***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES --To determine whether a single high dose of vitamin A given to all children in communities with high mortality and malnutrition could affect mortality and to assess whether periodic community wide supplementation could be readily incorporated into an ongoing primary health programme . DESIGN --Opportunistic controlled trial . SETTING --Jumla district , Nepal . SUBJECTS -- All children aged under 5 years ; 3786 in eight subdistricts given single dose of vitamin A and 3411 in remaining eight subdistricts given no supplementation .  MAIN OUTCOME MEASURES --Mortality and cause of death in the five months after supplementation . RESULTS --Risk of death for children aged 1 - 59 months in supplemented communities was 26 % lower ( relative risk 0.74 , 95 % confidence interval 0.55 to 0.99 ) than in unsupplemented communities . The reduction in mortality was greatest among children aged 6 - 11 months : death rate ( deaths/1000 child years at risk ) was 133.8 in supplemented children and 260.8 in unsupplemented children ( relative risk 0.51 , 0.30 to 0.89 ) . The death rate from diarrhoea was also reduced ( 63.5 supplemented v 97.5 unsupplemented ; relative risk 0.65 , 0.44 to 0.95 ) . The extra cost per death averted was about $ 11 . CONCLUSION --The results support a role for Vitamin A in increasing child survival . The supplementation programme was readily integrated with the ongoing community health programme at little extra cost The authors assessed the efficacy of the World Health Organization ( WHO ) recommendation of 200,000 IU of vitamin A in oil to treat acute non-xerophthalmic measles patients . Acute measles patients who did not require hospitalization were enrolled in a r and omized , double-masked , clinical trial of vitamin A ( n=90 ) versus placebo ( n=110 ) carried out in Ndola , Zambia , in 1991 . Measles-associated morbidity was defined by the presence of signs and symptoms of acute respiratory infection . Daily evaluations for the first 3 days were followed by weekly visits for a month at urban health centers . Baseline demographic , clinical , and biochemical characteristics were similar in both groups . Cross-sectional analysis of morbidity status , by group , at each weekly evaluation showed no significant differences until week 4 , when more placebo-treated patients had cough or pneumonia ( p=0.005 ) . However , longitudinal analysis , which looked at changes among individuals and controlled for initial health status , showed more equivocal results . The odds ratio for the development of pneumonia in patients with measles cough in vitamin A-treated subjects was 0.73 ( 95 % confidence interval ( Cl ) 0.30 - 1.80 ) . The odds ratio for the development of measles-associated cough or pneumonia in asymptomatic measles patients was 0.52 ( 95 % Cl 0.24 - 1.13 ) , in favor of vitamin A , but the odds ratio for failing to improve from pneumonia in vitamin A-treated subjects was 1.23 ( 95 % Cl 0.68 - 2.3 ) , a result in favor of placebo . These results suggest that the evidence for the efficacy of one dose of vitamin A in oil to prevent measles complications is not as strong as that previously shown for two 200,000 IU doses of water-miscible vitamin A , and that the WHO recommendation may need to be reexamined A prospect i ve study was conducted in slum children to determine the incidence of post-measles corneal disease and to clarify its relationship with nutritional status . A total of 318 cases of measles were identified over a period of 15 mo ; maximum incidence was observed for children between 1 - 2 yr . Most of the children showed weight loss and serum proteins decrease during the acute stage of measles . Corneal lesions were observed in 3 % of the children , and the lesions responded well to treatment . Serum vitamin A and RBP levels were significantly depressed during the acute stage of measles but were restored to normal 8 wk after recovery . There were no significant differences in the serum levels for those with and without eye lesions , which suggests that these lesions may not be mediated simply through the effect of infection on serum concentration of vitamin Incidence , duration , and severity of diarrhea and respiratory symptoms were monitored weekly for 1 y in 15,419 children 6 - 60 mo of age in a r and omized , placebo-controlled , masked clinical trial conducted in southern India . Half the children received weekly doses of 8.7 mumol ( 2500 microgram ) vitamin A and 46 mumol ( 20 mg ) vitamin E ( treated ) and the other half , 46 mumol vitamin E ( control ) . Medical and ocular examinations and anthropometric measurements were obtained before and after 52 wk of intervention . Ocular examinations also were obtained after 26 wk . Supplements were delivered weekly from calibrated dispenser bottles by community health volunteers who also recorded each mother 's recall of daily morbidity of her child during the previous week . Baseline characteristics of treated and control subjects were similar and documented a prevalence of 11 % xerophthalmia and 72 % undernutrition . Weekly treatment with the low-dose vitamin A supplement did not influence the incidence , severity , or duration of diarrhea or respiratory infections and did not influence linear or ponderal growth 450 villages in northern Sumatra were r and omly assigned to either participate in a vitamin A supplementation scheme ( n = 229 ) or serve for 1 year as a control ( n = 221 ) . 25 939 preschool children were examined at baseline and again 11 to 13 months later . Capsules containing 200 000 IU vitamin A were distributed to preschool children aged over 1 year by local volunteers 1 to 3 months after baseline enumeration and again 6 months later . Among children aged 12 - 71 months at baseline , mortality in control villages ( 75/10 231 , 7.3 per 1000 ) was 49 % greater than in those where supplements were given ( 53/10 919 , 4.9 per 1000 ) ( p less than 0.05 ) . The impact of vitamin A supplementation  seemed to be greater in boys than in girls . These results support earlier observations linking mild vitamin A deficiency to increased mortality and suggest that supplements given to vitamin A deficient population s may decrease mortality by as much as 34 % Micronutrients ( zinc , vitamins A and E ) and related proteins ( retinol binding protein ( RBP ) , prealbumin , albumin ) were measured in the serum of African children with measles , and the changes induced in these by vitamin A supplementation ( offered in a r and omised , double blind , placebo controlled trial ) were studied . All these substances were significantly reduced early in the exanthem in measles patients as compared to controls ; they attained control values by day 8 after the rash , except for serum albumin which became normal by day 42 . Vitamin A and prealbumin levels on day 8 were significantly increased in the supplemented over the placebo group . Vitamin A levels in serum correlated with those of RBP , prealbumin and zinc . These findings strengthen the hypothesis that hyporetinemia during measles is the consequence of impaired mobilisation . Our results indicate that our patients did not have pre-existing low liver stores . Accordingly , the results obtained here provide rational support for the recommendation that vitamin A should be given to all children with severe measles , even in communities where vitamin A deficiency is not a recognised public health problem A cross-sectional study , a follow-up study , and an intervention trial were carried out to investigate the association between mild vitamin A deficiency and the occurrence of diarrhea and respiratory diseases .  Cross-sectional analysis was performed among 1,772 children , aged 1 - 8 years , in the Sakon Nakhon province of northeastern Thail and . Children with a history of diarrhea or respiratory disease had lower levels of serum retinol and retinol-binding protein . Adjusted for age , sex , nutritional status , and level of urbanization , logistic regression using data for 877 children showed a negative association between serum retinol and both diarrhea and respiratory diseases . A follow-up three months later ( n = 146 children ) showed that children with deficient serum retinol ( less than 0.35 mumol/liter ) had a fourfold greater risk of respiratory disease ( p less than 0.01 ) . No relation was found for diarrhea . An intervention trial ( n = 166 children aged 1 - 5 years ) showed that , during 2 months of follow-up after administration of oral vitamin A ( 200,000 IU ) , the control group ( aged 3 - 5 years ) had a higher incidence of respiratory disease ( 2.9 times ) as well as diarrhea ( 3.1 times ) . Between 2 and 4 months , a significantly ( p less than 0.025 ) higher incidence of respiratory diseases ( 2.5 times ) could be observed in children aged 1 - 2 years . This study supports earlier reports on a greater risk of respiratory diseases and of diarrhea in mild vitamin A deficiency .  Supplementation reduced the incidence of both diarrhea and respiratory disease for a period of at least 2 months Recently , the efficacy of oral vitamin A supplementation for measles and respiratory syncytial ( RSV ) infection has been evaluated in developing countries . However , in developed countries where vitamin A deficiency is little worth consideration , few studies have been conducted on the effect of vitamin A supplementation . The effect of oral vitamin A ( 100,000 IU ) supplementation was evaluated in 105 children with measles ( age 5 months to 4 years ) and in 96 children with RSV infection ( ages a month to 2.5 years ) in Fukushima , Japan . Comparisons were made of clinical signs , duration of hospitalization and complications between treated groups and non-treated groups . Treated group ( measles n = 47 , RSV n = 54 ) and non-treated groups ( measles n = 58 , RSV n = 42 ) had similar baseline characteristics . Patients with measles given a vitamin A supplementation had a shorter duration of cough ( 7.2 + /- 1.6 vs 9.2 + /- 1.8 days , p < 0.05 ) and patients with severe RSV infection given a vitamin A supplementation had a shorter duration of retraction ( 3.6 + /- 1.4 vs 5.3 + /- 0.8 days , p < 0.05 ) and wheezing ( 4.4 + /- 1.7 vs 6.3 + /- 1.5 days , p < 0.05 ) . Toxicities , including excess vomiting and bulging fontanel were not observed . Our findings may suggest the efficacy of oral vitamin A supplementation for measles and severe RSV infection , in children who have no malnutrition The effect of vitamin A supplementation on preschool child  morbidity and mortality was assessed in a prospect i ve double-blind placebo-controlled  study around Hyderabad , India . Every six months 200,000 IU vitamin A was given to 7691 children ( treatment group ) whereas 8084 children received a placebo ( control group ) .  Morbidity and mortality data were collected every three months . Risk of respiratory infection was higher in children with mild xerophthalmia than in children with normal eyes .  Vitamin A supplementation had no effect on morbidity status . Mortality rates were similar in the two groups ; it was highest in children who did not receive either vitamin A or placebo . The findings suggest that vitamin A supplementation alone may not reduce child mortality The effect of vitamin A supplementation on selected factors of immunity was tested in African children ( ages 4 to 24 months with complicated measles ) during a r and omized doubleblind intervention trial .  Placebo ( n = 31 ) and treated groups ( n = 29 ) had similar baseline characteristics . The supplemented group had significant reductions in morbidity ( expressed as integrated morbidity scores ) during the acute ( Day 8 , P = 0.006 ) and chronic ( Day 42 , P = 0.02 ; 6 months ; P = 0.002 ) phases . In the treated group there was an increase in total number of lymphocytes ( Day 42 , P = 0.05 ) and measles IgG antibody concentrations ( Day 8 , P = 0.02 ) , both of which have consistently been previously shown to correlate more closely with outcome in measles than other immunologic , clinical and radiologic factors . Interleukin 2 and plasma complement values were unaffected by vitamin A supplementation . These findings reinforce results from animal studies that show that the pathways of vitamin A activity in decreasing morbidity and mortality are partly founded on selective immunopotentiation Although most studies on the effect of vitamin A supplementation have reported reductions in childhood mortality , the effects on morbidity are less clear . We have carried out two double-blind , r and omised , placebo-controlled trials of vitamin A supplementation in adjacent population s in northern Ghana to assess the impact on  childhood morbidity and mortality . The Survival Study included 21,906 children aged 6 - 90 months in 185 geographical clusters , who were followed for up to 26 months . The Health Study included 1455 children aged 6 - 59 months , who were monitored 
    Output:
    
We did not find evidence that a single dose of 200,000 IU of vitamin A per day , given in oil-based formulation in areas with low case fatality , was associated with reduced mortality  among children with measles .
However , there was evidence that the same dose given for two days was associated with a reduced risk of overall mortality and pneumonia specific mortality .
REVIEW ER 'S CONCLUSIONS Although we did not find evidence that a single dose of 200,000 IU of vitamin A per day was associated with reduced mortality among children with measles , there was evidence that the same dose given for two days was associated with a reduced risk of overall mortality and pneumonia specific mortality .
The effect was greater in children under the age of two years .