***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 It has been suggested that administering vitamin A with the measles vaccine may reduce the vaccine 's immunogenicity . This trial examined the effect of supplementing vitamin A during the early months of life on infants '  immune responses to tetanus and polio vaccines . Young infants ( n = 1085 ) were enrolled and individually r and omized into 1 of 4 groups in a factorial , double-blind , placebo-controlled trial . Three vitamin A supplementation strategies were investigated : 1 ) supplementation of breast-feeding mothers with 60 mg retinol equivalent ( RE ) vitamin A within 4 wk of delivery ; 2 ) Exp and ed Program on Immunization (EPI)-linked supplementation of infants with 7.5 mg RE vitamin A at 6 , 10 , and 14 wk ; and 3 ) combined mother and child supplementations . A 4th group in which mother and child were given placebos served as controls . Blood sample s were collected from each child at 6 wk and 6 mo of age to measure antipolio antibody titer , antitetanus toxoid antibodies , and avidity of antibodies to tetanus . Of the infants r and omized into the 4 arms of the study , 767 ( 71 % ) completed follow-up at 6 mo of age . Follow-up rates were similar in all 4 arms ( 69 - 72 % , P = 0.8 ) . Antibody titers were relatively high in all 4 groups at both 6 wk and 6 mo of age , with no differences among the groups . We found no evidence that vitamin A supplementation affects infants '  antibody responses to tetanus toxoid or oral polio vaccine delivered at EPI contacts BACKGROUND The effect of vitamin A supplementation on the survival of infants aged < 6 mo  is unclear . Because most infant deaths occur in the first few month of life , maternal supplementation may improve infant survival . OBJECTIVES The objective was to assess the effect of maternal vitamin A or beta-carotene supplementation on fetal loss and survival of infants < 6 mo of age . DESIGN Married women of reproductive age in 270 wards of Sarlahi district , Nepal , were eligible to participate . Wards were r and omly assigned to have women receive weekly doses of 7000 microg retinol equivalents as retinyl palmitate ( vitamin A ) , 42 mg all-trans-beta-carotene , or placebo . Pregnancies were followed until miscarriage , stillbirth , maternal death , or live birth of one or more infants , who were followed through 24 wk of age . RESULTS A total of 43559 women were enrolled ; 15832 contributed 17373 pregnancies and 15987 live born infants to the trial . The rate of fetal loss was 92.0/1000 pregnancies in the placebo group , comparable with rates in the vitamin A and beta-carotene groups , which had relative risks of 1.06 ( 95 % CI : 0.91 , 1.25 ) and 1.03 ( 95 % CI : 0.87 , 1.19 ) , respectively . The 24-wk mortality rate was 70.8/1000 live births in the placebo group , comparable with rates in the vitamin A and beta-carotene groups , which had relative risks of 1.05 ( 95 % CI : 0.87 , 1.25 ) and 1.03 ( 95 % CI : 0.86 , 1.22 ) , respectively . CONCLUSIONS Small weekly doses of vitamin A or beta-carotene given to women before conception , during pregnancy , and through 24 wk postpartum did not improve fetal or early infant survival in Nepal Vitamin A supplementation reduces child mortality and severe morbidity in less developed countries , and the Exp and ed Program on Immunization ( EPI ) offers an ideal opportunity to deliver supplements in developing countries . High-dose vitamin A supplementation has been shown to have no effect on the immunogenicity of oral polio vaccine , tetanus toxoid , pertussis , or on measles vaccine given at 9 mo , but a negative effect on measles vaccine administered at 6 mo and a potentiating effect on diphtheria vaccine . Its effect on the antibody response to hepatitis B and Haemophilus influenzae type b antigens has not yet been established . To assess these effects , the present trial was carried out in the Offinso district of Ghana ; 1077 infants were enrolled shortly after birth and r and omized either to receive or not to receive 15 mg retinol equivalent with vitamin A together with the pentavalent " diphtheria-polio-tetanus-Haemophilus influenzae b-hepatitis B " vaccine at 6 , 10 , and 14 wk of age . All mothers received a postpartum supplement of 120 mg retinol equivalent vitamin A as per national policy . Blood sample s were taken from infants at 6 and 18 wk of age . The results are based on 888 infants ( 82.4 % ) who completed the trial . The vitamin A supplementation did not affect the immune response to Haemophilus influenzae type b , but there was a significant improvement in the immune response to hepatitis B vaccine ( 93.9 vs. 90.2 % , P = 0.04 ) . However , given the high percentage of infants with seroprotection in the control group , it is doubtful that inclusion of vitamin A in the EPI would be justified on these grounds alone Community trials of the efficacy of vitamin A supplementation in reducing  preschool childhood mortality  have produced conflicting results . To resolve the question , a r and omised , double-masked , placebo-controlled community trial of 28,630 children aged 6 - 72 months was carried out in rural Nepal , an area representative of the Gangetic flood plain of South Asia . R and omisation was carried out by administrative ward ; the vitamin-A-supplemented children received 60,000 retinol equivalents every 4 months and placebo-treated children received identical capsules containing 300 retinol equivalents . After 12 months , the relative risk of death in the vitamin-A-supplemented compared with the control group was 0.70 ( 95 % confidence interval 0.56 - 0.88 ) , equivalent to a 30 % reduction in mortality . The trial , which had been planned to last 2 years , was discontinued . The reduction in mortality was present in both sexes ( relative risk for boys 0.77 ; for girls 0.65 ) , at all ages ( range of relative risks 0.83 - 0.50 ) , and throughout the year ( 0.76 - 0.67 ) . The reduction in mortality risk was not affected by acute nutritional status , as measured by arm circumference . Thus , periodic vitamin A delivery in the community can greatly reduce child mortality in developing countries BACKGROUND Clinical vitamin A deficiency affects millions of children worldwide , and sub clinical deficiency is even more common . Supplemental vitamin A has been reported to reduce mortality among these children , but the results have been question ed . METHODS We conducted a r and omized , controlled , masked clinical trial for one year in southern India involving 15,419 preschool-age children who received either 8.7 mumol ( 8333 IU ) of vitamin A and 46 mumol ( 20 mg ) of vitamin E ( the treated group ) or vitamin E alone ( the control group ) . Vitamin supplements were delivered weekly by community health volunteers who also recorded mortality and morbidity . Weekly contact was made with at least 88 percent of the children in both study groups . The base-line characteristics of the children were similar and documented a high prevalence of vitamin A deficiency and undernutrition . RESULTS One hundred twenty-five deaths occurred , of which 117 were not accidental . The risk of death in the group treated with vitamin A was less than half that in the control group ( relative risk , 0.46 ; 95 percent confidence interval , 0.30 to 0.71 ) . The risk was most reduced among children under 3 years of age ( 6 to 11 months -- relative risk , 0.28 ; 95 percent confidence interval , 0.09 to 0.85 ; 12 to 35 months -- relative risk , 0.46 ; 95 percent confidence interval , 0.26 to 0.81 ) and among those who were chronically undernourished , as manifested by stunting ( relative risk , 0.11 ; 95 percent confidence interval , 0.03 to 0.36 ) . The symptom-specific risk of mortality was significantly associated with diarrhea , convulsions , and other infection-related symptoms . CONCLUSIONS The regular provision of a supplement of vitamin A to children , at a level potentially obtainable from foods , in an area where vitamin A deficiency and under-nutrition are documented public health problems contributed substantially to children 's survival ; mortality was reduced on average by 54 percent 
    Output:
    
There was , however , evidence of an increased risk of acute respiratory infection and a reduced risk of clinic visits .
There is no convincing evidence of a reduced risk of mortality and possibly morbidity or of increased early adverse effects after neonatal supplementation with vitamin A. There is thus no justification for initiating such supplementation as a public health intervention in developing countries for reducing infant mortality and morbidity