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

机译：补充维生素A对尼泊尔儿童死亡率不平等的影响。

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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.
机译：目的：本文在维生素A分布的整群随机试验的背景下，研究了儿童死亡率的性别，种姓和经济差异，以确定干预措施是否缩小了这些差异。设计：该研究涉及对安慰剂对照的维生素A补充剂随机田间试验的数据进行二次分析。这项研究于1989年至1991年之间在尼泊尔的Sarlahi区进行，有30059名6至60个月大的儿童。主要的结果指标是男孩和女孩之间，印度教种姓最高的人和其他人之间，以及最贫穷的五分之一与其他四个五分之一之间的死亡率差异。结果：在没有维生素A的情况下，尼泊尔农村地区的女孩每千人有26.1例死亡，这比男孩的比较人口多8.3例死亡。使用维生素A，女孩的死亡率劣势几乎被完全消除，相对于男孩，每1000人仅增加1.41例死亡。补充维生素A还缩小了印度种姓之间的死亡率差异，但并未降低资产所有权五分位数之间死亡率的集中度。性别和种姓所致的维生素A相关的死亡率降低现象具有统计学意义。结论：我们得出结论，普遍补充维生素A缩小了尼泊尔农村地区不同性别和种姓儿童死亡的差异。确保整个尼泊尔的高覆盖率维生素A分布可以帮助减少该人群儿童生存的不平等现象。

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