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Dietary Vitamin A Intake and the Incidence of Diarrhea and Respiratory Infection among Sudanese Children^1,2,

Wafaie W. Fawzi^*,3, M. Guillermo Herrera^*,#,, Walter C. Willett^*,,, Penelope Nestel^#, Alawia El Amin and Kamal A. Mohamed

^* Department of Nutrition Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115 ^# Harvard Institute for International Development, Cambridge, MA 02138 Ministry of Health, Khartoum, Sudan

The relationship of vitamin A deficiency and child survival has been documented in a number of studies but not in others, yet the relationship of vitamin A with child morbidity remains controversial. We prospectively examined the relationship of dietary vitamin A intake and the incidences of diarrhea and respiratory infection among 28,753 Sudanese children between the ages of 6 mo and 6 y. Total dietary vitamin A intake was strongly and inversely associated with the risk of diarrhea (multivariate risk in top relative to bottom quintile = 0.58, 95% confidence interval = 0.47–0.72); we also observed a strong inverse association with the risk of having cough and fever (0.60, 0.45–0.81). On the other hand, we noted a significantly positive association of dietary vitamin A intake and incidence of cough alone (1.69, 1.52–1.88), a sign that may be associated with a healthy respiratory epithelium. Vitamin A intake was also negatively associated with the risk of measles. These prospective data emphasize the importance of adequate dietary vitamin A intake to protect the health of children in developing countries.

KEY WORDS: • vitamin A • diarrhea • humans • respiratory infection • Sudan

¹ This study was conducted under cooperative agreement no. DAN-0045-G-SS-6067 of the Office of Nutrition, U.S. Agency for International Development (USAID), Washington, DC, and the Harvard Institute for International Development, Cambridge, MA.

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom correspondence should be addressed.

Manuscript received 15 December 1993. Revision accepted 17 October 1994.

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