Mortality and morbidity among postpartum HIV-positive and HIV-negative women in Zimbabwe: Risk factors, causes, and impact of single-dose postpartum vitamin A supplementation
Journal of Acquired Immune Deficiency Syndromes
Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe; ZVITAMBO Project, Harare, Zimbabwe; Department of Paediatrics and Child Health, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe; College of Science, Institute of Nutrition and Family Sciences, Harare, Zimbabwe; Research Institute, McGill University Health Centre, Montreal, Que., Canada; Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States; Department of Immunology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe; Harare City Health Department, Harare, Zimbabwe; WHO, Switzerland; ZVITAMBO Project, 1 Borrowdale Road, Borrowdale, Harare, Zimbabwe
BACKGROUND: Vitamin A deficiency is common among women in resource-poor countries and is associated with greater mortality during HIV. METHODS: Fourteen thousand one hundred ten mothers were tested for HIV and randomly administered 400,000 IU vitamin A or placebo at less than 96 hours postpartum. The effects of vitamin A and HIV status on mortality, health care utilization, and serum retinol were evaluated. RESULTS: Four thousand four hundred ninety-five (31.9%) mothers tested HIV positive. Mortality at 24 months was 2.3 per 1000 person-years and 38.3 per 1000 person-years in HIV-negative and HIV-positive women, respectively. Vitamin A had no effect on mortality. Tuberculosis was the most common cause of death, and nearly all tuberculosis-associated deaths were among HIV-positive women. Among HIV-positive women, vitamin A had no effect on rates of hospitalization or overall sick clinic visits, but did reduce clinic visits for malaria, cracked and bleeding nipples, pelvic inflammatory disease, and vaginal infection. Among HIV-negative women, serum retinol was responsive to vitamin A, but low serum retinol was rare. Among HIV-positive women, serum retinol was largely unresponsive to vitamin A, and regardless of treatment group, the entire serum retinol distribution was shifted 25% less than that of HIV-negative women 6 weeks after dosing. CONCLUSIONS: Single-dose postpartum vitamin A supplementation had no effect on maternal mortality, perhaps because vitamin A status was adequate in HIV-negative women and apparently unresponsive to supplementation in HIV-positive women. Copyright © 2006 by Lippincott Williams & Wilkins.
placebo; retinol; adult; article; controlled study; female; health care utilization; hospitalization; human; Human immunodeficiency virus infection; major clinical study; malaria; morbidity; mortality; pelvic inflammatory disease; priority journal; puerperium; retinol deficiency; risk factor; tuberculosis; vaginitis; vitamin blood level; vitamin supplementation; Zimbabwe; Adult; Cause of Death; Dietary Supplements; Female; HIV Infections; HIV Seronegativity; HIV Seropositivity; Humans; Morbidity; Pregnancy; Puerperal Disorders; Risk Factors; Survival Rate; Tuberculosis; Vitamin A; Zimbabwe