| JiVitA-1: Maternal Vitamin A or Beta-Carotene Supplementation Trial in Bangladesh Each year, approximately 20,000 Bangladeshi women die from causes related to pregnancy. Micronutrient deficiencies may increase the risk of maternal morbidity and mortality. In particular, maternal vitamin A deficiency is common, with 10-15% of pregnant South Asian mothers becoming night blind and at increased risk of mortality. In Nepal, supplementing women with a recommended dietary allowance of vitamin A, either preformed or as beta-carotene, reduced pregnancy-related mortality by 40%, prompting an urgent need to extend knowledge of this effect elsewhere. The Districts of Gaibandha and Rangpur in Northern Bangladesh were selected as the site for JiVitA Bangladesh, a nutrition and health research project. The project has about 850 local staff (90% of whom are women) and has been set up in an area of approximately 650 sq km with over half a million people. JiVitA-1 was a double-masked, cluster-randomized, placebo-controlled 67,000 pregnancy trial. It sought to confirm the efficacy of weekly maternal supplementation with an RDA equivalent of vitamin A, preformed or as beta-carotene, in reducing all-cause pregnancy-related mortality, maternal morbidity, infant mortality, and other adverse pregnancy and infant health outcomes in Bangladesh. The trial reached its planned sample size toward the end of 2006, after which its Data and Safety Monitoring Board (DSMB) recommended it close out. Supplementation did not reduce maternal mortality for probably several reasons, including a markedly lower maternal mortality rate and better vitamin A status in Bangladesh versus Nepal. The JiVitA-1 trial received major support from USAID (Washington, DC and Dhaka) via the GRA and the Bill and Melinda Gates Foundation, with additional assistance from the Sight and Life Research Institute (Baltimore, MD), CIDA/Micronutrient Initiative (Ottawa, Canada), and the Nutrilite Health Institute (Santa Monica, CA). Principal Investigator: Keith P. West, Jr. (JHSPH) Co-Principal Investigators: Parul Christian (JHSPH), Rolf Klemm (JHSPH) and Alain Labrique (JHSPH) Co-Investigators:
Publications Christian P, Sommer A, West K. (2006). Reducing maternal mortality where rates are greatest [Correspondence]. The Lancet, 368, 9553, 2122-2123. Sugimoto JD, Ahmad S, Rashid M, Shamim AA, Labrique AB. (2007). A low-cost method to identify tubewells for longitudinal research on arsenic in groundwater. J Health Popul Nutr, 253, 377-81. Sugimoto JD, Labrique AB, Ahmad S, Rashid M, Klemm RD, Christian P, West KP Jr. (2007). Development and management of a geographic information system for health research in a developing-country setting: a case study from Bangladesh. Health Popul Nutr, 25, 4, 436-47. West KP Jr., Christian P, Klemm R, Labriqu A, Rashid M, Shamim AA, Katz J, Sommer A for the JiVitA Bangladesh Project. (2006). The JiVitA Bangladesh Project: Research to improve nutrition and health among mothers and infants in rural South Asia. Sight and Life Newsletter, 1, 10-14. For more information on JiVitA-1, visit the JHSPH Center for Human Nutrition. |