Abstract

EFFECTS OF VITAMIN A SUPPLEMENTATION ON TUBERCULOSIS TREATMENT IN CALABAR, NIGERIA: A RANDOMIZED CONTROLLED TRIAL

*Regina I. Ejemot-Nwadiaro, Edisua H. Itam and Emmanuel N. Ezedinachi

ABSTRACT

Background: Tuberculosis (TB) still remains one of the most devastating communicable diseases globally. TB and malnutrition often co-exist and exert mutually reinforcing effects on each other. How such relationship influences the natural history of TB is poorly understood particularly in this environment. Objective: To evaluate the effects of vitamin A supplementation on TB treatment outcome. Methods: Eighty-one adults fulfilling enrolment criteria were randomized to intervention group; (n = 41). This received oral administration of vitamin A of 10,000 IU as retinyl acetate given at alternate days plus anti-TB drug regimen, and 40 to control group received TB chemotherapy only. Clinical, bacteriological, biochemical and nutritional assessments were carried out at baseline and endline of two months after start of TB treatment. Main Results: Intervention group showed greater increase in weight. This difference was found to be statistically significant (p = 0.04). Similarly, intervention group had better Karnofsky index score (p = 0.04), than control group at endline. Intervention group had statistically significant (p = 0.030) lower proportion (22%) of patients with BMI below the lower range (< 18.5Kg/m2) against 40% for control. The proportion of patients with acid fast bacilli sputum smear negative at endline was higher in intervention group (85%) than control (75%) with relative risk (RR) 0.59 (95% CI 0.23 to 1.46), representing 41% risk reduction. Similar risk reduction (46%) was also observed when adjusted for HIV positivity (RR: 0.54; 95% CI 0.17 to 1.72). Conclusion: Findings support hypothesis that vitamin A supplementation as adjuncts to conventional anti-tuberculosis treatment may augment its efficacy and improve treatment outcome.

Keywords: Tuberculosis; Malnutrition; Micronutrients; Vitamin A supplementation.