The risk of respiratory disease and diarrhea were more closely associated with vitamin A status than with general nutritional status. These results may explain much of the excess mortality recently reported for mildly vitamin A-deficient children.

Children in developing countries die primarily from infections such as diarrhoea, respiratory disease and measles. Vitamin A deficiency presumably alters the incidence, duration or severity of such infections or the child's ability to withstand their consequences.

An average of 3481 preschool-age rural Indonesian children were re-examined every 3 months for 18 months. The mortality rate among children with mild xerophthalmia (night blindness and/or Bitot's spots) was on average 4 times the rate, and in some age groups 8 to 12 times the rate, among children without xerophthalmia. Mortality increased, almost linearly, with the severity of mild xerophthalmia (night blindness, Bitot's spots, and the two combined). These relations persisted after stratification for respiratory disease, wasting, gastroenteritis, pedal oedema, and childhood exanthems. Mild vitamin A deficiency was directly associated with at least 16% of all deaths in children aged from 1 to 6 years. These results suggest that mild xerophthalmia justifies vigorous community-wide intervention, as much to reduce childhood mortality as to prevent blindness, and that night blindness and Bitot's spots are as important as anthropometric indices in screening children to determine which of them need medical and nutritional attention.

Between 1986 and 1993, eight population-based intervention trials world-wide assessed the contribution of vitamin A deficiency (VAD) to child mortality. An independent meta-analysis of these trials showed that, in areas where VAD is prevalent, vitamin A repletion reduces child mortality by 23% on average. This significant reduction in child mortality is largely a result of the mortality reduction from measles, severe diarrhoea and falciparum malaria