Skip Navigation
JiVitA's Pioneering Patrimony

Photos by Saikat Mojumder

JiVitA's Pioneering Patrimony

The JiVitA Project's patrimony is the pioneering Vitamin A research of Hopkins legend Alfred Sommer, MD, MHS '73, Bloomberg School dean emeritus. Beginning in Indonesia in 1976, Sommer (right) and collaborators conducted large community studies in Asia proving that even a mild vitamin A deficiency reduces childhood resistance to disease and increases pediatric death rates.

Other community- and hospital-based studies in Africa showed that giving vitamin A to children increases resistance to measles, diarrhea and other infectious diseases and could cut the deaths of children by 25 percent to 55 percent.

Keith West's Nepal study grew out of those findings. From 1994 to 1997, the Hopkins research team, including Joanne Katz, ScD '93, MS, and Christian, enlisted 20,000 pregnant women in southern Nepal to find out if vitamin A would reduce maternal deaths. The maternal mortality ratio there was 600/100,000 live births. (For comparison, in the U.S. the ratio per 100,000 births was 12, and in Canada, 6, based on WHO data for 1995.)

The team gave each woman in the Nepal study either a placebo or one of two weekly vitamin capsules. One contained vitamin A and the other beta-carotene, a form of vitamin A found in vegetables and fruits.The results were dramatic: Vitamin A cut maternal deaths by 40 percent and beta-carotene by 49 percent. This was the first study to show that vitamin A could yield such marked reductions in maternal mortality.

Because rates of maternal mortality and malnutrition in Bangladesh were thought to be similar to those in Nepal, the next step was to set up a trial to test whether vitamin A could also save lives in Bangladesh. "That was an obvious one," said West. He laughs, adding, "It didn't work. "In Bangladesh, neither vitamin A nor beta-carotene reduced maternal deaths.

Why not? "By all indications," says West, "health and nutrition of young mothers, and the minimal care available to them, began to improve around the turn of the last decade, when the JiVitA trial was getting under way." Life in Bangladesh was changing rapidly. "We can point to roads that were barely passable in 2001 that are now paved. They bring access to a whole range of services and assets, including health care. It doesn't have to be great health care to reduce maternal mortality."

By the end of the first JiVitA trial in 2006, death rates were less than a third of what had been expected. As Christian explains, "If you have a very low baseline of mortality, then it is unlikely that the remaining causes of mortality can be influenced by an intervention such as vitamin A."

While the results of the maternal vitamin A trial were disappointing, the success of the concurrent trial of vitamin A for infants suggests an inexpensive strategy for saving the lives of babies. The 15 percent decline in infant deaths in Jivitaland confirmed similar outcomes in trials in India and Indonesia. Pooled analysis of the three studies suggested that newborn vitamin A could reduce infant deaths in rural Asia by 20 percent.

Nutritionists aren’t sure of the exact mechanisms for the protective effect of vitamin A, but they do know that A is critical for newborn lung development and that it enhances immunity. Researchers predicted that in Bangladesh alone, if 70 percent of vulnerable infants got a single two-cent dose, vitamin A could avert the deaths of nearly 24,000 babies each year.

  • Ratings
  • Comments
This forum is closed
  • Benoit Labrique

    Belgium 11/20/2009 11:45:37 AM

    A great project.

  • Habib Chaklader

    Arlington, VA 01/22/2010 11:39:46 AM

    I think that Jivita is doing a great job in two fronts: 1) Conducting a valuable research that will save life not only in Bangladesh but also in other countries around the world once the research has been validated, 2) developed an infrastructure in a developing country for further research that is hard to come-by.

    The question is how to sustain such an infrastructure where public health funding is always hard to come-by. Since I was born in Gaibandha, and completed my MPH from New York, I. personally, can understand the need for such projects. I think opening up this Jivitaland to other research institute (i.e. Harvard, Oxford, Columbia, and local public health schools) will benefit both the researcher and the staff working for this project. Since these staff has an intimate knowledge of this population, just having researcher visiting this area will help researcher either develop a good research question, or find a way to solve their existing research question. I would also urge to open this area up for valuable clinical study. Few ways Jivitaland can survive and benefit others would be recommend this area to major research/ scientific journal, advertise to the research/ clinical trial institutes, and invite prospective researcher. I am not sure Johns Hopkins can, also, benefit from lending their already developed infrastructure to these potential teams in the form of realty fee/ contribution or not.

    Thanks for the good work.

Read about our policy on comments to magazine articles.

design element
Online Extras

Images from Jivitaland

Images from Jivitaland

Experience the on-the-ground realities of the JiVitA project in Bangladesh through the images of Bangla photographer Saikat Mojumder.

Photo Gallery

Talk to Us

Amazed? Enthralled? Disappointed? We want to hear from you. Share your thoughts on articles and your ideas for new stories:

Download the PDF

Get a copy of all Feature articles in PDF format. Read stories offline, optimized for printing.

Download Now (1.7MB)