Where to buy Pharmacies address
Q & A Have questions? ask them

Vitamin and mineral complexes for children. Results of parent questionnaires in nine cities Russia

Authors:Klyuchnikov SO
Location:Astrakhan, Ekaterinburg, Irkutsk, Krasnoyarsk, Moscow, Novosibirsk, Omsk, Tver, Yaroslavl

Without attempting a comprehensive analysis of vitamin preparations existing in the market (which are reviewed in Pharmexpert), in this paper we have tried to draw the attention of pediatricians, public health organizers, scientists and representatives of pharmaceutical companies to the attitude of parents to vitamin and vitamin-mineral complex (WMC) that they choose for their children after reviewing advertising, popular scientific, professional and other sources of information.

9296 surveys of parents whose children received any vitamin and / or vitamin-mineral complexes in the last 3 years were made. Surveys were conducted in November-December of 2006 in nine cities of Russia: Astrakhan, Yekaterinburg, Irkutsk, Krasnoyarsk, Moscow, Novosibirsk, Omsk, Tver, and Yaroslavl. Questionnaires, (850 to 1180 in each city) were distributed in clinics, kindergartens and schools, and were filled out by parents voluntarily, without any involvement of health workers. On this basis, we consider this obtained results as exclusive, although subjective, opinion of parents about vitamin-mineral complexes.

One of the principal conclusions to be drawn from the data obtained through questionnaires, is that the vast majority of parents still consider the use of vitamin and mineral supplements as one of the most important ways to strengthen the health of their children. Thus, 98% of respondents indicated that over the past 3 years they had given certain vitamins to their children, with a similar situation was typical of all cities without exception.

Questionnaires included child's age, presence of chronic diseases, the frequency of SARS during the year, simultaneous use of antibacterial and desensitizing drugs, development of side effects. Parents also were asked to answer the questions: "Who recommended the VMC?" and "What was the duration of their intake?".

As a result of questioning the choice was limited to following 29 vitamin and vitamin-mineral complexes: Aevit, Alvito, ALFAVIT, Biovital gel, Wibowo, VITRUM, Jungle, Junior Vision, Dr. Theissen, Duovit, Golden Ball, Revit, Calcium-D3-Nycomed, Kaltsimaks, Calcinova, Complivit, Makrovit, Multi-tabs, Neyromultivit, Pantoshka, Pikovit, Multivitamin Baby, Sana-Sol, Tantorium, Triovite, Centrum. This list does not include individual vitamins that were occasionally encountered in the questionnaire (vitamins A, C, E), and also imported vitamins and biologically active supplements, that were not registered in Russia.

The most 9 most popular complexes chosen by parents are shown in Table 1. The difficulty of analyzis and interpretation of the data was due not only because of a great variety of vitamin-mineral complexes, but also because many of these complexes were used for a short period of time . Unfortunately, parents, often, were not able to reproduce exactly the duration of courses and the naming of specific vitamins that were given to the child. In some cases, their number reached 5-7 per only one year, with the replacement of one VMC with another in a course of few days without any significant reason. Nonetheless, individual analysis and subsequent mathematical processing of all applications, showed that analysis of only one VMC showed identical results compared with the total sample. On average, the lowest frequency of only one complex was noted for Centrum (10%) and Sana Sola (15%), and the highest - for ALFAVIT (23%), Komplivit (25%) and Multi-tabs (28%) which indicates a greater commitment (connection) of parents towards the latter.

Further discussion of results mainly focused on the 9 preparations mentioned in Table 1, because the frequency if use for other vitamins was negligible and did not exceed 3% for each of them.

Figure 1 shows the average frequency of chosen VMC among the total number of polled parents.
As shown in Figure 1, the most popular VMC in all the cities were Multitabs, Pikovit and ALFAVIT, followed by Complivit and Djungli. Analysis of mean values indicates the absence of significant differences in the frequency of choice of VMC’s between the cities. The exception is Biovital gel, which had a minimal frequency in the cities of Astrakhan and Omsk (total of 4,4%), with maximum choice in Yekaterinburg (23,4%) and Moscow (15.9%). Furthermore, a more detailed analysis, taking into account the age of children, allowed to point out some additional features. In the group of preschool children, Multi-Tubbs was predominant in all cities, Pikovit was frequently chosen in Astrakhan and Omsk, the Djungli - in Moscow and Tver. In the group of children of school age, ALFAVIT was frequently chosen in the following cities: Astrakhan, Novosibirsk, Moscow and Tver, Pikovit - in Novosibirsk and Omsk, Multi-tabs - in Yekaterinburg. In the group of children older than 12 years parents chose ALFAVIT more frequently in Astrakhan, Krasnoyarsk and Moscow, Komplivit - in Ekaterinburg, Omsk and Tver.
Of course, the age of children is the most important factor determining the choice of vitamin preparations. On average, the difference between age groups was minimal only for two VMCs (VITRUM and Pikovit) and amounted to 3-4%, while for other vitamins the difference was significant and ranged from 1.5 to 4 times. In general, this should be a consequence of the availability of age-specific recommendations developed by the manufacturers. However, as evidenced by the results of the survey, parents do not always adhere to instructions specified in the recommendations. The most striking example is the ALFAVIT, which was used for preschool children in 14% of cases, despite the absence of Alphabet Kindergraten specially designed for children under age of 7 years in the period under review. Another proof of neglect of instructions by parents is VITRUM, which is recommended for children over 12 years by manufacturer. However, to our knowledge, this complex was used not only for children of primary school age (14%), but even at preschool age (12%). This feature is a common fact for all cities.
For this reason, the question of who prescribes VMC to children is of particular value. Analysis of responses to this question revealed that nearly in every second case, the choice of complexes was carried out by the parents by themselves. For such VMC as Djungli, Complivit, Pikovit and ALFAVIT proportion of self-selection ranged from 58% to 70%. To some extent this is an indicator of the popularity of these complexes among parents. As mentioned above, VMC Biovital gel was characterized by the minimum percentage of self-selection - 44%. This complex, along with Sana Saul was the most popular for medical appointments which were 65% and 71% respectively. In this case, as shown in Table 1, the largest number of medical appointments of Biovital gel was found in Yekaterinburg and Moscow, exceeding 2-4 times the figures for other cities.

A special role in shaping attitudes towards VMC belongs to district pediatricians, whose recommendations must be both maximally individualized for the individual child, and also cause the greatest confidence in parents. However, analysis of survey materials showed that for the majority of VMC the frequency of prescriptions by district pediatricians was only 34-53%. The lowest activity of local doctors was noted for prescriptions of Komplivit and ALFAVIT.

It is known that the effectiveness of VMCs directly dependents not only on their quality, but also on the duration of the reception. Analysis of the duration of intake of vitamin-mineral complexes by children divided the courses in three time periods: up to 7 days, from 7 to 14 days and more than 2 weeks. Analysis of this factor should be done, while keeping in mind that among the causes of short reception of complexes (up to 7 days or from 7 to 14 days), the most significant may be the following:

  • Lack of awareness of parents about the need for long-term (not less than 4 weeks) intake of VMC;
  • "Indiscipline" of parents in regard to daily prolonged use of VMC;
  • Refusal to intake the VMC because of emergence, in the opinion of parents, of any "adverse reactions" in the child.

Nonetheless, only the ALFAVIT, Djungli and San Sol were characterized by the minimum percentage of "refusals" within first 7 days, which ranged from 4% to 7% for each of them. During the first week parents ceased to use Pikovit and Centrum in 18% and 21% of the cases, respectively.

It could be assumed that the child's frequent colds would be a significant factor in forming a strong interest in VMC for the parents of such children. However, the frequency of choice VMC in this group was practically identical compared with not frequently ill children. A similar pattern was found in all cities.

In spite of this fact it was established that the assignment of frequently ill children affected the choice of the VMC. Thus, for sickly children under school age parents more often chose Multi-tabs and ALFAVIT. At school age, children with frequent colds choice were treated with ALFAVIT Komplivit and Djungli, and in adolescence with VITRUM and Sana-Sol.

It stands out that nearly in all cities the high cost of complexes did not negatively influence the choice of VMC. The most popular VMCs are the most expensive (Multitabsis, 140 rubles in average) or the complexes with the average cost - Alphabet, Djungli and Complivit (an average of 89-105 rubles).

The data obtained from questionnaires, also indicates that only in every second case, the parents take into account that a child has a chronic illness. At the same time, parents in the questionnaires indicated the diseases, which are, in their view, are the most important for the health of their children, namely: chronic tonsillitis, atopic dermatitis, chronic gastritis and pyelonephritis. Other diseases such as bronchial asthma, glomerulonephritis, cardiovascular and neurological diseases are mentioned only sporadically. The "incorrect" awareness among parents regarding indications for use of VMC is also shown by the fact that parents point to such state as "an increase in adenoid vegetations" as the main and most frequent reason for the use of vitamins.
Along with this, we need to note that the fact of chronic illness of a child does play a role in choice of VMC by parents. Specifically, VMC Complivit is most often used for school-age children with the presence of any chronic illnesses - the frequency of its selection increases by 9% compared with children without chronic diseases. For children over 12 years with illnesses the most frequent choice was VITRUM (an increase of 6 %). We can assume that the opinion of parents is formed in such a way that Complivit and VITRUM are viewed as having a "curative" effect rather than "preventive". Using this "logic" Multi-tabs, according to the parents, seems to be classified as the latter, but the frequency of use of this complex in the presence of chronic diseases among children in all age groups decreases significantly (8%).

A special place is occupied by VMC Alphabet. Designed to take into accounrt synergy and antagonism between the components that are separated into 3 tablets, it requires parents much more attention (triple dose) than other vitamins. Nevertheless, analysis of frequency selection and duration of reception of this VMC evidences its popularity among parents in the cities of European Russia and in Siberia. Noteworthy is the fact that in case of prescription of this complex the parents noted improvement in child health in the highest percentage of cases (65%), whereas for the rest of VMCs this figure ranged from 47% to 58%.

A significant fact, reflecting the attitude of parents to choice of VMC, is the results of combined use of VMCs with different drugs. In the case of antibiotic therapy VMCs Sana-Sol (29%) and VITRUM (27%) were more frequently selected. It should be noted that in some cities this figure was significantly differenct. For example, in Astrakhan ALFAVIT had 36%, in Omsk - 29%, while in Moscow - only 17%.

Given the great population frequency of allergic diseases and alertness of the public regarding the risk of allergies, it is of particular importance to have information on the combined use of VMCs with desensitizing drugs. We established that, simultaneously with the latter, parents frequently used Centrum (13%), Sana-Sol (11%) and Pikovit (10%). The results of this survey did not make possible to make firm conclusions about the true motives of use of these VMCs in patients with allergic conditions, but we cannot exclude the development of side effects of vitamins as a possible cause for prescription of desensitizing drugs.

A number of reputable domestic and foreign publications recognize that inappropriate treatment of many diseases and polypharmacy, especially in pediatrics, has become one of the major problems of modern medical practice. One of the most significant consequence is the increase of the frequency of side effects with medical and supplement preparations.

In all the cities during the use of VMC, in an extremely high percentage of cases, the parents noticed various "adverse reactions". On average, as shown in Figure 2, the frequency of "adverse events" ranged from 7% (Alphabet) and 8% (Complivit) to 14% (Biovital gel, VITRUM, Sana-Sol). However, a number of cities identified salient features. In particular, in Omsk and Astrakhan and the frequency of "adverse reactions" for Biovital gel reached 28% and 18% respectively, and in Krasnoyarsk it was only 9%. For Complivit maximum values (18.3%) were recorded in Yekaterinburg, and minimal (3,3%) - in Krasnoyarsk. The smallest differences in the incidence of adverse effects were observed for Alfavit from 6,2% in Tver to 11,4% in Astrakhan.
It is advisable to pay special attention to the characteristics of the "side effects". All reactions to ALFAVIT marked byr parents, were small and expressed, usually in the form of facial flushing (4%). The side effects of other complexes were more varied. Among them, in particular the following reactions were recorded: appetite loss, sleep disturbance, anxiety, itching, dysfunction of the gastrointestinal tract and some others. Thus, the rash as "adverse reaction" was noted by parents during the use of Sana-Sol 11% and Djungli at 8%, pruritus was often recorded for Sana-Sol, Multi-tabs and VITRUM (5%), and redness of the facial skin was characteristic for Biovital gel (8%).

Note that not all so-called "adverse events" (or perceived as such by parents) really ought to be attributed just to the side or adverse effects from the VMC. However, the emergence of any adverse effects while taking VMC and, consequently, the formation of the negative perception of the parents require the close attention of specialists and detailed study.

The "adverse reactions" could be caused by:

  • Non-compliance (excess) with age-recommended dosages.
  • The combined use of VMCs with drugs or agents that promote the emergence of the antagonism between the ingredients.
  • Simultaneous use of complexes similar in individual ingredients, causing a cumulative effect.
  • Unfounded choice of VMC in the presence of chronic illness that require a step application of several preparations.
  • Timeliness of choice VMC in the presence of acute illness or exacerbation.

Thus, the problem of vitamins and vitamin-mineral complexes in children requires careful epidemiological and special research, as well as addressing a number of organizational and legal aspects. District pediatricians are required to carry out daily, methodically well thought-out, preventive work with parents of observed children.

Preparation of materials for publication involved students and teachers of medical schools in Russia: Korshunov AV, Mitin YY, Stroeva SV, Mozzhuhina MV, Sergeicheva EN, Shchegoleva A.D, Chuprynova MY, Ripp, MV, Alekseev, RK, Kuhterina SV, Kurdyukova TA, Anshakova OA, Chubar SA, Shiryayeva SI, Milman JA, Smirnova AV, Kulakova MS, Kapustina PS.

Fig. 1. Mean values of frequency of selection VMCs (%) relative to the total number of surveyed (9296 children)

Fig. 2. The frequency of "adverse reactions" (%) during application of vitamin-mineral complexes (average data from 9 cities of Russia).

Table 1.
Some of the most popular vitamin-mineral complexes, marked during survey among parents in the cities of Russia.