Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Vitamin D Supplementation on the Incidence of Pneumonia in Children in Afghanistan: a Randomized Controlled Trial
Brief Summary: Background: Pneumonia is the leading cause of childhood mortality, accounting for 19% of the 10.6 million deaths that occur each year1. Case-control studies from Ethiopia2 and India3 suggest that sub-clinical vitamin D deficiency may increase ten times the risk of pneumonia in children. We postulate that controlling childhood vitamin D deficiency has the potential to dramatically reduce the incidence of pneumonia and save \>700,000 lives each year since vitamin D deficiency is widespread in developing countries.

Aim: To investigate whether 3-monthly oral supplementation of 100,000iu vitamin D reduces pneumonia and its consequences among children aged 1-12 months (followed for 18 months), living in a deprived area of Kabul, Afghanistan, where \>70% of young children are vitamin D deficient (\<8ng/dl). The effect of vitamin D on the incidence of other diseases, in particular diarrhea and rickets will also be investigated.

Methods: Randomised double-blind placebo-controlled trial: 3000 children will be randomised to receive either 6 doses of vitamin D or placebo. The first dose will be given at the start of autumn and the second and subsequent doses every 3 months thereafter; children will be followed for 18 months. Incidence of pneumonia will be ascertained though weekly home visits (active surveillance) and from attendances and admissions at the trial clinic and wards in the hospital serving the study area (passive surveillance).


Options:
A: Inclusion Criteria:

* Children of either sex aged 3 - 59 months, with a clinical diagnosis of severe pneumonia with or without diarrhea.

Exclusion Criteria:

1. Known case of hypercalcaemia or allergy to vitamin D, as determined by history or previous medical records.
2. Congenital Heart disease, evidenced by clinical exam or past medical records.
3. Renal or hepatic insufficiency, evidenced by clinical exams or past medical records.
4. Known case of tuberculosis, evidenced by medical records
5. Known case of asthma, evidenced by history and clinical exam findings.
6. Critically ill children requiring ICU care, such as those with septic shock or cardiac arrest or apnoea.
7. Received vitamin D or calcium supplementation within the last 4 weeks before current admission, as evidenced by history or medical prescription.
8. Any children diagnosed as hypernatraemia during the main phase of the study.
B: Inclusion Criteria:

* Clinically definite MS
* Age 18-55
* EDSS 0-6.5

Exclusion Criteria:

* EDSS =\> 7.0
* Current Vitamin D3 use \>4000 IU/d
* Baseline (25(OH)D) level \<20 mmol/L (frank deficiency) and \>150 mmol/L
* Pregnancy or inability/unwillingness to use contraception
* History of cardiac arrhythmia
* History of renal disease and nephrolithiasis
* History of granulomatous disease or lymphoma
* Relapse activity or steroid use in the past 60 days
C: Inclusion Criteria:

1. 1 to 11 month old infants living in the study area
2. caretakers are willing to give consent to take part in the study

Exclusion Criteria:

1. the family is likely to migrate out of the study area within the next 18 months
2. the child has been diagnosed with rickets or known to have received a course of vitamin D treatment in the past 3 monDths.
3. Child with Kwashiorkor or Marasmus.
D: Inclusion Criteria:

* Children diagnosed clinically with pneumonia according to the World Health Organization criteria of severity.

Exclusion Criteria:

* Children who have clinical signs of rickets.
* Children who have severe illnesses (meningitis, heart or renal disorders, measles)
* Children who have severe malnutrition.
* Children who have endocrine dysfunction, hypercalcemia, hyperthyroidism.
* Children with suspected tuberculosis.
* Children who have received high-dose vitamin D treatment in the past 3 months.
* Children with sufficient or toxic levels of vitamin D.

Answer: C