Please select the eligibility criteria that correspond to the clinical trial below.
Title: Vitamin D Supplementation: Impact on Severe Pneumonia Among Under-five Children
Brief Summary: Background:

* Burden: Pneumonia is the leading cause of morbidity and mortality in under-five children, particularly in developing countries.
* Knowledge gap: Although many studies have reported an association between vitamin D deficiency and pneumonia, there is lack in information on its therapeutic impact, i.e. the impact of vitamin D supplementation in the management of childhood pneumonia.
* Relevance: Vitamin D plays an important role in modulating the innate immune response against infections. We, therefore, propose to conduct this study to assess the impact of vitamin D supplementation, in addition to standard antibiotic and supportive therapy, on the outcome of severe childhood pneumonia.

Hypothesis: The investigators hypothesise that in the management of hospitalized severe pneumonia in under-five children, vitamin D3 supplementation, as an adjunct to the standard antibiotic and other supportive therapy, will hasten recover from severe pneumonia and may thereby shorten duration of severe pneumonia and also reduce the risk of new episode of pneumonia.

Objectives: The objective of the investigators study is to assess the clinical benefit of oral supplementation of vitamin D3, in addition to standard antibiotic and other supportive therapy, to hospitalised, under-five children with severe pneumonia.

Methods: This would be a randomised, double blind, controlled clinical trial (RCT). Children of either sex, aged 3-59 months, attending the Dhaka Hospital of icddr,b, with clinically diagnosed severe pneumonia will comprise the study population. Eligible children will be allotted a sequential study number, which will have been previously assigned to vitamin D or placebo in accordance with the randomisation. The study staff and mothers/ caregivers of the children will be blinded as to whether vitamin D3 or placebo has been added to their child's diet. Infants aged 3-5 months will receive breast milk and/or infant formula, and those 6 months or older will receive "Milk Suji" as a complementary food. Vitamin D3 supplementation will be given on five consecutive days, from the day of enrolment in addition to standard antibiotic and other supportive therapy.

Outcome measures/variables:

Primary outcome measure will be time to resolution of severe pneumonia.

Secondary outcome measures will be duration of hospitalization, fever, tachypnoea, chest in drawing, hypoxia, lethargy and inability to feed during hospital stay and as well as new episode of pneumonia after discharge.


Options:
A: 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.
B: 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.
C: 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.
D: 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

Answer: C