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Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial
M M Rahman1, S H Vermund, M A Wahed
1International Centre for Diarrhoeal Disease Research, Dhaka 1000, Bangladesh. mujib_99@yahoo.com
Insights
Combined zinc and vitamin A supplementation effectively reduced diarrhoea in children. However, zinc alone increased respiratory infections, an effect mitigated by vitamin A co-supplementation.
Area of Science:
- Nutritional Immunology
- Pediatric Infectious Diseases
- Micronutrient Research
Background:
- Diarrhoea and acute lower respiratory infections (ALRI) are leading causes of child mortality globally.
- Zinc and vitamin A are essential micronutrients crucial for immune function.
- Understanding their combined effects on childhood infections is vital for public health interventions.
Purpose of the Study:
- To investigate the synergistic effects of simultaneous zinc and vitamin A supplementation on childhood diarrhoea and ALRI.
- To evaluate the individual and combined impacts of these micronutrients on infection morbidity.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted in urban slums of Dhaka, Bangladesh.
- 800 children aged 12-35 months received one of four treatments: zinc, vitamin A, both, or placebo.
- Children were monitored weekly for six months to collect morbidity data.
Main Results:
- Simultaneous zinc and vitamin A supplementation significantly reduced the prevalence of persistent diarrhoea and dysentery.
- Zinc supplementation alone was associated with a significant increase in the incidence and prevalence of ALRI.
- The adverse effect of zinc on ALRI was attenuated when co-administered with vitamin A.
Conclusions:
- Combined zinc and vitamin A supplementation demonstrates synergistic benefits in reducing persistent diarrhoea and dysentery.
- While zinc alone may increase ALRI risk, its combination with vitamin A mitigates this adverse effect.
- This study highlights the importance of balanced micronutrient interventions for child health.
Objective:
To evaluate the effect of simultaneous zinc and vitamin A supplementation on diarrhoea and acute lower respiratory infections in children.
Study Design:
Randomised double blind placebo controlled trial.
Setting:
Urban slums of Dhaka, Bangladesh.
Participants And Methods:
800 children aged 12-35 months were randomly assigned to one of four intervention groups: 20 mg zinc once daily for 14 days; 200 000 IU vitamin A, single dose on day 14; both zinc and vitamin A; placebo. The children were followed up once a week for six months, and morbidity information was collected.
Results:
The incidence and prevalence of diarrhoea were lower in the zinc and vitamin A groups than in the placebo group. Zinc and vitamin A interaction had a rate ratio (95% confidence interval) of 0.79 (0.66 to 0.94) for the prevalence of persistent diarrhoea and 0.80 (0.67 to 0.95) for dysentery. Incidence (1.62; 1.16 to 2.25) and prevalence (2.07; 1.76 to 2.44) of acute lower respiratory infection were significantly higher in the zinc group than in the placebo group. The interaction term had rate ratios of 0.75 (0.46 to 1.20) for incidence and 0.58 (0.46 to 0.73) for prevalence of acute lower respiratory infection.
Conclusions:
Combined zinc and vitamin A synergistically reduced the prevalence of persistent diarrhoea and dysentery. Zinc was associated with a significant increase in acute lower respiratory infection, but this adverse effect was reduced by the interaction between zinc and vitamin A.