Zinc and vitamin A supplementation in Australian Indigenous children with acute diarrhoea: a randomised controlled trial
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Patricia C Valery1, Paul J Torzillo, Naomi C Boyce
1Population Studies and Human Genetics, Queensland Institute of Medical Research, Herston, Australia. patriciV@qimr.edu.au
Insights
Zinc and vitamin A supplementation did not significantly improve recovery from acute diarrhoea in Indigenous children. Further research is needed for malnourished children, as this study found no benefit for hospitalized children.
Area of Science:
- Pediatric infectious diseases
- Nutritional science
- Public health
Background:
- Acute diarrhoea remains a significant health concern for Indigenous children in remote areas.
- The role of micronutrient supplementation, specifically zinc and vitamin A, in managing acute diarrhoea in hospitalized children requires further investigation.
Purpose of the Study:
- To assess the efficacy of zinc and vitamin A supplementation in reducing the duration and recurrence of acute diarrhoea in hospitalized Indigenous children.
Main Methods:
- A randomized controlled 2x2 factorial trial was conducted.
- Participants included 392 Aboriginal children under 11 years hospitalized for acute diarrhoea.
- Outcomes measured were duration of diarrhoeal illness and re-admission rates within 120 days.
Main Results:
- Supplementation with zinc, vitamin A, or both showed no significant reduction in diarrhoea duration compared to placebo.
- Median diarrhoea duration was 3.0 days across all groups.
- No significant difference in re-admission rates was observed between supplemented and placebo groups.
Conclusions:
- In-hospital supplementation with zinc and vitamin A may not be beneficial for acute diarrhoeal disease in remote Indigenous children.
- Findings may differ for malnourished children, where other studies suggest potential benefits.
- Future research should explore the impact of baseline nutritional status on treatment outcomes.
Objective:
To evaluate the role of zinc and vitamin A supplementation in the recovery of Indigenous children hospitalised for acute diarrhoea.
Design:
A randomised controlled 2 by 2 factorial trial of supplementation with zinc and vitamin A.
Setting And Participants:
Aboriginal children (aged < 11 years) hospitalised for acute diarrhoea at Alice Springs Hospital, Northern Territory, April 2001-July 2002.
Main Outcome Measures:
Duration of diarrhoeal illness; re-admission for diarrhoeal illness within 120 days.
Results:
Our study involved 392 Aboriginal children with 436 episodes of diarrhoea. Supplementation with zinc, vitamin A, or combined zinc and vitamin A had no significant effect on duration of diarrhoea or rate of re-admission compared with placebo. Median diarrhoea duration after starting supplementation was 3.0 days for the vitamin A and zinc supplemented and placebo groups (P values 0.25 and 0.69, respectively). The number of re-admissions did not differ significantly between those receiving vitamin A or zinc and the relevant placebo groups (relative risk [95% CI], 1.2 [0.7-2.1] and 1.3 [0.8-2.1], respectively).
Conclusion:
Vitamin A and zinc supplementation may not be indicated for in-hospital management of acute diarrhoeal disease in Aboriginal children living in remote areas. This finding may not apply to children with malnutrition, for whom other studies suggest a benefit. Larger trials incorporating more comprehensive data on the vitamin A and zinc status as well as nutritional status of study populations might help to explain the different results in different populations.
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