http://bmj.com/cgi/content/abstract/323/7308/314
BMJ 2001;323:314-318 ( 11 August )
Mohammad M Rahman
a International Centre for Diarrhoeal Disease Research, PO Box
128, Dhaka 1000, Bangladesh, b Department of
Epidemiology and International Health, School of Public Health, University of
Alabama at Birmingham, AL 35294, USA
Correspondence to: M M Rahman, Division of
Infectious Diseases and Geographic Medicine, Stanford University School of
Medicine, 300 Pasteur Drive, S-025 Stanford, CA 94305-5107, USA mujib_99@yahoo.com
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.
|
What is already known on this topic Experimental studies have shown that, in the presence of
zinc deficiency, vitamin A supplementation fails to reverse vitamin A
deficiency Coexistence of deficiencies of zinc and vitamin A could be
a reason for the failure of vitamin A supplementation, but data in humans are
limited What this paper adds Zinc alone increased respiratory illnesses, but
interaction between zinc and vitamin A reduced this adverse effect |
© BMJ 2001
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