http://bmj.com/cgi/content/abstract/324/7350/1358
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 Collections under
which this article appears: Other
respiratory medicine Medicine
in Developing Countries Other
nutrition and metabolism Other
Pediatrics |
Nita Bhandari
a Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India, b Centre for International Health, University of Bergen, 5021 Bergen, Norway, c Statens Serum Institut, Artillerivej 5-2300 Copenhagen S, Denmark, d Institute of Clinical Biochemistry, University of Bergen, Bergen
Correspondence to: M K Bhan
community.research@cih.uib.no
Objectives: To evaluate the effect of daily zinc supplementation
in children on the incidence of acute lower respiratory tract
infections and pneumonia.
Design: Double masked, randomised placebo controlled trial.
Setting: A slum community in New Delhi, India.
Participants: 2482 children aged 6 to 30 months.
Interventions: Daily elemental zinc, 10 mg to infants and
20 mg to older children or placebo for four months. Both groups
received single massive dose of vitamin A (100 000 IU for infants and
200 000 IU for older children) at enrolment.
Main outcome measures: All households were visited weekly. Any children
with cough and lower chest indrawing or respiratory rate 5 breaths
per minute less than the World Health Organization criteria for
fast breathing were brought to study physicians.
Results: At four months the mean plasma zinc concentration was
higher in the zinc group (19.8 (SD 10.1) v 9.3 (2.1) µmol/l,
P<0.001). The proportion of children who had acute lower respiratory
tract infection during follow up was no different in the two groups
(absolute risk reduction 
0.2%, 95%
confidence interval 3.9%
to 3.6%). Zinc supplementation resulted in a lower incidence of
pneumonia than placebo (absolute risk reduction 2.5%, 95% confidence
interval 0.4% to 4.6%). After correction for multiple episodes in the
same child by generalised estimating equations analysis the odds
ratio was 0.74, 95% confidence interval 0.56 to 0.99.
Conclusions: Zinc supplementation substantially reduced the
incidence of pneumonia in children who had received vitamin A.
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What is already known on this topic What this study adds Routine zinc supplementation of such children aged 6 months to 3 years substantially reduced the incidence of pneumonia |
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