title: Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of simultaneous zinc and vitamin A supplementation on diarrhoea and acute lower respiratory infections in children.
  
  
  METHODS
  Randomised double blind placebo controlled trial.
  
  
  METHODS
  Urban slums of Dhaka, Bangladesh.
  
  
  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.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka 1000, Bangladesh. mujib_99@yahoo.com
authors.forename: M M
authors.initials: MM
authors.lastname: Rahman
authors.forename: S H
authors.initials: SH
authors.lastname: Vermund
authors.forename: M A
authors.initials: MA
authors.lastname: Wahed
authors.forename: G J
authors.initials: GJ
authors.lastname: Fuchs
authors.forename: A H
authors.initials: AH
authors.lastname: Baqui
authors.forename: J O
authors.initials: JO
authors.lastname: Alvarez
mesh_terms: D000208:Acute Disease; D001459:Bangladesh; D002675:Child, Preschool; D003968:Diarrhea, Infantile / Q000517:prevention & control*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004403:Dysentery / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D011204:Poverty Areas; D012141:Respiratory Tract Infections / Q000139:chemically induced / Q000517:prevention & control*; D014801:Vitamin A / Q000008:administration & dosage*; D015032:Zinc / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014801:Vitamin A; D015032:Zinc