Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomised controlled trial in an urban slum.
OBJECTIVE
To evaluate the effect of daily zinc supplementation in children on the incidence of acute lower respiratory tract infections and pneumonia.


METHODS
Double masked, randomised placebo controlled trial.


METHODS
A slum community in New Delhi, India.


METHODS
2482 children aged 6 to 30 months.


METHODS
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 enrollment.


METHODS
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) micromol/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.
Bhandari
Nita
N
Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.
Bahl
Rajiv
R
Taneja
Sunita
S
Strand
Tor
T
Mølbak
Kåre
K
Ulvik
Rune Johan
RJ
Sommerfelt
Halvor
H
Bhan
Maharaj K
MK
D000208:Acute Disease; D002675:Child, Preschool; D003906:Developing Countries; D019587:Dietary Supplements; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D007223:Infant; D016017:Odds Ratio; D011014:Pneumonia / Q000517:prevention & control*; D011204:Poverty Areas; D012141:Respiratory Tract Infections / Q000517:prevention & control; D014504:Urban Health; D014801:Vitamin A / Q000627:therapeutic use; D015032:Zinc / Q000097:blood / Q000627:therapeutic use*
D014801:Vitamin A; D015032:Zinc