title: Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomised controlled trial in an urban slum.
abstract: 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.
authors.affiliation: Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.
authors.forename: Nita
authors.initials: N
authors.lastname: Bhandari
authors.forename: Rajiv
authors.initials: R
authors.lastname: Bahl
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.forename: Tor
authors.initials: T
authors.lastname: Strand
authors.forename: Kåre
authors.initials: K
authors.lastname: Mølbak
authors.forename: Rune Johan
authors.initials: RJ
authors.lastname: Ulvik
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.forename: Maharaj K
authors.initials: MK
authors.lastname: Bhan
mesh_terms: 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*
chemical_list: D014801:Vitamin A; D015032:Zinc