title: Zinc supplementation and psychosocial stimulation: effects on the development of undernourished Jamaican children.
abstract: BACKGROUND
  Undernourished children have poor levels of development that benefit from stimulation. Zinc deficiency is prevalent in undernourished children and may contribute to their poor development.
  
  
  OBJECTIVE
  We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children.
  
  
  METHODS
  This was a randomized controlled trial with 4 groups: stimulation alone, zinc supplementation alone, both interventions, and control (routine care only). Subjects were 114 children aged 9-30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics. Clinics were randomly assigned to receive stimulation or not; individual children were randomly assigned to receive zinc or placebo. The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged. The supplementation was 10 mg Zn as sulfate daily or placebo. Development (assessed by use of the Griffiths Mental Development Scales), length, and weight were measured at baseline and 6 mo later. Weekly morbidity histories were taken.
  
  
  RESULTS
  Significant interactions were found between zinc supplementation and stimulation. Zinc benefited the developmental quotient only in children who received stimulation, and benefits from zinc to hand and eye coordination were greater in stimulated children. Zinc supplementation alone improved hand and eye coordination, and stimulation alone benefited the developmental quotient, hearing and speech, and performance. Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth.
  
  
  CONCLUSIONS
  Zinc supplementation benefits development in undernourished children, and the benefits are enhanced if stimulation is also provided.
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica. julie.meeksgardner@uwimona.edu.jm
authors.forename: Julie M Meeks
authors.initials: JM
authors.lastname: Gardner
authors.forename: Christine A
authors.initials: CA
authors.lastname: Powell
authors.forename: Helen
authors.initials: H
authors.lastname: Baker-Henningham
authors.forename: Susan P
authors.initials: SP
authors.lastname: Walker
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Cole
authors.forename: Sally M
authors.initials: SM
authors.lastname: Grantham-McGregor
mesh_terms: D002657:Child Development; D015362:Child Nutrition Disorders / Q000503:physiopathology*; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D006128:Growth; D006801:Humans; D007223:Infant; D008297:Male; D009034:Mother-Child Relations; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D015032:Zinc