Effect of zinc and vitamin A supplementation in undernourished children with persistent diarrhoea in Bangladesh(abstract)

Abstract

Objective: Evaluate and compare the efficacy of vitamin A and/or zinc supplementation on the clinical course of persistent diarrhoea in Bangladeshi children. Methodology: A double-blind randomized, controlled trial was carried out with 96 moderately malnourished children (60%-75% of wt./age of 50th centile of NCHS standard) aged 6 months io 3 years with diarrhoea for more than 14 days. Children were randomly allocated in 4 groups. Each group (n=24) received either zinc (20 mg elemental zinc in two divided doses per day), or vitamin A (total 200,000 IU in twice daily doses over 7 days) or both (zinc plus vitamin A in a multivitamin syrup); and the control group received only multi vitamins (except vitamin A) equal to that of the treatment groups for 7 days. Clinical data were collected by a physician, and stool output, consistency, and frequency were recorded by using metabolic balance for 7 days. Results: The baseline characteristics of the 4 study groups were comparable. The total diarrhoea! stool output among the 4 groups over 7 days was significantly different (p<0.02). Cumulative stool weight reduced significantly (p<0.0001) from day 2 to day 7 in the children receiving zinc compared to the control group and also significantly reduced (p<0.02) from day 5 to day 7 in the children receiving vitamin A compared to the control group. Differences between zinc and vitamin A or zinc vs. zinc plus vitamin A were not significant (p=0.5, p=0.7 respectively). The cumulative stool frequency significantly reduced from day 4 to day 7 in the zinc group compared to the control group (p<0.001). No significant differences were found between any other pairs. The net gain in the body weight over the 7-day study period was significant only in the children receiving zinc compared to the control group (+100 g vs. -40 g, p<0.04). The percentage of children who had clinical recovery (passage of soft stool was taken as recovery) within 7 days was significantly greater in the zinc group (86%) compared to the control group (48%, p=0.007) or vitamin A (48%, p=0.007), but not with zinc plus vitamin A (68%, p=0.14). Conclusion: The results indicate that zinc supplementation in persistent diarrhoea reduces stool output along with frequency, and promotes earlier recovery; and strongly suggest that zinc supplementation is a standard management for undernourished children with persistent diarrhoea