Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh

Abstract

Objective: To assess the impact of zinc supplementation on clinical recovery, weight gain and subsequent growth and morbidity in moderately malnourished children with shigellosis. Design: A randomized, double-blind, controlled trial. Setting: Dhaka hospital of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh. Subjects: Fifty-six moderately malnourished children, aged 12–59 months with culture-proven shigellosis. Methods: Subjects were randomly allocated to receive zinc (20 mg/day elemental) in multivitamin syrup (intervention) or multivitamin syrup without zinc (control) in two equally divided doses daily for 2 weeks. All children received pivmecillinam in a dose of 15 mg/kg every 6 h for 5 days. After supplementation, children were followed in their respective homes every 2 weeks for 6 months. Results: Children receiving zinc recovered from acute illness significantly faster than the control children (Po0.05). The medians time (days) to recovery and disappearances of blood and mucous were significantly 50% shorter in the zinc-supplemented group compared to the control group. The mean body weight of zinc supplemented children increased significantly from 8.8 kg on admission to 9.2 kg (Po0.01) at recovery, which was not observed in the control children (from 9.3 to 9.6 kg; P¼0.12). During the 6-month follow-up period, zinc-supplemented children had significantly fewer mean episodes of diarrhoea compared to the control children (2.2 vs 3.3; P¼0.03). Conclusion: Zinc supplementation significantly shortens the duration of acute shigellosis, promotes better weight gain during recovery and reduces diarrhoeal morbidity during the subsequent 6 months. European Journal of Clinical Nutrition advance online publication, 30 May 2007; doi:10.1038/sj.ejcn.1602795