Effects of prenatal and postnatal maternal multiple micronutrient supplementation on child growth and morbidity in Tanzania: a double-blind, randomized-controlled trial.

BACKGROUND: Maternal micronutrient status is critical for child growth and nutrition. It is unclear whether maternal multiple micronutrient supplementation (MMS) during pregnancy and lactation improves child growth and prevents child morbidity. METHODS: This study aimed to determine the effects of prenatal and postnatal maternal MMS on child growth and morbidity. In this double-blind, randomized-controlled trial, 8428 HIV-negative pregnant women were enrolled from Dar es Salaam, Tanzania, between 2001 and 2004. From pregnancy (12-27 weeks of gestation) through to 6 weeks postpartum, participants were randomized to receive daily oral MMS or placebo. All women received daily iron and folic acid during pregnancy. From 6 weeks postpartum through to 18 months postpartum, 3100 women were re-randomized to MMS or placebo. Child-growth measures, haemoglobin concentrations and infectious morbidities were assessed longitudinally from birth to ≤18 months. RESULTS: Prenatal MMS led to modest increases in weight-for-age z-scores (mean difference: 0.050; 95% confidence interval: 0.002, 0.099; p = 0.04) and length-for-age z-score (mean difference: 0.062; 95% confidence interval: 0.013, 0.111; p = 0.01) during the first 6 months of life but not thereafter. Prenatal or postnatal MMS did not have benefits for other child outcomes. CONCLUSIONS: Whereas maternal MMS is a proven strategy to prevent adverse birth outcomes, other approaches may also need to be considered to curb the high burdens of child morbidity and growth faltering.

Zinc as an adjunct treatment for reducing case fatality due to clinical severe infection in young infants: study protocol for a randomized controlled trial.

BACKGROUND: An estimated 2.7 of the 5.9 million deaths in children under 5 years of age occur in the neonatal period. Severe infections contribute to almost a quarter of these deaths. Mortality due to severe infections in developing country settings is substantial despite antibiotic therapy. Effective interventions that can be added to standard therapy for severe infections are required to reduce case fatality. METHODS/DESIGN: This is a double-blind randomized placebo-controlled parallel group superiority trial to investigate the effect of zinc administered orally as an adjunct to standard therapy to infants aged 3 days up to 2 months (59 days) hospitalized with clinical severe infection, that will be undertaken in seven hospitals in Delhi, India and Kathmandu, Nepal. In a 1:1 ratio, we will randomly assign young infants to receive 10 mg of elemental zinc or placebo orally in addition to the standard therapy for a total of 14 days. The primary outcomes hospital case fatality, which is death due to any cause and at any time after enrolment while hospitalized for the illness episode, and extended case fatality, which encompasses the period until 12 weeks after enrolment. DISCUSSION: A previous study showed a beneficial effect of zinc in reducing the risk of treatment failure, as well as a non-significant effect on case fatality. This study was not powered to detect an effect on case fatality, which this current study is. If the results are consistent with this earlier trial, we would have provided strong evidence for recommending zinc as an adjunct to standard therapy for clinical severe infection in young infants. TRIAL REGISTRATION: Universal Trial Number: U1111-1187-6479, Clinical Trials Registry - India: CTRI/2017/02/007966 : Registered on February 27, 2017.

Zinc as an adjunct for childhood pneumonia - interpreting early results.

Zinc supplementation has been consistently shown to reduce the incidence of childhood pneumonia, but its effect on the course of pneumonia when administered as an adjunct to antibiotic therapy is still unclear. Three trials published to date have shown mixed results, and a recent trial from India raises the possibility that zinc may be detrimental in some circumstances. Study sites and designs differ, particularly in the timing of zinc treatment and in determining recovery from pneumonia, which can explain the differences in study findings. Serum zinc concentrations are unreliable indicators of zinc status, particularly during acute infectious illnesses. Subgroup analyses, especially using serum zinc levels, must be cautioned against. Future studies are needed that are large enough to be sufficiently powered to accommodate larger treatment failure rates, an issue that ongoing trials will hopefully address.

Zinc in child health and disease.

Zinc deficiency is common in children from developing countries due to lack of intake of animal foods, high dietary phytate content, inadequate food intake and increased fecal losses during diarrhea. Zinc has a fundamental role in cellular metabolism, with profound effects on the immune system and the intestinal mucosa. Zinc supplementation has shown significant benefits in prevention and treatment of diarrhea and pneumonia. Routine zinc supplementation given to low birth weight babies for a year has resulted in substantial reduction in mortality. Zinc deficiency may have adverse effects on physical growth and neurodevelopment. WHO Task Force, 2001, and the National task Force of IAP has recommended use of zinc in the treatment of diarrhea. It is also recommended as part of standard case management in persistent diarrhea and in those with severe malnutrition. Further evidence is required for qualifying its use in treatment of other infective diseases like pneumonia and malaria. Improved dietary quality & intake, food fortification and cultivation of zinc dense plants are some ways of mitigating zinc deficiency.