Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind, randomized controlled trial

Mahalanabis, Dilip; Chowdhury, Ashif; Jana, Snehasis; Bhattacharya, Mihir; Chakrabarti, MK; Wahed, M. A.; Khaled, M. A.

doi:10.1093/ajcn/76.3.604

Cited by 41 publications

(22 citation statements)

References 6 publications

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“…Of the four outcomes related to the duration of pneumonia symptoms, the effect size ranged from 17% for hours to severe disease resolution (based on two RCTs 34 , 35 ) to 2% for hours to tachypnoea resolution (based on four RCTs 34 , 35 , 37 , 38 ). Since there were no mortality data in order to estimate the effect on pneumonia mortality, we used the hours of hospitalization effect based on the summary analysis of two RCTs 34 , 35 [13% (−37, 45%)] (according to the CHERG Rules for Evidence Review.…”

Section: Resultsmentioning

confidence: 99%

The effect of case management on childhood pneumonia mortality in developing countries

Τheodoratou

Al-Jilaihawi

Woodward

et al. 2010

International Journal of Epidemiology

152

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Background With the aim of populating the Lives Saved Tool (LiST) with parameters of effectiveness of existing interventions, we conducted a systematic review of the literature assessing the effect of pneumonia case management on mortality from childhood pneumonia.Methods This review covered the following interventions: community case management with antibiotic treatment, and hospital treatment with antibiotics, oxygen, zinc and vitamin A. Pneumonia mortality outcomes were sought where available but data were also recorded on secondary outcomes. We summarized results from randomized controlled trials (RCTs), cluster RCTs, quasi-experimental studies and observational studies across outcome measures using standard meta-analysis methods and used a set of standardized rules developed for the purpose of populating the LiST with required parameters, which dealt with the issues of comparability of the studies in a uniform way across a spectrum of childhood conditions.Results We estimate that community case management of pneumonia could result in a 70% reduction in mortality from pneumonia in 0–5-year-old children. In contrast treatment of pneumonia episodes with zinc and vitamin A is ineffective in reducing pneumonia mortality. There is insufficient evidence to make a quantitative estimate of the effect of hospital case management on pneumonia mortality based on the published data.Conclusion The available evidence reinforces the effectiveness of community and hospital case management with World Health Organization-recommended antibiotics and the lack of effect of zinc and vitamin A supportive treatment for children with pneumonia. Evidence from one trial demonstrates the effectiveness of oxygen therapy but further research is required to give higher quality evidence so that an effect estimate can be incorporated into the LiST model. We identified no trials that separately evaluated the effectiveness of other supportive care interventions. The summary estimates of effect on pneumonia mortality will inform the LiST model.

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Section: Resultsmentioning

confidence: 99%

The effect of case management on childhood pneumonia mortality in developing countries

Τheodoratou

Al-Jilaihawi

Woodward

et al. 2010

International Journal of Epidemiology

152

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“…Again, dramatic reductions in the duration of acute and persistent diarrhoea and severe acute lower respiratory infection have been observed (Baqui et al 2002;Brooks et al 2004;Mahalanabis et al 2004), but so far no therapeutic effect has been noted with daily Zn supplements for measles (Mahalanabis et al 2002) or malaria therapy (Zinc Against Plasmodium Study Group, 2002).…”

Section: Importance Of Zinc For Human Healthmentioning

confidence: 99%

Zinc: the missing link in combating micronutrient malnutrition in developing countries

2006

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The first cases of human Zn deficiency were described in the 1960s in the Middle East. Nevertheless, it was not until 2002 that Zn deficiency was included as a major risk factor in the global burden of disease, and only in 2004 did WHO/UNICEF include Zn supplements in the treatment of acute diarrhoea. Despite this recognition Zn is still not included in the UN micronutrient priority list, an omission that will continue to hinder efforts to reduce child and maternal mortality, combat HIV/AIDS, malaria and other diseases and achieve the UN Millennium Development Goals for improved nutrition in developing countries. Reasons for this omission include a lack of awareness of the importance of Zn in human nutrition, paucity of Zn and phytate food composition values and difficulties in identifying Zn deficiency. Major factors associated with the aetiology of Zn deficiency include dietary inadequacies, disease states inducing excessive losses or impairing utilization and physiological states increasing Zn requirements. To categorize countries according to likely risk of Zn deficiency the International Zinc Nutrition Consultative Group has developed indirect indicators based on the adequacy of Zn in the national food supplies and/or prevalence of childhood growth stunting. For countries identified as at risk confirmation is required through direct measurements of dietary Zn intake and/or serum Zn in a representative sample. Finally, in at risk countries either national or targeted Zn interventions such as supplementation, fortification, dietary diversification or modification, or biofortification should be implemented, where appropriate, by incorporating them into pre-existing micronutrient intervention programmes.

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“…In India, zinc supplementation had no beneficial effect on measles-associated pneumonia 44 and a recent study to assess the effect of zinc and/or vitamin A supplementation on the clinical outcome of severe acute lower respiratory infection concluded that zinc supplementation is associated with shorter duration of fever and severely ill status, but that this benefit is mostly observed in boys. 43 There is therefore evidence that zinc supplementation is effective in preventing ARI as well as diarrhoea and it could be introduced along with vitamin A supplementation.…”

Section: Zinc and Acute Respiratory Infectionsmentioning

confidence: 99%

Zinc and infection: a review

Cuevas

Koyanagi

2005

Annals of Tropical Paediatrics

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Dietary zinc deficiency is widespread in developing countries and is often aggravated by intercurrent acute and chronic infections. Recent studies have demonstrated that zinc supplementation can significantly reduce the morbidity and mortality of apparently well-nourished children and shorten the time to recovery from acute infectious diseases. This review summarises current knowledge of the role of zinc in childhood diarrhoea, acute respiratory infections and malaria, and its potential role in diseases associated with impaired cellular immunity, namely tuberculosis, lepromatous leprosy and leishmaniasis, and explores avenues for future research.

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Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind, randomized controlled trial

Abstract: Children with severe measles accompanied by pneumonia treated with antibiotics and vitamin A did not show any additional benefit from also receiving a zinc supplement.

Cited by 41 publications

References 6 publications

The effect of case management on childhood pneumonia mortality in developing countries

The effect of case management on childhood pneumonia mortality in developing countries

Zinc: the missing link in combating micronutrient malnutrition in developing countries

Zinc and infection: a review

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