BMJ 2002;324:1358 ( 8 June )

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Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomised controlled trial in an urban slum

Nita Bhandari, scientist, ^a Rajiv Bahl, scientist, ^a Sunita Taneja, scientist, ^a Tor Strand, research fellow, ^b Kåre Mølbak, senior researcher, ^c Rune Johan Ulvik, professor, ^d Halvor Sommerfelt, professor, ^b Maharaj K Bhan, professor. ^a

^a Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India, ^b Centre for International Health, University of Bergen, 5021 Bergen, Norway, ^c Statens Serum Institut, Artillerivej 5-2300 Copenhagen S, Denmark, ^d Institute of Clinical Biochemistry, University of Bergen, Bergen

Correspondence to: M K Bhan community.research{at}cih.uib.no

Objectives: To evaluate the effect of daily zinc supplementation in children on the incidence of acute lower respiratory tract infections and pneumonia.
Design: Double masked, randomised placebo controlled trial.
Setting: A slum community in New Delhi, India.
Participants: 2482 children aged 6 to 30 months.
Interventions: Daily elemental zinc, 10 mg to infants and 20 mg to older children or placebo for four months. Both groups received single massive dose of vitamin A (100 000 IU for infants and 200 000 IU for older children) at enrolment.
Main outcome measures: All households were visited weekly. Any children with cough and lower chest indrawing or respiratory rate 5 breaths per minute less than the World Health Organization criteria for fast breathing were brought to study physicians.
Results: At four months the mean plasma zinc concentration was higher in the zinc group (19.8 (SD 10.1) v 9.3 (2.1) µmol/l, P<0.001). The proportion of children who had acute lower respiratory tract infection during follow up was no different in the two groups (absolute risk reduction 0.2%, 95% confidence interval 3.9% to 3.6%). Zinc supplementation resulted in a lower incidence of pneumonia than placebo (absolute risk reduction 2.5%, 95% confidence interval 0.4% to 4.6%). After correction for multiple episodes in the same child by generalised estimating equations analysis the odds ratio was 0.74, 95% confidence interval 0.56 to 0.99.
Conclusions: Zinc supplementation substantially reduced the incidence of pneumonia in children who had received vitamin A.

What is already known on this topic Mild to moderate zinc deficiency is common in children in developing countries and increases the risk of respiratory morbidity What this study adds A third of children from low socioeconomic classes in India have low plasma concentrations of zinc Routine zinc supplementation of such children aged 6 months to 3 years substantially reduced the incidence of pneumonia

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