BMJ 2002;325:1059 ( 9 November )

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Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial

Abdullah H Baqui, associate research professor, ^a Robert E Black, chairman, ^a Shams El Arifeen, head, ^c Mohammad Yunus, head, ^d Joysnamoy Chakraborty, senior manager, ^d Saifuddin Ahmed, assistant scientist, ^b J Patrick Vaughan, professor. ^e

^a Department of International Health, Johns Hopkins Bloomberg School of Public Heath, 615 N Wolfe Street, Baltimore, MD 21205, USA, ^b Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Heath, ^c Child Health Program, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh, ^d Matlab Health Research Program, ICDDR,B: Centre for Health and Population Research, ^e London School of Hygiene and Tropical Medicine, London WC1A 7HT

Correspondence to: A H Baqui abaqui{at}jhsph.edu

Objective: To evaluate the effect on morbidity and mortality of providing daily zinc for 14 days to children with diarrhoea.
Design: Cluster randomised comparison.
Setting: Matlab field site of International Center for Diarrhoeal Disease Research, Bangladesh.
Participants: 8070 children aged 3-59 months contributed 11 881 child years of observation during a two year period.
Intervention: Children with diarrhoea in the intervention clusters were treated with zinc (20 mg per day for 14 days); all children with diarrhoea were treated with oral rehydration therapy.
Main outcome measures: Duration of episode of diarrhoea, incidence of diarrhoea and acute lower respiratory infections, admission to hospital for diarrhoea or acute lower respiratory infections, and child mortality.
Results: About 40% (399/1007) of diarrhoeal episodes were treated with zinc in the first four months of the trial; the rate rose to 67% (350/526) in month 5 and to >80% (364/434) in month 7 and was sustained at that level. Children from the intervention cluster received zinc for about seven days on average during each episode of diarrhoea. They had a shorter duration (hazard ratio 0.76, 95% confidence interval 0.65 to 0.90) and lower incidence of diarrhoea (rate ratio 0.85, 0.76 to 0.96) than children in the comparison group. Incidence of acute lower respiratory infection was reduced in the intervention group but not in the comparison group. Admission to hospital of children with diarrhoea was lower in the intervention group than in the comparison group (0.76, 0.59 to 0.98). Admission for acute lower respiratory infection was lower in the intervention group, but this was not statistically significant (0.81, 0.53 to 1.23). The rate of non-injury deaths in the intervention clusters was considerably lower (0.49, 0.25 to 0.94).
Conclusions: The lower rates of child morbidity and mortality with zinc treatment represent substantial benefits from a simple and inexpensive intervention that can be incorporated in existing efforts to control diarrhoeal disease.

What is already known on this topic Zinc deficiency is highly prevalent in children in developing countries Zinc supplements given during diarrhoea reduce the duration and severity of treated episodes If given for 14 days during and after diarrhoea, zinc reduces the incidence of diarrhoea and pneumonia in the subsequent two to three months What this study adds Zinc used as a treatment for diarrhoea reduces mortality in children Zinc reduces admissions to hospital for diarrhoea The impact of zinc on mortality and morbidity can be achieved in a realistic large scale public health programme

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