Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria

BMC Public Health

Review

Arnoupe Jhass¹  Igor Rudan¹  Evropi Theodoratou¹  Joy Ferguson¹  Harry Campbell¹  Thomas P Eisele²  Robert E Black³  Zulfiqar A Bhutta⁴  Aamer Imdad⁴  Mohammad Yawar Yakoob⁴  Afshan Jabeen⁴ 

[1] Centre for Population Health Sciences, University of Edinburgh, UK;Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, USA;Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA;Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan;

关键词: Malaria;    Zinc Supplementation;    Specific Mortality;    LiST Model;    Diarrheal Episode;   

DOI  :  10.1186/1471-2458-11-S3-S23

来源: Springer

【 摘 要 】

BackgroundZinc deficiency is commonly prevalent in children in developing countries and plays a role in decreased immunity and increased risk of infection. Preventive zinc supplementation in healthy children can reduce mortality due to common causes like diarrhea, pneumonia and malaria. The main objective was to determine all-cause mortality and cause-specific mortality and morbidity in children under five in developing countries for preventive zinc supplementation.Data sources/ review methodsA literature search was carried out on PubMed, the Cochrane Library and the WHO regional databases to identify RCTs on zinc supplementation for greater than 3 months in children less than 5 years of age in developing countries and its effect on mortality was analyzed.ResultsThe effect of preventive zinc supplementation on mortality was given in eight trials, while cause specific mortality data was given in five of these eight trials. Zinc supplementation alone was associated with a statistically insignificant 9% (RR = 0.91; 95% CI: 0.82, 1.01) reduction in all cause mortality in the intervention group as compared to controls using a random effect model. The impact on diarrhea-specific mortality of zinc alone was a non-significant 18% reduction (RR = 0.82; 95% CI: 0.64, 1.05) and 15% for pneumonia-specific mortality (RR = 0.85; 95% CI: 0.65, 1.11). The incidence of diarrhea showed a 13% reduction with preventive zinc supplementation (RR = 0.87; 95% CI: 0.81, 0.94) and a 19% reduction in pneumonia morbidity (RR = 0.81; 95% CI: 0.73, 0.90). Keeping in mind the direction of effect of zinc supplementation in reducing diarrhea and pneumonia related morbidity and mortality; we considered all the outcomes for selection of effectiveness estimate for inclusion in the LiST model. After application of the CHERG rules with consideration to quality of evidence and rule # 6, we used the most conservative estimates as a surrogate for mortality. We, therefore, conclude that zinc supplementation in children is associated with a reduction in diarrhea mortality of 13% and pneumonia mortality of 15% for inclusion in the LiST tool. Preventive zinc supplementation had no effect on malaria specific mortality (RR = 0.90; 95% CI: 0.77, 1.06) or incidence of malaria (RR=0.92; 95 % CI 0.82-1.04)ConclusionZinc supplementation results in reductions in diarrhea and pneumonia mortality.

【 授权许可】

Unknown   
© Yakoob et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.