Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhoea

Objective: To assess the impact of zinc supplementation during acute diarrhoea on subsequent growth and morbidity in malnourished young children. Design: Double blind randomized controlled clinical trial Setting: International Centre for Diarrhoeal Disease Research, Bangladesh. Subjects: Sixty-five children aged 3-24 months with acute diarrhoea for less than 3 d. Intervention: Either elemental zinc (20mg/d) in a multivitamin syrup or multivitamin syrup alone divided in three divided daily doses for a period of two weeks. Children were followed up weekly at home to assess subsequent growth and morbidity for a period of eight weeks. Main outcome measures: Gain in lengh and body weight and reduction in diarrhoea and respiratory tract infection. Results: During the follow-up, zinc supplemented children showed si,significantly greater cumulative length gain (18.9mm vs 14.5 mm, P < 0.03) and comparable body weight gain than the children of the control group. Subsequent length gain was not correlated with initial height in the zinc-supplemented group (r = -0.13), P = 0.5), but was significantly correlated in the control group (r = -0.6, P < 0.0007). Zinc-supplemented and stunted children (less than or equal to 90% length for age n = 18) experienced significantly fewer episodes of diarrhoea (0.07 vs 0.6, P < 0.05) and respiratory illness (1.0 vs 2.4, P < 0.01) compared to the control group. The underweight children (less than or equal to 71 % weight/age n = 38) receiving zinc-supplementation also had fewer episodes of diarrhoea (0.4 vs 1.0, P < 0.04) and shorter duration of diarrhoeal episodes (1.0 vs 3.0d, P < 0.04) compared to their counterparts in the control group. Conclusion: These results suggest that a short course of zinc supplementation to malnourished children during acute diarrhoea reduces growth-faltering and diarrhoeal and respiratory morbidity during subsequent two months.