Academic journal article Journal of Health Population and Nutrition

Impact of Zinc Supplementation on Subsequent Morbidity and Growth in Bangladeshi Children with Persistent Diarrhoea

Academic journal article Journal of Health Population and Nutrition

Impact of Zinc Supplementation on Subsequent Morbidity and Growth in Bangladeshi Children with Persistent Diarrhoea

Article excerpt

INTRODUCTION

Diarrhoea is an important factor to precipitate malnutrition in children, and a frequent cause of growth faltering (1,2). Associated zinc deficiency is likely to augment the process of growth faltering. Children with proteinenergy malnutrition are often deficient in essential micronutrients, including zinc. Results of studies suggest that zinc deficiency is likely to be a causal factor of increased morbidity (3) and growth faltering in malnourished children (4,5).

Zinc supplementation reduced the incidence (6), duration, and severity of diarrhoea in children (7) and had a protective effect on diarrhoea and respiratory infections (8). A study in India documented that zinc supplementation reduced the incidence of persistent diarrhoea by 73% in children with lower serum zinc concentrations (<7.65 µmol/L). Results of a study also showed a significant reduction in episodes of dysentery in male children (6). It is likely that episodes of diarrhoea result in a further zincdeficient state in malnourished children due to the higher loss of zinc in persistent diarrhoea stool, which may lead to increased morbidity. Loss of zinc in diarrhoea stool may be as high as 159 µg/kg.day in acute diarrhoea (9) and 300 µg/kg.day in persistent diarrhoea (10).

Several studies have shown the positive effect of zinc supplementation on growth among stunted (11-13) and malnourished children. Recently, result of a meta-analysis of 25 studies showed that zinc supplementation increased height and weight in children (14). Results of another study showed that zinc supplementation for five months (10 mg/d) increased both weight and height significantly in the zinc-supplemented group compared to the non-supplemented group (11). During nutritional rehabilitation, severely-malnourished children had a greater gain in length with zinc supplementation in many countries, including Bangladesh (15). Supplementation of zinc has also led to better growth rate in preterm and full-term healthy infants compared to non-supplemented ones (4).

Although some information is available on the effect of zinc supplementation on subsequent morbidity and growth in children with acute diarrhoea (13), there is no information about any subsequent effect of zinc supplementation on morbidity and growth of children who received zinc for two weeks only during persistent diarrhoea.

We, therefore, undertook a study to follow up children who received zinc during persistent diarrhoea to explore whether there is any subsequent effect of zinc supplementation on morbidity and growth after discharge from hospital. It is hypothesized that supplementation of zinc during persistent diarrhoea will reduce subsequent morbidity and growth faltering in malnourished children.

MATERIALS AND METHODS

Study design

A prospective follow-up study was conducted among children aged 3-24 months, who participated earlier in a double-blind randomized placebo-controlled trial for clinical recovery from persistent diarrhoea to explore the impact of zinc supplementation on morbidity and growth after discharge from hospital.

Participants

The participants were children of both sexes, aged 3-24 months, who were previously treated with zinc or placebo during persistent diarrhoea (16). Children who attended the Clinical Research and Service Centre (now Dhaka Hospital) of ICDDR,B, during 1987-1989, were included in the study. Children from urban and peri-urban areas within the 20-km radius of the Centre only were considered for the study. The exclusion criteria included the presence of any severe systemic infection, temperature more than 38 °C, and pedal oedema.

Selection of subjects

Initially, 190 children with persistent diarrhoea were enrolled into the clinical study. Of these children, 154 children were available for the morbidity and growth follow-up study. The remaining 36 children (17 from the zinc group and 19 from the placebo group) were dropped from the study for various reasons (Fig. …

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