ORIGINAL ARTICLE

Micronutrients (including zinc) reduce diarrhoea in children: The Pakistan Sprinkles Diarrhoea Study

W Sharieff¹, Z Bhutta², C Schauer³, G Tomlinson⁴, S Zlotkin⁵

¹ Department of Health Policy, Management and Evaluation, and the Hospital for Sick Children, Research Institute, University of Toronto, Canada
² Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan
³ The Hospital for Sick Children, Research Institute, University of Toronto, Canada
⁴ Department of Medicine, The University Health Network, and the Departments of Medicine, Public Health Sciences, Health Policy, Management and Evaluation, University of Toronto, Canada
⁵ Departments of Paediatrics, Public Health Sciences, and Nutritional Sciences, The Hospital for Sick Children, Research Institute, University of Toronto, Canada

Correspondence to:
Dr S Zlotkin
Departments of Paediatrics, Public Health Sciences, and Nutritional Sciences, The Hospital for Sick Children, Research Institute, University of Toronto, 555 University Avenue # 8260, Toronto ON M5G 1X8, Canada; Stanley.zlotkin{at}sickkids.ca

Aims: To examine the effect of the daily use of micronutrients (including zinc) or the same micronutrients plus heat inactivated lactic acid bacteria (LAB), on diarrhoea in children compared to placebo.

Methods: A triple blind randomised clinical trial in an urban slum of Karachi, Pakistan. Micronutrients (including zinc), micronutrients (including zinc and LAB), or placebo, were provided daily for two months to 75 young children (aged 6–12 months) identified at high risk for diarrhoea related mortality on the basis of history of at least one episode of diarrhoea in the preceding two weeks. The longitudinal prevalence of diarrhoea was defined as the percentage of days a child had diarrhoea out of the days the child was observed.

Results: Mean longitudinal prevalence of diarrhoea in the micronutrient–zinc group was 15% (SD = 10%) child-days compared to 26% (SD = 20%) child-days in the placebo group and 26% (SD = 19%) child-days in the micronutrient–zinc–LAB group. The difference between the micronutrient–zinc–LAB and placebo groups was not significant.

Conclusion: The daily provision of micronutrients (including zinc) reduces the longitudinal prevalence of diarrhoea and thus may also reduce diarrhoea related mortality in young children; heat inactivated LAB has negative effects in these children.

Abbreviations: AKU, Aga Khan University; EPEC, enteropathic E coli; ETEC, enterotoxic E coli; HPF, high power field; HSC, Hospital for Sick Children; LAB, lactic acid bacteria; MB, micronutrients which included LAB; MZ, micronutrients which included zinc; ORT, oral rehydration therapy; OTC, over the counter; SF, serum ferritin; WBC, white blood cell

Keywords: micronutrients; diarrhoea; zinc; probiotic; lactic acid bacteria; randomised clinical trial; Sprinkles; Pakistan

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Howard Bauchner
Arch. Dis. Child. 2006 91: 549. [Extract] [Full Text] [PDF]

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