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Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa

European Journal of Clinical Nutrition volume 63, pages 850–857 (2009)Cite this article

Abstract

Background/Objective:

The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children.

Methods:

We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6–24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting.

Results:

We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children.

Conclusions:

Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups.

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Acknowledgements

We thank Professors Jeffrey K Griffiths and Parke E Wilde for their critical review. We also thank the study participants and staff who carried out the study.

This study was supported by grants from the United States National Institute of Health (1 UO1 AI45508-01, 1 K24 AI/HDO1671-01, D43TW05572-01 to Dr Bennish) and the Wellcome Trust (Wellcome Grants 62925 to Dr Bennish and 063009 to Dr Van den Broeck), NICHD/FIC International Maternal and Child Health Training Grant D43-TW001277-11 and International Nutrition Foundation Fellowship support to Dr Chhagan.

Author information

Authors and Affiliations

  1. Department of Paediatrics and Child Health, University of KwaZulu-Natal, KwaZulu-natal, South Africa

    M K Chhagan

  2. Department of Epidemiology and Public Health, University College Cork, Cork, Ireland

    J Van den Broeck

  3. Africa Centre for Health and Population Studies, University of KwaZulu Natal, Somkhele, South Africa

    K-KA Luabeya

  4. Pharmaceutical Product Development, Cambridge, UK

    N Mpontshane

  5. Nutritional Epidemiology Program, Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA

    M K Chhagan & K L Tucker

  6. Mpilonhle, Mtubatuba, South Africa

    M L Bennish

  7. Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    M L Bennish

Authors
  1. M K Chhagan
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  2. J Van den Broeck
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  3. K-KA Luabeya
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  4. N Mpontshane
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  5. K L Tucker
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  6. M L Bennish
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Corresponding author

Correspondence to M K Chhagan.

Additional information

Contributors: MK Chhagan planned and completed the current analysis and prepared the manuscript draft. ML Bennish was principal investigator for the study and responsible for study design. J Van den Broeck and KA Luabeya served as Project Directors. N Mpontshane supervised the fieldwork. The manuscript was critically reviewed and approved by all of the authors.

Conflict of Interest

KA Luabeya, N Mpontshane, J Van den Broeck and M L Bennish all received salary and travel support form the National Institutes of Health.

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Chhagan, M., Van den Broeck, J., Luabeya, KK. et al. Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa. Eur J Clin Nutr 63, 850–857 (2009). https://doi.org/10.1038/ejcn.2008.78

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