LEADER 00000nam 2200361 4500
001 AAI3351928
005 20100721091753.5
008 100721s2009 ||||||||||||||||| ||eng d
020 9781109087260
035 (UMI)AAI3351928
040 UMI|cUMI
100 1 Chhagan, Meera Kurson
245 14 The effect of micronutrient supplementation on morbidity
and growth in South African children
300 120 p
500 Source: Dissertation Abstracts International, Volume: 70-
03, Section: B, page: 1620
500 Adviser: Katherine L. Tucker
502 Thesis (Ph.D.)--Tufts University, Gerald J. and Dorothy R.
Friedman School of Nutrition Science and Policy, 2009
520 Background. Micronutrient supplementation trials often
yield inconsistent results that may not be generalizable
to African settings
520 Objectives and methods. We analyzed data collected during
a randomized controlled double-blinded trial to assess the
effect of daily zinc plus vitamin A (VAZ) or multiple
micronutrients that contained both vitamin A and zinc (MM),
compared to vitamin A alone (VA), on diarrheal morbidity,
growth outcomes and anemia in children aged 6-24 months.
This trial was performed in a rural community in the
province of KwaZulu-Natal, South Africa. It was designed
to allow analysis by HIV status to account for 3 groups
with different inherent risks: HIV-infected children, HIV-
uninfected but exposed children (that is, mother is HIV-
infected) and HIV-uninfected, unexposed children (that is,
mother is HIV-uninfected). The specific aims were: (1) to
compare the effect of the 3 supplementation strategies on
the frequency of diarrheal episodes and to assess whether
baseline stunting or HIV-infection modified the effect of
supplementation, (2) to compare the effects on changes in
linear growth and occurrence of anemia, and (3) to
describe the cost of childhood diarrhea and assess cost
effectiveness of zinc supplementation
520 Results. In HIV-uninfected children with stunting at
baseline, those receiving VAZ or MM had significantly
lower incidence of diarrhea. HIV-uninfected stunted
children had better linear growth over an 18 month period
if given MM compared to VAZ or VA. We were unable to
conduct meaningful analyses in HIV-infected children due
to lower than target enrolment in this cohort. The MM and
VA arms had significant declines in anemia over a 12 month
period. MM had a much larger decline in anemia although
this was not statistically significant when compared to
vitamin A. Interestingly, zinc supplemented children had a
lower mean change in hemoglobin compared to the other arms
suggesting a negative influence of zinc on iron. Given
that protective effects of our interventions were limited
to stunted children, we conducted a threshold analysis
that revealed that at a prevalence of stunting of 15%
universal zinc supplementation would be a cost saving
strategy in diarrhea prevention programs
520 Conclusions. While zinc supplementation is adequate to
prevent diarrhea in stunted children, multiple
micronutrients are required in addition to zinc to improve
linear growth. For diarrhea prevention programs, universal
prophylactic zinc supplementation may be cost-saving even
where benefits are limited to stunted children. Further
study is needed to confirm benefits in anemia reduction
590 School code: 1546
650 4 Health Sciences, Nutrition
650 4 Health Sciences, Public Health
690 0570
690 0573
710 2 Tufts University, Gerald J. and Dorothy R. Friedman School
of Nutrition Science and Policy
773 0 |tDissertation Abstracts International|g70-03B
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