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 
856 40 |uhttp://pqdd.sinica.edu.tw/twdaoapp/servlet/