| Descript |
120 p |
| Note |
Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1620 |
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Adviser: Katherine L. Tucker |
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Thesis (Ph.D.)--Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, 2009 |
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Background. Micronutrient supplementation trials often yield inconsistent results that may not be generalizable to African settings |
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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 |
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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 |
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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 |
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School code: 1546 |
| Host Item |
Dissertation Abstracts International 70-03B
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| Subject |
Health Sciences, Nutrition
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Health Sciences, Public Health
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0570
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0573
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| Alt Author |
Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy
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