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Zinc and vitamin A supplementation in Indigenous Australian children hospitalised with lower respiratory tract infection: a randomised controlled trial

Anne B Chang, Paul J Torzillo, Peter M Stewart, Naomi C Boyce, Andrew V White, Gavin R Wheaton, David M Purdie, John Wakerman and Patricia C Valery
Med J Aust 2006; 184 (3): 107-112.

Summary

Objective: To evaluate the efficacy of supplementation with zinc and vitamin A in Indigenous children hospitalised with acute lower respiratory infection (ALRI).

Design: Randomised controlled, 2-by-2 factorial trial of supplementation with zinc and vitamin A.

Setting and participants: 187 Indigenous children aged < 11 years hospitalised with 215 ALRI episodes at Alice Springs Hospital (April 2001 to July 2002).

Interventions: Vitamin A was administered on Days 1 and 5 of admission at a dose of 50 000 IU (infants under 12 months), or 100 000 IU; and zinc sulfate was administered daily for 5 days at a daily dose of 20 mg (infants under 12 months) or 40 mg.

Main outcome measure: Time to clinical recovery from fever and tachypnoea, duration of hospitalisation, and readmission for ALRI within 120 days.

Results: There was no clinical benefit of supplementation with vitamin A, zinc or the two combined, with no significant difference between zinc and no-zinc, vitamin A and no-vitamin A or zinc + vitamin A and placebo groups in time to resolution of fever or tachypnoea, or duration of hospitalisation. Instead, we found increased morbidity; children given zinc had increased risk of readmission for ALRI within 120 days (relative risk, 2.4; 95% CI, 1.003–6.1).

Conclusion: This study does not support the use of vitamin A or zinc supplementation in the management of ALRI requiring hospitalisation in Indigenous children living in remote areas. Even in populations with high rates of ALRI and poor living conditions, vitamin A and zinc therapy may not be useful. The effect of supplementation may depend on the prevalence of deficiency of these micronutrients in the population.

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  • Anne B Chang1
  • Paul J Torzillo2
  • Peter M Stewart3
  • Naomi C Boyce4
  • Andrew V White5
  • Gavin R Wheaton6
  • David M Purdie7
  • John Wakerman8
  • Patricia C Valery9

  • 1 Flinders University Northern Territory Clinical School and Royal Children's Hospital, Brisbane, QLD.
  • 2 Royal Prince Alfred Hospital, Sydney, NSW.
  • 3 Flinders University Northern Territory Clinical School, Alice Springs, NT.
  • 4 Northern Territory Department of Health and Community Services, Alice Springs, NT.
  • 5 Alice Springs Hospital, Alice Springs, NT.
  • 6 Queensland Institute of Medical Research and School of Population Health, University of Queensland, Brisbane, QLD.
  • 7 Flinders University and Charles Darwin University, Alice Springs, NT.
  • 8 Queensland Institute of Medical Research, Population Studies and Human Genetics and Centre for International and Tropical Health and Nutrition, University of Queensland, Brisbane, QLD.

Correspondence: 

Acknowledgements: 

We thank the children and their families who participated in the study, Valerie Logan for technical support, and Alison Furber for helping to obtain consent.

The study was partly funded by the Sylvia and Charles Viertel Charitable Foundation (Anne Chang’s Clinical Investigatorship), a Flinders University Research Grant and Flinders University NT Clinical School. Anne Chang is funded by a National Health and Medical Research Council Practitioner Fellowship and the Royal Children’s Hospital Foundation. None of the funding bodies had any role in study design, data collection and analysis, or writing of the manuscript.

Competing interests:

None identified.

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