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

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.     

Acute diarrhoeal diseases--an approach to management

Acute diarrhoeal diseases rank second amongst all infectious diseases as a killer in children below 5 years of age worldwide. Globally, 1.3 billion episodes occur annually, with an average of 2-3 episodes per child per year. The important aetiologic agents of diarrhoea and the guidelines for management are discussed. Management of acute diarrhoea is entirely based on clinical presentation of the cases. It includes assessment of the degree of dehydration clinically, rehydration therapy, feeding during diarrhoea, use of antibiotic(s) in selected cases, micronutrient supplementation and use of probiotics. Assessment of the degree of dehydration should be done following the WHO guidelines. Dehydration can be managed with oral rehydration salt (ORS) solution or intravenous fluids. Recently WHO has recommended a hypo-osmolar ORS solution for the treatment of all cases of acute diarrhoea including cholera. Feeding during and after diarrhoea (for at least 2-3 weeks) prevents malnutrition and growth retardation. Antibiotic therapy is not recommended for the treatmentof diarrhoea routinely. Only cases of severe cholera and bloody diarrhoea (presumably shigellosis) should be treated with a suitable antibiotic. Pilot studies in several countries have shown that zinc supplementation during diarrhoea reduces the severity and duration of the disease as well as antidiarrhoeal and antimicrobial use rate. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.     

5岁以下儿童补充维生素A对预防死亡、疾病及失明的系统回顾和荟萃分析

目的研究补充维生素A与6个月至5岁儿童死亡率和发病率的减少是否相关。方法系统回顾和荟萃分析,由2名研究者独立筛选文献,数据经双方提取,不同点通过讨论解决,主要进行死亡、疾病、视力及副作用的荟萃分析。数据来源于Cochrane中心注册的对照研究,包括Cochrane图书馆、Medline、Embase、GlobalHealth、Latin American和Caribbean HealthSciences,metaRegister of Controlled Trials和African Index Medicus。数据检索至2010年4月前已发表或待发表的各种语言的文献。入选标准为对口服合成维生素A的6个月至5岁儿童的随机对照研究,研究儿童患有疾病（包括腹泻、麻疹及HIV）,排除住院以及食物强化或B胡萝卜素儿童。结果包括215633名儿童的43项研究人选。其中17项研究（194483名儿童）显示全因死亡率减少了24％,其比值比为0．76,95％可信区间（95％CI）0．69～0．83。7项研究报道与腹泻相关的死亡率减少了28％,其比值比为0．72（95％C10．57—0．91）。维生素A的补充与腹泻减少的比值比为0．85（95％C10．82—0．87）、与麻疹、视力问题包括夜盲和眼球干燥症减少的比值比分别为0．50（95％C10．37—0．67）、0．32（95％C10．21～0．50）和0．31（95％C10．22—0．45）。3项研究报道在补充维生素A的48小时内呕吐增加的风险为2．75（95％CI1．81～4．19）。结论补充维生素A在一定范围内与儿童的死亡率、发病率及视力问题的大幅减少有关,且这一结论不能由偏倚来解释。在6个月至59个月的儿童中已无需进行补充维生素A的安慰剂对照研究,但是有必要进一步比较不同剂量和不同给药方式（如强化）的区别。就目前得到的数据而言,所有可能缺乏维生素A的儿童均应得到补充,尤其是中低收入的国家。     

Zinc in human health

Malnutrition is a contributing cause of about half of the 10 million deaths annually worldwide, and contributes to a substantial proportion of the infectious disease morbidity among children in developing countries. Recent epidemiological and clinical evidence has shown that in most developing countries deficiencies of specific micronutrients are partly responsible for the severity of infectious disease morbidity and mortality in malnourished children. Efforts to improve micronutrient status have focused on iron, vitamin A and iodine. Supplementation with iron and vitamin A significantly reduces child mortality, while implementation of the universal salt iodization strategy reduces the incidence of iodine deficiency disorders. These strategies are considered to be among the most cost-effective health interventions in developing countries. A number of recent zinc supplementation studies in developing countries suggest that greater priority should also be given to the correction of mild to moderate zinc deficiency in children, pregnant women and lactating mothers. Some of these studies showed that zinc supplementation reduces the duration of malaria, and the severity of diarrhoea and respiratory infections (including pneumonia), and improves immunocompetence in susceptible children. The results of these studies indicate that zinc may be another specific micronutrient in which there is widespread deficiency in developing countries and that great benefits can be achieved by its supplementation.     

Role of vitamin A supplementation in the treatment of tuberculosis

Vitamin A deficiency has been commonly observed in patients with tuberculosis. Low serum retinol levels return to normal after antituberculosis treatment even when no supplements are provided. The deficiency of vitamin A observed in patients with tuberculosis might have contributed to the development of tuberculous disease in them. Alternatively, deficiency could be the result of loss of appetite, poor intestinal absorption, increased urinary loss of vitamin A or acute phase reaction in TB. Vitamin A deficiency lowers immunity while vitamin A supplementation reduces morbidity and mortality, particularly from measles and diarrhoea. Vitamin A supplementation also decreases the mortality rate in HIV-infected children and delays the progression of HIV disease in infected subjects. A higher incidence of lung cancer and increased mortality have been observed in smokers after beta-carotene supplementation. Zinc deficiency is also common in tuberculosis, which may impose a secondary vitamin A deficiency. Clinical trials have shown conflicting results regarding the effect of supplementation of vitamin A, alone or with other micronutrients, on time taken to sputum conversion in patients with pulmonary tuberculosis. Supplementation with multiple micronutrients (including zinc) rather than vitamin A alone may be more beneficial in patients with tuberculosis, but clinical trials on such a combination are lacking.     

Effect of Micronutrient Supplementation on the Growth of Preschool Children in China

Objective To study the relationship between micronutrient supplementation and children growth. Methods A double-blind, placebo-controlled trial was conducted in 156 growth retarded preschool children. They were randomly assigned to five groups: supplemental control (S-control,n=28), zinc supplementation(+Zn, 3.5mg Zn/day, n=34), zinc and calcium supplementation (+ZnCa,3.5mg Zn+250mg Ca/day, n=37), zinc and calcium and vitamin A supplementation (+ZnCaVA,3.5mgZn +250mgCa+200gVA/day, n=28), Calcium and vitamin A supplementation (+CaVA,250mgCa + 200gVA/day, n=29). Another 34 children with normal height were selected as normal control (N-control). Supplementation continued for twelve months. Results The height gain in +Zn group (7.84cm per year) and +ZnCa group (7.70 cm per year) was significantly higher than that in S-control group (6.74 cm per year, P＜0.05); The weight gain in +ZnCaVA group (2.55kg per year)and +CaVA group (2.57 kg per year) was also significantly higher than that in S-control group (2.19kg per year, P＜0.05); The average days of illness in each supplementation group were lower than that in S-control (13 days per year compared with 23 days per year). No significant difference was observed on bone age. Conclusion Zinc and Zinc+Calcium supplementation can improve the height gain,and vitamin A can improve weight gain in growth retarded preschool children, but do not affect the maturity of bone. Micronutrient supplementation can lower the morbidity of these children.     

Effect on clinical outcome of breast feeding during acute diarrhoea

The effects of oral rehydration fluid alone and of oral rehydration fluid plus breast feeding on the course and outcome of acute diarrhoea were assessed in two groups of 26 children aged under 2 years. Children who continued to be breast fed during treatment with oral rehydration solutions passed significantly fewer diarrhoeal stools. They also passed, on average, a smaller volume of diarrhoeal stools and recovered from diarrhoea sooner after the start of treatment. Their requirement for oral rehydration fluid was significantly reduced. Breast feeding exerts a beneficial effect on the course and outcome of acute diarrhoea by reducing the number and volume of diarrhoeal stools.     

补锌治疗对有感染性疾病婴儿的辅助疗效分析

目的探讨对感染性疾病补锌辅助治疗的疗效。方法收集1～12个月龄大的可能患有严重细菌感染的婴儿,随机分为两个组,补锌组87例和对照组80例,两组除标准的抗菌治疗外,补锌组每天接受口服硫酸锌2mg／（kg·d）,对照组接受同等剂量安慰剂,比较两组最终住院时间及严重症状缓解时间。结果两组间性别、月龄、疾病种类、疾病基础状态、高敏C反应蛋白水平、血锌水平比较无显著差异,P〉0．05;补锌组治疗失败7例（8o％）,对照组15例（187％）,有统计学差异,P〈0.05,补锌治疗降低了治疗失败的相对风险;补锌组住院时间10d,对照组11d,差异无统计学意义,P〉0.05;补锌组症状缓解时间3d,对照组4d,差异有统计学意义,P〈0.05。结论补锌治疗可降低抗感染失败的风险,可以加快严重感染症状的缓解。     

Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur

The risk factors and modes of death following acute diarrhoeal illness in children admitted to University Hospital, Kuala Lumpur between 1982 and 1997 were studied retrospectively. Among 4,689 cases of acute gastroenteritis admitted, ten deaths were noted. The case mortality rate was 2.1/1000 admissions. All deaths were infants below one year, with eight females and two males. Acute renal failure and acute pulmonary oedema were common preceding events. Female sex, infants less than twelve months, the presence of hyper or hyponatraemia and moderate to severe dehydration on admission were risk factors for deaths.     

Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities

OBJECTIVES: To describe the short-term outcomes in Aboriginal children admitted to hospital with radiological alveolar lobar changes; and determine whether predischarge chest radiography can predict respiratory morbidity found at follow-up. DESIGN, PARTICIPANTS, SETTING: Prospective cohort study of Aboriginal children admitted to Alice Springs Hospital between October 2000 and April 2001 with alveolar lobar abnormalities (area of consolidation, > or = 1 cm) on chest radiographs. Participants were to have a predischarge radiograph and be followed up for 12 months. MAIN OUTCOME MEASURES: Comorbidities, follow-up rate, and new respiratory disease found at follow-up. RESULTS: Of 113 children hospitalised with radiological alveolar lobar changes, 109 were Aboriginal. Their median age was 1.8 years (range, 0.2 months-13.3 years), and 124 episodes were recorded. Comorbidities were common in these children (anaemia, 51.5%; suppurative otitis media, 37.3%). The follow-up rate one year after admission was 83.1% of episodes. New treatable chronic respiratory morbidity was found in 20 (25.6%) of the 78 children with completed follow-up. Predischarge chest radiographs were predictive of all chronic respiratory morbidity when they showed no or minimal resolution (0-20% resolution) (relative risk, 7.43; 95% CI, 2.07-26.60). CONCLUSIONS: Central Australian Aboriginal children admitted to hospital with alveolar changes on chest radiographs have a substantial burden of chronic respiratory illness, and should be clinically followed up for early detection and management of chronic respiratory morbidity. A predischarge radiograph is useful, and patients whose radiograph shows no or minimal resolution should have a follow-up x-ray film.     

A 5- versus 3-day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial

OBJECTIVE: To determine whether a 5-day course of oral prednisolone is superior to a 3-day course in reducing the 2-week morbidity of children with asthma exacerbations who are not hospitalised. DESIGN, SETTING AND PARTICIPANTS: Double-blind randomised controlled trial of asthma outcomes following a 5-day course of oral prednisolone (1 mg/kg) compared with a 3-day course of prednisolone plus placebo for 2 days. Participants were children aged 2-15 years who presented to the emergency departments of three Queensland hospitals between March 2004 and February 2007 with an acute exacerbation of asthma, but were not hospitalised. Sample size was defined a priori for a study power of 90%. MAIN OUTCOME MEASURES: Difference in proportion of children who were symptom-free at Day 7, as measured by intention-to-treat (ITT) and per-protocol analysis; quality of life (QOL) on Days 7 and 14. RESULTS: 201 children were enrolled, and there was an 82% completion rate. There was no difference between groups in the proportion of children who were symptom-free (observed difference, 0.04 [95% CI, - 0.09 to 0.18] by ITT analysis; 0.04 [95% CI, - 0.17 to 0.09] by per-protocol analysis). There was also no difference between groups in QOL (P = 0.42). The difference between groups for the primary outcome was within the equivalence range calculated post priori. CONCLUSION: A 5-day course of oral prednisolone confers no advantage over a 3-day course for children with asthma exacerbations who are not hospitalised. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN012605000305628.     

Diarrhoea morbidity in children in the Asaro Valley, Eastern Highlands Province, Papua New Guinea

A morbidity study of diarrhoea covering 1926 children aged less than 5 years was carried out in Goroka town and the Lowa and Asaro Census Divisions, Eastern Highlands Province between 1986 and 1989. The study involved weekly demographic surveillance of the total population and morbidity surveillance of children by lay reporters who enquired about the presence or absence on any of the preceding 8 days of a range of symptoms associated with diarrhoeal and respiratory diseases. A three-day symptom-free period was used to define distinct episodes of diarrhoea. The average number of episodes/child-year for all children in the study population was 3.0. Boys suffered a significantly higher incidence of diarrhoea under 48 months of age than girls (4.4 episodes compared to 3.6/child-year). Incidence was highest among those aged 6-17 months (5.5/child-year) with a rapid decline after age 35 months. Incidence of diarrhoea was highest in the more remote Asaro Census Division and was higher in periurban areas than in Goroka town. Incidence also varied significantly between villages, some villages experiencing up to 10 times the incidence of diarrhoea found in Goroka town. The incidence of diarrhoea was significantly higher in January than at other times of year. Duration of diarrhoea varied with age, the longest duration being an average of 4.7 days in the 12-17 months age group. In order to reduce diarrhoea morbidity, it is necessary to improve access to water, encourage improved hygiene practices and breastfeeding and warn people about the risks of sleeping with pigs.     

妊娠期农妇补锌对幼儿生长发育的影响

目的　探讨农村孕妇在孕期补锌干预是否可影响其幼儿的生长发育。方法　随机双盲对照法补锌干预研究。 16 0名孕妇随机分为 4组 ,A、B、C组自第一次孕期保健门诊开始至分娩期间每天分别口服补充 5、10和 30mg剂量的锌 ,对照组每天口服安慰剂。在其幼儿 3～ 5岁时进行体格、智力、行为适应能力的测量和评定 ,对幼儿体格测量值按同年龄同性别儿童生长发育参考值进行了标准化 (Z评分 )。结果　A、B、C组幼儿的年龄别标准化头围评分 (Z评分 )均高于对照组幼儿 ,其中C组幼儿的年龄别头围Z评分高出对照组 0 .73(95 %CI :0 .0 0 4～ 1.4 4 ) ;3个补锌组合并后 ,年龄别头围Z评分较对照组增加了 0 .5 0 (95 %CI :0 .0 1～ 0 .99)。尽管各补锌组幼儿的智商均高于对照组幼儿 ,但均无统计学意义 ,也未见明显剂量效应趋势 ,但 3个补锌组合并后幼儿的智商高于对照组 4 .72 (95 %CI :0 .2 6～ 9.2 0 )。补锌组与对照组间的其他发育指标未见明显差异。结论　对摄取以植物性食物为主的非平衡性膳食的农村孕妇每日补锌 5～ 30mg ,可能增加其所生幼儿的头围 ,并可能提高幼儿的智商 ,促进其智力发育 ,而对身高、体重、坐高及行为适应能力的发育无明显影响     

补锌在小儿腹泻治疗中的疗效观察

目的:观察补锌在小儿腹泻治疗中的效果,分析补锌治疗小儿腹泻的应用价值。方法:采用对比分析法对我院自2011年3月²012年9月收治的42例腹泻患儿进行资料分析,随机分为治疗组(21例)与对照组(21例),两组患儿均根据实际病情给予思密达常规治疗及全面饮食康复护理,治疗组患儿在此基础上给予补锌辅助治疗(<10个月患儿15 mg/d,>10个月患儿25 mg/d),疗程2周左右。观察对比两组患儿治疗效果、止泻时长、退热时间及住院时间。结果:治疗组患儿总体治疗效果明显优于对照组,平均止泻时长、退热时间及住院时间明显短于对照组,差异有统计学意义(P<0.05)。结论:锌作为人体内不可或缺的微量元素,有利于提高人体内的免疫功能,因此补锌能够显著提高小儿腹泻的治疗效果,值得在临床上推广应用。     

Vitamin C and the common cold: a double-blind trial

A large scale double-blind trial was conducted to test the claim that the intake of one gram of vitamin C per day substantially reduces the frequency and duration of “colds”. It was found that in terms of the average number of colds and days of sickness per subject the vitamin group experienced less illness than the placebo group, but the differences were smaller than have been claimed and were statistically not significant. However, there was a statistically significant difference (P <0.05) between the two groups in the number of subjects who remained free of illness throughout the study period. Furthermore the subjects receiving the vitamin experienced approximately 30% fewer total days of disability (confined to the house or off work) than those receiving the placebo, and this difference was statistically highly significant (P <0.001). The reduction in disability appeared to be due to a lower incidence of constitutional symptoms such as chills and severe malaise, and was seen in all types of acute illness, including those which did not involve the upper respiratory tract.     

Single megadose vitamin A supplementation of Indian mothers and morbidity in breastfed young infants

Background and objective: In developing countries low maternal vitamin A stores combined with increased demands of pregnancy and lactation may lead to its deficiency in breastfed infants. This study evaluates the effects of maternal supplementation with a high dose of vitamin A on the serum retinol levels of exclusively breastfed infants, and their morbidity in the first six months of life. Setting: Hospital based. Study design: Randomised controlled trial. Subjects and methods: Mothers of the test group (n=150) were orally supplemented with a single dose of retinol (209 µmol) soon after delivery and were advised exclusive breastfeeding for six months. Before supplementation retinol levels were estimated in the mothers'' and newborns'' blood, and in colostrum. On follow up, breastmilk and infants'' serum retinol contents were assessed monthly for six months. Retinol level <0.7 µmol/l indicated vitamin A deficiency. Morbidity patterns like vitamin A deficiency, diarrhoea, febrile illnesses, acute respiratory infection, measles, and ear infection were also studied and compared between the two groups. Results: Presupplement mean maternal serum retinol levels were 0.98 and 0.92 µmol/l and mean breastmilk levels were 3.85 and 3.92 µmol/l in the test and control groups respectively (p>0.05). Mean cord blood retinol levels were also comparable (0.68 v 0.64 µmol/l). After supplementation, the test group showed a rise in mean breastmilk retinol content (12.08 v 2.96 µmol/l) which remained significantly higher for four months. The infants'' mean serum retinol level, initially 322.06% of the baseline value, was significantly higher for five months. In the control group, significant numbers of mothers and infants showed deficient breastmilk and serum retinol throughout the follow up (p<0.01). Decreased incidence and duration of various diseases were also found in the test group suggesting lesser morbidity. Conclusion: Maternal supplementation with single megadose vitamin A is an effective strategy for vitamin A prophylaxis of exclusively breastfed infants of 0–6 months.     

强化糕点改善学前儿童营养状况的研究

目的：观察强化钙、锌、维生素Ａ、维生素Ｄ的糕点对改善学前儿童营养状况及生长发育的效果。方法：以５４名５￣６岁健康儿童为对象,分为强化组和对照组,于午睡后加餐,连续观察７０ｄ,比较两组儿童的身高、体重、维生素Ａ缺乏症检出率及血清中总蛋白、白蛋白、钙、锌、维生素Ａ水平。结果：强化组儿童的身高增长值高于对照组;血钙、血锌、血清维生素Ａ的水平较加餐前明显提高;维生素Ａ缺乏症检出率明显下降。结论：强化钙、锌     

Coronavirus-like particles in Aboriginals and non-Aboriginals in Western Australia

Pleomorphic virus-like particles which resemble coronaviruses in morphology were found in faecal specimens from Aboriginal and non-Aboriginal children in Western Australia. They were equally prevalent in those with or without symptoms of diarrhoea. A much greater proportion of Aboriginal than non-Aboriginal children were found to be excreting the particles. The proportion of children who excreted the virus-like particles increased with age. Coronavirus-like particles, indistinguishable from those found in humans, were found in a number of Aboriginals' dogs.     

致病性大肠杆菌肠炎36例分析

977例急性腹泻患儿中致病性大肠杆菌检出率为3.68%,其血清分型以 O_(126)B_(16)和 O_(111)B_4为主,发病季节多见于夏秋季,2步以下发病率最高占80.6%,临床症状以轻度至中度腹泻为主,无明显全身症状,症状的表现与血清型无明显关系。