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Iron and zinc deficiencies are common in developing countries and supplementation is one way of reversing these deficiencies. The objective of this randomized, placebo-controlled clinical trial was to identify the effect of daily supplementation with iron, zinc, and iron plus zinc on the morbidity experience of 855 children 0.5–15 years of age in Peru. Single nutrient supplementation with zinc reduced diarrhea morbidity by 23% in all children. In older children (more than five years of age), iron supplementation increased morbidity due to Plasmodium vivax and diarrhea. In younger children, iron combined with zinc provided protection against P. vivax malaria, but also interfered with some of the diarrhea protection associated with zinc supplementation. No statistically significant effect was observed of either supplement on incidence of respiratory infection or anthropometric indices. Iron and zinc deficiencies should be remedied, and combined supplementation may be a good option, particularly in younger children in P. vivax malaria-endemic areas, although local endemicity and species-specific prevalence should be considered carefully when designing any supplementation program involving iron in a malaria-endemic area.
Received November 4, 2005. Accepted for publication February 23, 2006.
Acknowledgments: We thank the parents and children who generously participated in the study; the study team, in particular Dr. Manuel Ríos for medical care of children, Sofia Madrid for field supervision, and Jorge Quintana for laboratory support; and the staff of Hospital Regional de Apoyo Iquitos and the Ministry of Health authorities in the region of Loreto, Peru for their assistance. We also thank Elizabeth Johnson and Ping Chen for statistical support and guidance.
Financial support: This study was supported by the United Nations Children’s Fund (New York) and the Johns Hopkins Family Health and Child Survival Cooperative Agreement with the United States Agency for International Development.
Disclosure: None of the authors had a personal or financial conflict of interest in this study.
* Address correspondence to Anuraj H. Shankar, Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Room E8527, Baltimore, MD 21205. E-mail: ashankar{at}jhsph.edu
Author’s addresses: Stephanie A. Richard and Laura E. Caulfield, Center for Human Nutrition, Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Room W2041, Baltimore, MD 21205 Telephone: 410-955-2786, Fax: 410-955-0196, E-mails: cyq9{at}cdc.govlcaulfie{at}jhsph.edu. Nelly Zavaleta, Instituto de Investigacion Nutricional, Avenida la Universidad 685, La Molina, Lima 18, Peru, Telephone: 51-14-349-6023, Fax: 51-14-349-6025, E-mail: nzavalet{at}iin.sld.pe. Robert E. Black, Richard S. Witzig, and Anuraj H. Shankar, Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Room E8527, Baltimore, MD 21205, Telephone: 410-955-3934, Fax: 410-955-0196, E-mails: rblack{at}jhsph.edu, rwitzig{at}tulane.edu, and ashankar{at}jhsph.edu.
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