Baqui Abdullah H, Black Robert E, El Arifeen Shams, Yunus Mohammad, Chakraborty Joysnamoy, Ahmed Saifuddin, Vaughan J Patrick
Department of International Health, Johns Hopkins Bloomberg School of Public Heath, 615 N Wolfe Street, Baltimore, MD 21205, USA.
BMJ. 2002 Nov 9;325(7372):1059. doi: 10.1136/bmj.325.7372.1059.
To evaluate the effect on morbidity and mortality of providing daily zinc for 14 days to children with diarrhoea.
Cluster randomised comparison.
Matlab field site of International Center for Diarrhoeal Disease Research, Bangladesh.
8070 children aged 3-59 months contributed 11 881 child years of observation during a two year period.
Children with diarrhoea in the intervention clusters were treated with zinc (20 mg per day for 14 days); all children with diarrhoea were treated with oral rehydration therapy.
Duration of episode of diarrhoea, incidence of diarrhoea and acute lower respiratory infections, admission to hospital for diarrhoea or acute lower respiratory infections, and child mortality.
About 40% (399/1007) of diarrhoeal episodes were treated with zinc in the first four months of the trial; the rate rose to 67% (350/526) in month 5 and to >80% (364/434) in month 7 and was sustained at that level. Children from the intervention cluster received zinc for about seven days on average during each episode of diarrhoea. They had a shorter duration (hazard ratio 0.76, 95% confidence interval 0.65 to 0.90) and lower incidence of diarrhoea (rate ratio 0.85, 0.76 to 0.96) than children in the comparison group. Incidence of acute lower respiratory infection was reduced in the intervention group but not in the comparison group. Admission to hospital of children with diarrhoea was lower in the intervention group than in the comparison group (0.76, 0.59 to 0.98). Admission for acute lower respiratory infection was lower in the intervention group, but this was not statistically significant (0.81, 0.53 to 1.23). The rate of non-injury deaths in the intervention clusters was considerably lower (0.49, 0.25 to 0.94).
The lower rates of child morbidity and mortality with zinc treatment represent substantial benefits from a simple and inexpensive intervention that can be incorporated in existing efforts to control diarrhoeal disease.
评估为腹泻儿童连续14天每日补充锌对发病率和死亡率的影响。
整群随机对照试验。
孟加拉国腹泻病研究国际中心的马特实验室现场。
8070名年龄在3至59个月的儿童在两年期间贡献了11881个儿童年的观察数据。
干预组中腹泻儿童接受锌治疗（每日20毫克，共14天）；所有腹泻儿童均接受口服补液治疗。
腹泻发作持续时间、腹泻和急性下呼吸道感染发病率、因腹泻或急性下呼吸道感染住院情况以及儿童死亡率。
在试验的前四个月，约40%（399/1007）的腹泻发作接受了锌治疗；在第5个月这一比例升至67%（350/526），在第7个月超过80%（364/434）并维持在该水平。干预组儿童在每次腹泻发作期间平均接受锌治疗约7天。与对照组儿童相比，他们的腹泻持续时间更短（风险比0.76，95%置信区间0.65至0.90），腹泻发病率更低（率比0.85，0.76至0.96）。干预组急性下呼吸道感染发病率降低，而对照组未降低。干预组腹泻儿童住院率低于对照组（0.76，0.59至0.98）。干预组因急性下呼吸道感染住院率较低，但无统计学意义（0.81，0.53至1.23）。干预组非伤害性死亡率显著较低（0.49，0.25至0.94）。
锌治疗降低儿童发病率和死亡率，表明一种简单且廉价的干预措施具有显著益处，可纳入现有的腹泻病控制工作中。
