Small-quantity lipid-based nutrient supplements, regardless of their zinc content, increase growth and reduce the prevalence of stunting and wasting in young Burkinabe children : a cluster-randomized trial

Small-quantity lipid-based nutrient supplements (SQ-LNS) are promising home fortification products, but the optimal zinc level needed to improve growth and reduce morbidity is uncertain. We aimed to assess the impact of providing SQ-LNS with varied amounts of zinc, along with illness treatment, on zinc-related outcomes compared with standard care. In a placebo-controlled, cluster-randomized trial, 34 communities were stratified to intervention (IC) or nonintervention cohorts (NIC). 2435 eligible IC children were randomly assigned to one of four groups: 1) SQ-LNS without zinc, placebo tablet; 2) SQ-LNS containing 5mg zinc, placebo tablet; 3) SQ-LNS containing 10mg zinc, placebo tablet; or 4) SQ-LNS without zinc and 5mg zinc tablet from 9-18 months of age. During weekly morbidity surveillance, oral rehydration salts were provided for reported diarrhea and antimalarial therapy for confirmed malaria. Children in NIC (n = 785) did not receive SQ-LNS, tablets, illness surveillance or treatment. At 9 and 18 months, length, weight and hemoglobin were measured in all children. Reported adherence was 97 +/- 6% for SQ-LNS and tablets. Mean baseline hemoglobin was 89 +/- 15g/L. At 18 months, change in hemoglobin was greater in IC than NIC (+8 vs -1g/L, p<0.0001), but 79.1% of IC were still anemic (vs. 91.1% in NIC). Final plasma zinc concentration did not differ by group. During the 9-month observation period, the incidence of diarrhea was 1.10 +/- 1.03 and of malaria 0.54 +/- 0.50 episodes per 100 child-days, and did not differ by group. Length at 18 months was significantly greater in IC compared to NIC (77.7 +/- 3.0 vs. 76.9 +/- 3.4cm; p<0.001) and stunting prevalence was significantly lower in IC (29.3%) than NIC (39.3%; p<0.0001), but did not differ by intervention group within IC. Wasting prevalence was also significantly lower in IC (8.7%) than in NIC (13.5%; p = 0.0003). Providing SQ-LNS daily with or without zinc, along with malaria and diarrhea treatment, significantly increased growth and reduced stunting, wasting and anemia prevalence in young children

Effect of zinc added to a daily small-quantity lipid-based nutrient supplement on diarrhoea, malaria, fever and respiratory infections in young children in rural Burkina Faso : a cluster-randomised trial

Objective: Preventive zinc supplementation in the form of tablets or syrup reduces the incidence of diarrhoea and acute lower respiratory tract infections (RTI), but its effect on malaria is inconsistent. When zinc is administered with other micronutrients or foods, its effect is also uncertain. We assessed the effects of different amounts and sources of zinc on the frequency of diarrhoea, malaria, fever and RTI in young children. Design, setting and populations: This community-based, double-blind, placebo-controlled, cluster-randomised trial of 2435 children 9 months of age was carried out between April 2010 and July 2012 in rural southwestern Burkina Faso. Interventions: Participants were randomly assigned at the concession level to receive daily 1 of 4 interventions for 9 months: (1) 20 g small-quantity lipid-based nutrient supplement (SQ-LNS) without zinc and placebo tablet, (2) 20 g SQ-LNS with 5 mg zinc and placebo tablet, (3) 20 g SQ-LNS with 10 mg zinc and placebo tablet or (4) 20 g SQ-LNS without zinc and 5 mg zinc tablet. Participants were visited weekly in their homes for morbidity surveillance for 9 months, and those with uncomplicated diarrhoea and malaria received treatment from the study field workers in the community. Main outcomes: Incidence and longitudinal prevalence of diarrhoea, malaria, fever, and lower and upper RTI by intervention group. Results: The incidence of diarrhoea, malaria and fever was 1.10 (+/- 1.03 SD), 0.61 (+/- 0.66 SD) and 1.49 (+/- 1.12 SD) episodes per 100 child-days at risk, respectively, and did not differ by intervention group (p=0.589, p=0.856 and p=0.830, respectively). The longitudinal prevalence of acute lower RTI (0.1%; 95% IC 0.1-0.2%) and of upper RTI (7.8%; 95% IC 7.1-8.4%) did not differ among groups (p=0.234 and p=0.501, respectively). Conclusions: Inclusion of 5 or 10 mg zinc in SQ-LNS and provision of 5 mg zinc dispersible tablet along with SQ-LNS had no impact on the incidence of diarrhoea, malaria and fever or the longitudinal prevalence of RTI compared with SQ-LNS without zinc in this population

Prevalence and incidence of diarrhea and malaria among young Burkinabe children receiving SQ-LNS and tablets from 9 to 18 months of age.

<p>¹Prevalence shown as mean percent (95% CI) and incidence as mean ± SD per 100 child-days. Means are weighted for number of days of observation for prevalence and number of days at risk for incidence.</p><p>²Diarrhea defined as ≥3 liquid or semi-liquid stools reported by caregiver</p><p>³Malaria was defined by a positive result of a HRP-II (histidine-rich protein II) rapid diagnostic test for malaria parasites</p><p>⁴Treatment of diarrhea included treatments provided by project field workers and health centers</p><p>⁵ Treatment of malaria was considered if provided by project field workers</p><p>⁶ P-values obtained from binominal regression models, which included a random effect of concession, baseline characteristics and potential covariates and accounted for overdispersion.</p><p>Prevalence and incidence of diarrhea and malaria among young Burkinabe children receiving SQ-LNS and tablets from 9 to 18 months of age.</p

Child and maternal baseline characteristics by group.

<p>HFIAS, Household food insecurity access scale; LAZ, length-for-age z-score; positive RDT, positive result of a HRP-II (histidine-rich protein II) rapid diagnostic test for malaria parasites; WAZ, weight-for-age z-score; WLZ, weight-for-length z-score; ZPP, zinc protoporphyrin</p><p>¹P-values are for Chi square tests from survey procedure for comparing proportions in more than 2 categorical variables across groups or logistic regression for categorical variables, and linear mixed model for continuous variables. All comparison were done adjusting for cluster randomization (village, concession);</p><p>²Mean ± SD, geometric mean (95% CI) and n (%), all such values.</p><p>³ZPP adjusted categorically for RDT result;</p><p>⁴Malaria is defined as a positive result of a HRP-II rapid diagnostic test for malaria parasites</p><p>⁵Household food insecurity access scale (HFIAS) adjusted for season.</p><p>Child and maternal baseline characteristics by group.</p

Change in length by initial length in young children in Burkina Faso.

<p>Change in length by initial length in young children in Burkina Faso.</p

Anthropometry at baseline and after 9 mo of intervention in young Burkinabe children.

<p>HC, head circumference; LAZ, length-for-age z-score; mo, months; MUAC, mid-upper arm circumference; WAZ, weight-for-age z-score; WLZ, weight-for-length z-score</p><p>¹ Adjusted mean ± SD and n (%), all such values. Values in the same row with different superscript letters are significantly different (P<0.05).</p><p>² Adjusting for cluster randomization (village, concession), baseline value, age and potential co-variates, when applicable.</p><p>Anthropometry at baseline and after 9 mo of intervention in young Burkinabe children.</p