Zinc-MNP Trial for Prevention of Diarrhea and Promotion of Linear Growth

Primary Investigator

  • Dr. Robert Black, Johns Hopkins Bloomberg School of Public Health

Study Period

February 2018 - January 2020

Study Description

This is a randomized, double-blind, community-based efficacy trial of different doses, forms, and frequencies of zinc supplementation for the prevention of diarrhea and promotion of linear growth among children 9-11 months of age in Dhaka, Bangladesh.

Zinc is essential to support growth in young children especially for tissues undergoing rapid cellular differentiation and turnover, such as those in the immune system and gastrointestinal tract. Therapeutic zinc supplementation has been initiated in low-income countries as part of diarrhea treatment programs to support these needs for young children but, the effects of preventive supplemental zinc as a tablet or as a multiple micronutrient powder (MNP) on child growth and diarrheal disease are mixed and pose programmatic uncertainties. Thus, a randomized, double-blind community-based efficacy trial of five different doses, forms, and frequencies of preventive zinc supplementation vs. a placebo was designed for a study in children aged 9-11 months in an urban community in Dhaka, Bangladesh. The primary outcomes of this 24-week study are incidence of diarrheal disease and linear growth. Study workers will conduct in-home morbidity checks twice weekly; anthropometry will be measured at baseline, 12 weeks and 24 weeks. Serum zinc and other related biomarkers will be measured in a subsample along with an estimate of the exchangeable zinc pool size using stable isotope techniques in a subgroup. Therapeutic zinc will be provided as part of diarrhea treatment, in accordance with Bangladesh's national policy. Therefore, the proposed study will determine the additional benefit of a preventive zinc supplementation intervention.

Study Arms

  • Experimental: 1. Standard MNP
  • Experimental: 2. High zinc, low iron MNP
  • Experimental: 3. High zinc, low/no iron
  • Active Comparator: 4. Dispersible zinc supplement
  • Experimental: 5. Intermittent zinc supplement
  • Placebo Comparator: 6. Placebo powder

Primary Outcomes

  • Incidence of diarrhea [ Time Frame: Incidence over the 24-week follow-up period ]
  • Change in length-for-age Z score [ Time Frame: Measured at enrollment and the end of the 24-week follow-up period ]

Study Intervention

  • Micronutrient powders (MNP)

Research Gaps

  • Effectiveness

    How well do different food compositions and interventions prevent or treat undernutrition, when implemented "on the ground"?

Study Population