Effect of zinc supplementation on mortality in children aged 1–48 months: a community-based randomised placebo-controlled trial

Sazawal, Sunil; Black, Robert E; Ramsan, Mahdi; Chwaya, Hababu M; Dutta, Arup; Dhingra, Usha; Stoltzfus, Rebecca J; Othman, Mashavi K; Kabole, Fatma M

doi:10.1016/s0140-6736(07)60452-8

Cited by 138Child Nutrition and Water AccessTrace Elements in HealthGlobal Maternal and Child Health

Effect of zinc supplementation on mortality in children aged 1–48 months: a community-based randomised placebo-controlled trial

Sazawal, Sunil, Black, Robert E, Ramsan, Mahdi, Chwaya, Hababu M, Dutta, Arup, Dhingra, Usha, Stoltzfus, Rebecca J, Othman, Mashavi K +1 more·2007·The Lancet

DOI 10.1016/s0140-6736(07)60452-8

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Abstract

Background Studies from Asia have suggested that zinc supplementation can reduce morbidity and mortality in children, but evidence from malarious populations in Africa has been inconsistent. Our aim was to assess the effects of zinc supplementation on overall mortality in children in Pemba, Zanzibar.Methods We enrolled 42,546 children aged 1-36 months, contributing a total of 56,507 child-years in a randomised, double-blind, placebo-controlled trial in Pemba, Zanzibar. Randomisation was by household. 21 274 children received daily supplementation with zinc 10 mg (5 mg in children younger than 12 months) for mean 484.7 days (SD 306.6). 21,272 received placebo. The primary endpoint was overall mortality, and analysis was by intention to treat. This study is registered as an International Standard Randomised Clinical Trial, number ISRCTN59549825.Findings Overall, there was a non-significant 7% (95% CI -6% to 19%; p=0.29) reduction in the relative risk of all-cause mortality associated with zinc supplementation.Interpretation We believe that a meta-analysis of all studies of mortality and morbidity, will help to make evidence-based recommendations for the role of zinc supplementation in public health policy to improve mortality, morbidity, growth, and development in young children.

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Re-analysing the zinc trials for disease-specific outcomes reduced their statistical power and produced 95% confidence intervals that included 1.0.
“Re-Analysis of the same trials for disease-specific outcomes, which is necessary to extrapo late effects to populations with different causes of death, reduced their statistical power and gave 95% CIs that spanned 1·0.”
From A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 (2012) · cites this paper as [153]
Randomised trials of zinc supplementation were designed to detect effects on total mortality.
“randomised trials of zinc supplementation were designed to detect effects on total mortality.36,153”
From A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 (2012) · cites this paper as [153]

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Zinc supplements probably reduce childhood deaths in Zanzibar
(2007) · BMJ · doi:10.1136/bmj.334.7594.609-a

Authors: Sazawal, S., Black, R. E., Ramsan, M., Chwaya, H. M., Dutta, A., Dhingra, U., Stoltzfus, R. J., Othman, M. K., & Kabole, F. M.
Affiliations: Johns Hopkins University (US)
Public Health Laboratory Ivo de Carneri (TZ)
United Nations Children's Fund (US)
Cornell University (US)
Corresponding author: Black, Robert E
ORCID: Sazawal, Sunil
Black, Robert E
Dutta, Arup
Dhingra, Usha
Venue: The Lancet
Publisher: Elsevier BV
Published: 2007-03
Volume: 369
Issue: 9565
Pages: 927-934
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(07)60452-8
OpenAlex: W2146384937
Cited by: 138
References: 49
Citations by year: 2026: 1 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 1 · 2021: 6 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 6 · 2016: 5 · 2015: 5 · 2014: 9 · 2013: 9 · 2012: 11
FWCI: 17.03
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Funders: United States Agency for International Development
Bill and Melinda Gates Foundation
United Nations Foundation
Johns Hopkins Bloomberg School of Public Health
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords: zinc supplementation, child mortality, infant and young child nutrition, micronutrient supplementation, all-cause mortality, community-based trial
MeSH terms: Cause of Death, Child, Preschool, Communicable Disease Control, Communicable Diseases, Community Health Services, Diarrhea, Infantile, Double-Blind Method, Female, Follow-Up Studies, Humans, Infant, Malaria, Male, Mosquito Control, Socioeconomic Factors, Tanzania, Zinc, Age Distribution, Sex Distribution, Dietary Supplements, Child Mortality

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Effect of zinc supplementation on mortality in children aged 1–48 months: a community-based randomised placebo-controlled trial

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