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Cochrane Database of Systematic Reviews

Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months

Information

DOI:
https://doi.org/10.1002/14651858.CD005978.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 04 December 2016see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Acute Respiratory Infections Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Zohra S Lassi

    The Robinson Research Institute, The University of Adelaide, Adelaide, Australia

  • Anoosh Moin

    Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan

  • Zulfiqar A Bhutta

    Correspondence to: Center for Global Child Health, Hospital for Sick Children, Toronto, Canada

    [email protected]

    [email protected]

Contributions of authors

Zohra S Lassi (ZSL) entered data, created the comparisons, carried out the analysis and wrote the text of the review under the guidance of Dr Zulfiqar A Bhutta (ZAB). Anoosh Moin (AM) took part in screening results and updating the review.

Sources of support

Internal sources

  • The Aga Khan University, Pakistan.

External sources

  • No sources of support supplied

Declarations of interest

Zohra S Lassi: none known.

Anoosh Moin: none known.

Zulfiqar A Bhutta: none known.

Acknowledgements

The authors wish to thank Ammad Saeed, who assisted in the development of protocol and Ms Sarah Thorning for her assistance with the literature search. The review authors would like to thank the following people for commenting on the draft review: Abdullah Brooks, Robert Black, Teenah Handiside and Jiaan‐Der Wang, Mark Griffin, and John Holden.The draft protocol was written by Dr Batool A Haider (BAH) who also took part in the initial stages of the 2010 review and assisted in data extraction.

Version history

Published

Title

Stage

Authors

Version

2016 Dec 04

Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months

Review

Zohra S Lassi, Anoosh Moin, Zulfiqar A Bhutta

https://doi.org/10.1002/14651858.CD005978.pub3

2010 Dec 08

Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months

Review

Zohra S Lassi, Batool A Haider, Zulfiqar A Bhutta

https://doi.org/10.1002/14651858.CD005978.pub2

2006 Apr 19

Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months

Protocol

Batool A Haider, Muhammad Ammad Saeed, Zulfiqar A Bhutta

https://doi.org/10.1002/14651858.CD005978

Differences between protocol and review

We have added mandatory sections such as subgroup analysis and sensitivity analysis for this update.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Child, Preschool; Humans; Infant;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study
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Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study

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Comparison 1 Zinc supplementation vs placebo, Outcome 1 Pneumonia incidence.
Figures and Tables -
Analysis 1.1

Comparison 1 Zinc supplementation vs placebo, Outcome 1 Pneumonia incidence.

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Comparison 1 Zinc supplementation vs placebo, Outcome 2 Pneumonia prevalence.
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Analysis 1.2

Comparison 1 Zinc supplementation vs placebo, Outcome 2 Pneumonia prevalence.

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Summary of findings for the main comparison. Zinc supplementation compared with placebo for the prevention of pneumonia in children aged 2 months to 59 months

Zinc supplementation compared with placebo for the prevention of pneumonia in children aged 2 months to 59 months

Patient or population: children aged 2 months to 59 months
Settings: Bangladesh, India, Peru, South Africa
Intervention: zinc supplementation
Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Zinc supplementation

Pneumonia incidence

343 per 1000

299 per 1000
(278 to 323)

RR 0.87
(0.81 to 0.94)

5193
(6 studies)

⊕⊕⊝⊝
low1,2

Pneumonia prevalence

22 per 1000

13 per 1000
(8 to 22)

RR 0.59
(0.35 to 0.99)

609
(1 study)

⊕⊕⊝⊝
low3,4

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Studies have unclear information on allocation concealment, blinding and reporting biases.
2 Pneumonia diagnosis criteria was used differently.
3 Studies have limited information on blinding of outcomes assessors and reporting bias.
4 Total number of events were less than 300.

Figures and Tables -
Summary of findings for the main comparison. Zinc supplementation compared with placebo for the prevention of pneumonia in children aged 2 months to 59 months
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Table 1. Zinc supplement schedule and duration

Study

Supplement

Schedule

Duration

Surveillance

Zinc

Control

Bhandari 2002

Zinc gluconate

10 mg

Both groups vitamin A

Daily

4 months

Once weekly

Bobat 2005

Zinc sulphate

10 mg

Placebo

Daily

6 months

Every 2 weeks

Brooks 2005

Zinc acetate 35 mg to infants

70 mg to children aged > 12 months

Placebo

Weekly

12 months

Once weekly

Luabeya 2007

Zinc gluconate

10 mg

Both groups vitamin A

Daily

(Continued until 24 months of age)

Once weekly

Penny 2004

Zinc gluconate

10 mg

Placebo

Daily

6 months

Once weekly

Sazawal 1998

Zinc gluconate

10 mg

Placebo

Daily

4 months

Every 5th day
Figures and Tables -
Table 1. Zinc supplement schedule and duration
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Comparison 1. Zinc supplementation vs placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pneumonia incidence Show forest plot

6

5193

Risk Ratio (Fixed, 95% CI)

0.87 [0.81, 0.94]

1.1 Diagnosis based on age‐specific fast breathing with or without lower chest indrawing

4

1932

Risk Ratio (Fixed, 95% CI)

0.95 [0.86, 1.06]

1.2 Diagnosis based age‐specific fast breathing and confirmed by chest examination or chest radiograph

4

3261

Risk Ratio (Fixed, 95% CI)

0.79 [0.71, 0.88]

2 Pneumonia prevalence Show forest plot

1

609

Risk Ratio (Fixed, 95% CI)

0.59 [0.35, 0.99]
Figures and Tables -
Comparison 1. Zinc supplementation vs placebo
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