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月齢2〜59カ月の小児における肺炎予防のための亜鉛補充

Appendices

Appendix 1. Previous search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 2), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to January Week 2, 2010), Embase (1974 to January 2010) and LILACS (1985 to January 2010).

We used the following search strategy to search MEDLINE and CENTRAL. The search strategy incorporates the search strategy devised by Boluyt 2008 to identify child studies. Due to the small number of search results we chose not to use a search filter to identify randomised trials. We adapted the search strategy to search Embase (see Appendix 2) and LILACS (see Appendix 3).

MEDLINE (Ovid)

1 exp Pneumonia/
2 pneumon*.tw.
3 lower respiratory tract infection*.tw.
4 lower respiratory infection*.tw.
5 lrti.tw.
6 or/1‐5
7 Zinc/
8 (zinc or zn).tw,nm.
9 or/7‐8
10 exp Infant/
11 (infant* or infancy or newborn* or baby* or babies or neonat* or preterm* or prematur*).tw.
12 exp Child/
13 (child* or schoolchild* or school age* or preschool* or kid or kids or toddler*).tw.
14 Adolescent/
15 (adoles* or teen* or boy* or girl*).tw.
16 Minors/
17 Puberty/
18 (minor* or pubert* or pubescen*).tw.
19 exp Pediatrics/
20 (pediatric* or pediatric*).tw.
21 exp Schools/
22 (nursery school* or kindergar* or primary school* or secondary school* or elementary school* or high school* or highschool*).tw.
23 or/10‐22
24 6 and 9 and 23

Embase search strategy

14. #5 AND #9 AND #13
13. #10 OR #11 OR #12
12. child*:ab,ti OR schoolchild*:ab,ti OR preschool*:ab,ti OR kid:ab,ti OR kids:ab,ti OR toddler*:ab,ti OR pediatric*:ab,ti OR paediatric*:ab,ti OR kindergar*:ab,ti OR (school* NEAR/2 (nursery OR primary OR elementary OR age*)):ab,ti
11. infant*:ab,ti OR infancy:ab,ti OR newborn*:ab,ti OR baby*:ab,ti OR babies:ab,ti OR neonat*:ab,ti
OR preterm*:ab,ti OR prematur*:ab,ti
10. 'infant'/exp OR 'child'/exp OR 'pediatrics'/exp OR 'school'/exp
9. #6 OR #7 OR #8
8. zinc:ab,ti OR zn:ab,ti
7. 'gluconate zinc'/exp
6. 'zinc'/exp
5. #1 OR #2 OR #3 OR #4
4. 'lower respiratory tract infection':ab,ti OR 'lower respiratory tract infections':ab,ti OR
'lower respiratory infection':ab,ti OR 'lower respiratory infections':ab,ti OR lrti:ab,ti
3. 'lower respiratory tract infection'/de
2. pneumon*:ab,ti
1. 'pneumonia'/exp

LILACS search strategy

pneumon$ or namonia or pulmonia or neumonia [Words] and zinc$ or cinc [Words]

"PNEUMONIA" [Subject descriptor] and "ZINC" [Subject descriptor]

Appendix 2. MEDLINE (Ovid) search strategy

1 exp Pneumonia/
2 (pneumon* or bronchopneumon* or pleuropneumon*).tw.
3 ((respiratory tract infect* or respiratory infect*) adj3 lower).tw.
4 (lower respiratory adj3 infect*).tw.
5 lrti.tw.
6 or/1‐5
7 Zinc/
8 (zinc* or zn).tw,nm.
9 Dietary Supplements/
10 trace elements/ or zinc/
11 Micronutrients/
12 exp Zinc Compounds/
13 ((essential or trace) adj1 (mineral* or nutrient*)).tw.
14 micronutrient*.tw.
15 or/7‐14
16 6 and 15

Appendix 3. Embase.com search strategy

#24 #15 AND #23
#23 #18 NOT #22
#22 #19 NOT #21
#21 #19 AND #20
#20 'human'/de AND [embase]/lim
#19 'animal'/de OR 'nonhuman'/de OR 'animal experiment'/de
#18 #16 OR #17
#17 random*:ab,ti OR placebo*:ab,ti OR crossover*:ab,ti OR 'cross over':ab,ti OR allocat*:ab,ti OR trial:ti OR (doubl* NEXT/1 blind*):ab,ti
#16 'randomized controlled trial'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp
#15 #6 AND #14
#14 #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13
#13 micronutrient*:ab,ti
#12 ((essential OR trace) NEAR/1 (mineral* OR nutrient*)):ab,ti
#11 'zinc derivative'/de
#10 'trace element'/exp
#9 'diet supplementation'/de
#8 zinc*:ab,ti OR zn:ab,ti
#7 'zinc'/de
#6 #1 OR #2 OR #3 OR #4 OR #5
#5 lrti:ab,ti
#4 'lower respiratory tract infection':ab,ti OR 'lower respiratory tract infections':ab,ti OR 'lower respiratory infection':ab,ti OR 'lower respiratory infections':ab,ti
#3 'lower respiratory tract infection'/de
#2 pneumon*:ab,ti OR bronchopneumon*:ab,ti OR pleuropneumon*:ab,ti
#1 'pneumonia'/exp

Appendix 4. LILACS (Virtual Health Library) search strategy

> Search > (MH:pneumonia OR pneumon$ OR Neumonía OR MH:C08.381.677$ OR MH:C08.730.610$ OR Pulmonía OR Bronchopneumonia OR Bronconeumonía OR Broncopneumonia OR Pleuropneumonia OR Pleuroneumonía OR MH:"Respiratory Tract Infections" OR "Infecciones del Sistema Respiratorio" OR "Infecções Respiratórias" OR "lower respiratory infection" OR "lower respiratory infections" OR "lower respiratory tract infection" OR "lower respiratory tract infections" OR lrti) AND (MH:zinc OR zinc OR zinco OR zn OR MH:"Zinc Compounds" OR MH:D01.975$ OR MH:"Dietary Supplements" OR "Suplementos Dietéticos" OR "Suplementos Dietéticos" OR MH:"Trace Elements" OR Oligoelementos OR MH:Micronutrients OR Micronutrientes)

Appendix 5. CINAHL (EBSCO) search strategy

S23 S13 and S22
S22 S14 or S15 or S16 or S17 or S18 or S19 or S20 or S21
S21 (MH "Quantitative Studies")
S20 TI placebo* OR AB placebo*
S19 (MH "Placebos")
S18 TI random* OR AB random*
S17 TI ((singl* or doubl* or tripl* or trebl*) N1 (blind* or mask*)) OR AB ((singl* or doubl* or tripl* or trebl*) N1 (blind* or mask*))
S16 TI clinic* trial* OR AB clinic* trial*
S15 PT clinical trial Search modes ‐
S14 (MH "Clinical Trials+")
S13 S4 and S12
S12 S5 or S6 or S7 or S8 or S9 or S10 or S11
S11 TI micronutrient* OR AB micronutrient*
S10 TI ((essential or trace) N1 (mineral* or nutrient*)) OR AB ((essential or trace) N1 (mineral* or nutrient*))
S9 (MH "Micronutrients")
S8 (MH "Trace Elements")
S7 (MH "Dietary Supplements")
S6 TI (zinc* or zn) OR AB (zinc* or zn)
S5 (MH "Zinc") OR (MH "Zinc Compounds+")
S4 S1 or S2 or S3
S3 TI (lower respiratory tract infect* or lower respiratory infect* or lrti) OR AB (lower respiratory tract infect* or lower respiratory infect* or lrti)
S2 TI (pneumon* or bronchopneumon* or pleuropneumon*) OR AB (pneumon* or bronchopneumon* or pleuropneumon*)
S1 (MH "Pneumonia+")

Appendix 6. Web of Science (Thomson Reuters)

Topic=(pneumonia or bronchopneumonia or pleuropneumonia) AND Topic=(zinc)
Refined by: Topic=(random* or placebo* or clinical trial* or double blind*)
Timespan=All Years. Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC.
Lemmatization=Off  

Study flow diagram
Figuras y tablas -
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
Figuras y tablas -
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
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.

Figuras y tablas -
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
Ir a la tabla de la revisión
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
Figuras y tablas -
Table 1. Zinc supplement schedule and duration
Ir a la tabla de la revisión
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]
Figuras y tablas -
Comparison 1. Zinc supplementation vs placebo
Ir a la tabla de la revisión