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

Zohra S Lassi; Anoosh Moin; Zulfiqar A Bhutta

doi:10.1002/14651858.CD005978.pub3

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Figure 1

Study flow diagram

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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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Figure 3

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

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Analysis 1.1

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

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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)	⊕⊕⊝⊝ low^1,2
Pneumonia prevalence	22 per 1000	13 per 1000 (8 to 22)	RR 0.59 (0.35 to 0.99)	609 (1 study)	⊕⊕⊝⊝ low^3,4
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.

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
Study	Zinc	Control	Schedule	Duration	Surveillance
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

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]

Comparison 1. Zinc supplementation vs placebo

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