Infectious Diseases Among Children

Zinc has many roles in the immune system, contributing both to specific and nonspecific immune functions. Indeed, there is ample information indicating that zinc deficiency makes an important situation may also explain the observation in some studies of a transient effect of zinc on growth.

Low-birth-weight infants (<2.5 kg) may have additional needs for zinc, presumably to facilitate their rapid postnatal catch-up growth. Some benefits of supplemental zinc to growth have been observed among low-birth-weight infants in the first 6 months of life.

Severely malnourished infants and children have exhibited improved rates of weight gain, height gain, or synthesis of lean tissue when supplemental zinc has been included in their usual rehabilitation treatment regimen. In these recovering children, zinc has been shown to augment the deposition of lean tissue by increasing protein synthesis.

Cognitive function and behavior There are a few possible mechanisms by which zinc may be speculated to affect neurobehavioral function; these include neurotransmission in the synapses or development of the central nervous system via the synthesis of genetic material, proteins, and cell replication. Adequate zinc status appears to be important for certain aspects of neurobehavioral development among infants and children, although these associations are not conclusive. Higher levels of activity, specifically more frequent engagement in walking or

Table 5 Countries from developing regions with documented evidence of a reduced prevalence of infectious disease in response to supplemental zinc for prevention



Population studied

Health condition

Latin America and Caribbean

South and Southeast Asia

Sub-Saharan Africa Western Pacific







Burkina Faso Ethiopia

Papua New Guinea

Preschool children Infants

Preschool children

Infants and preschool children

Infants and preschool children

(recovered from acute diarrhea) Infants (term, small-for-gestational-age) Infants and preschool children

(growth stunted and underweight) Infants and preschool children Infants

Infants and preschool children

Diarrhea Diarrhea Diarrhea Diarrhea Pneumonia






Malaria contribution to some of the most common childhood infections that occur in developing countries, as summarized in Table 5.

Diarrhea Zinc has an important role in both the prevention and treatment of diarrhea, which may be mediated both through functions in immune competence and maintenance of the integrity of the intestine. Studies in various settings indicate that provision of supplemental zinc on a nearly daily basis reduces the incidence of childhood diarrhea by nearly 20%, and reduces the prevalence of diarrhea by about 25%. The magnitude of this decrease is similar to that expected from programs to improve water quality and sanitation. There is no strong evidence to suggest that greater benefits of zinc in diarrhea prevention would occur among children who are growth stunted. Rather, all children living under poor conditions with exposure to diar-rheal pathogens may potentially benefit from improved zinc intakes.

Zinc also has therapeutic benefits for recovery from diarrheal infections. Overall, supplemental zinc provided to children during recovery from either acute or persistent diarrhea leads to a reduction in the duration and severity of the episode. It has been recommended that zinc be used in the management of acute diarrhea, in conjunction with oral rehydration therapy. The current recommendation is to provide 10-20 mg of zinc once daily for 10-14 days.

Lower respiratory tract infections Zinc deficiency appears to be associated with an increased incidence of pneumonia. Evidence thus far indicates that supplemental zinc reduces the incidence of pneumonia in children by about 40%.

Malaria Only a few studies to date have considered the possible importance of zinc in protection against malaria. Nonetheless, while it is unlikely that improved zinc status could prevent infection with malarial parasites, it does appear that zinc may reduce the severity of the infection or the symptoms of morbidity associated with the infection. Evidence for this is suggested by a reduction in the number of visits to health facilities due to malaria, but not in the number of cases of malaria as determined during daily surveillance at the child's home, when children in malaria endemic areas were provided with supplemental zinc.

Mortality Given the contribution of zinc deficiency to three of the most common causes of death among children in developing countries (i.e., diarrhea, pneumonia, and malaria) it can be expected that zinc deficiency also contributes substantially to childhood mortality among these populations. Although still limited, available information does suggest that supplemental zinc leads to sizeable reductions in mortality among vulnerable groups of children. In Bangladesh, evaluation of a program that provided supplemental zinc for 14 days as treatment for diarrhea demonstrated a 68% reduction in mortality among infants and preschool children. Mortality was also reduced by two-thirds following supplemental zinc among low-birth-weight infants in India. A nearly 60% reduction in child mortality was observed among children in Burkina Faso, although this was not statistically significant. Further large-scale studies are required to better quantify the impact of zinc on child mortality.

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