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Effect on longitudinal growth and anemia of zinc or multiple micronutrients added to vitamin A: a randomized controlled trial in children aged 6-24 months

Meera K Chhagan12*, Jan Van den Broeck3, Kany-Kany A Luabeya45, Nontobeko Mpontshane6, Andrew Tomkins7 and Michael L Bennish89

Author Affiliations

1 Department of Paediatrics and Child Health, University of KwaZulu-Natal, Umbilo Road, Durban, South Africa

2 Friedman School of Nutrition Science and Policy, Tufts University, Harrison Avenue, Boston, USA

3 Department of Epidemiology and Public Health, University College Cork, College Road, Cork, Ireland

4 South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Cape Town, South Africa

5 School of Child & Adolescent Health, University of Cape Town, Cape Town, South Africa

6 Department of Clinical Development, Pharmaceutical Product Development, Granta Park, Cambridge, UK

7 Centre for International Health and Development, Institute of Child Health, University College, London, WC1N 1EH, UK

8 Mpilonhle, Mtubatuba, 3935, South Africa

9 Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, John Hopkins University, Wolfe Street, Baltimore, USA

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BMC Public Health 2010, 10:145  doi:10.1186/1471-2458-10-145

Published: 18 March 2010



The benefits of zinc or multiple micronutrient supplementations in African children are uncertain. African children may differ from other populations of children in developing countries because of differences in the prevalence of zinc deficiency, low birth weight and preterm delivery, recurrent or chronic infections such as HIV, or the quality of complementary diets and genetic polymorphisms affecting iron metabolism.

The aim of this study was to ascertain whether adding zinc or multiple micronutrients to vitamin A supplementation improves longitudinal growth or reduces prevalence of anemia in children aged 6-24 months.


Randomized, controlled double-blinded trial of prophylactic micronutrient supplementation to children aged 6-24 months. Children in three cohorts - 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers, and 187 uninfected children born to HIV-uninfected mothers - were separately randomly assigned to receive daily vitamin A (VA) [n = 124], vitamin A plus zinc (VAZ) [n = 123], or multiple micronutrients that included vitamin A and zinc (MM) [n = 126].


Among all children there were no significant differences between intervention arms in length-for-age Z scores (LAZ) changes over 18 months. Among stunted children (LAZ below -2) [n = 62], those receiving MM had a 0.7 Z-score improvement in LAZ versus declines of 0.3 in VAZ and 0.2 in VA (P = 0.029 when comparing effects of treatment over time). In the 154 HIV-uninfected children, MM ameliorated the effect of repeated diarrhea on growth. Among those experiencing more than six episodes, those receiving MM had no decline in LAZ compared to 0.5 and 0.6 Z-score declines in children receiving VAZ and VA respectively (P = 0.06 for treatment by time interaction). After 12 months, there was 24% reduction in proportion of children with anemia (hemoglobin below 11 g/dL) in MM arm (P = 0.001), 11% in VAZ (P = 0.131) and 18% in VA (P = 0.019). Although the within arm changes were significant; the between-group differences were not significant.


Daily multiple micronutrient supplementation combined with vitamin A was beneficial in improving growth among children with stunting, compared to vitamin A alone or to vitamin A plus zinc. Effects on anemia require further study.

Trial registration

This study is registered with, number .NCT00156832.