Micronutrients as adjunct therapy of acute illness in children: impact on the episode outcome and policy implications of current findings

Role of micronutrients namely vitamin A, zinc and folate, as adjunct therap y of illness episodes in children in developing countries have been discuss ed in the light of health policy. Apart from a selective review, attempts h ave been made to statistically combine results of several studies to addres s policy issues. In children, vitamin A supplementation during illness has (a) a profound effect in reducing mortality in measles, (b) possibly a sign ificant effect in reducing persistent diarrhea episodes in children with ac ute diarrhea, and (c) no benefit in pneumonia. Use of large dose vitamin A is recommended during measles episodes but not in non-measles pneumonia. Its use in acute diarrhea is debatable but recomm ended in persistent diarrhea and in severe malnutrition as a component of a micronutrient mixture. Large dose vitamin A supplementation should be used with caution in young infants as there are unresolved concerns about its s afety particularly, bulging fontanelle observed in infants when co-administ ered at immunization. In children, zinc supplementation during illness, (a) had a marked effect in reducing prolonged episodes and a modest effect on episode duration in acute diarrhea, (b) resulted in reduced rate of treatme nt failure and death in persistent diarrhea, (c) had no effect in measles a nd non-measles pneumonia, and (d) probably had a detrimental effect of incr easing death rate when a large dose was used in severely malnourished child ren. The desirability of routine zinc supplementation therapy of undernouri shed children with acute diarrhea should be assessed further. Concerning po licy, zinc supplementation as a component of a micronutrient mixture is rec ommended in the rehabilitation of severely malnourished children and in per sistent diarrhea. However, recommendation for its routine use in all cases of acute diarrhea in children needs additional studies on effectiveness, co st, operations and safety. In two randomized controlled trials folate has b een evaluated in acute and persistent diarrhea and found to have no benefic ial effect. Folate is not recommended as adjunct therapy of diarrhea. Role of folate in preventing severe disease and/or death deserves further evalua tion.