Pakistan (Waseem Sharrief-Completed)
It has been estimated that diarrheal illnesses account for 12,600 deaths each day in children in Asia, Africa, and
Latin America while pre-school children spend 35 to 70 days per year with diarrhea. Although, oral rehydration therapy has
reduced diarrhea-related mortality by 50%, its affect has plateaud. To further decrease this burden malnutrition and immunity
needs to be targeted. Sprinkles Supplefer Plus is unique in that micronutrients such as iron, zinc, Vitamin A and C, together
with a probiotic can be formulated into the sachet to prevent common micronutrient deficiencies as well as diarrhea.
We investigated the effect of zinc and a heat-killed strain of probiotic L. acidophilus provided as micronutrient Sprinkles on
diarrhea morbidity in infants. This community-based, double-blind, placebo-controlled trial took place in an urban slum of Karachi,
Pakistan. 75 infants at high-risk for diarrhea-related-mortality identified as: (a) age between 6 to12 months; and (b) history of
1 episode of diarrhea in the past 2 weeks, were randomly allocated to receive: (a) Sprinkles; or (b) Sprinkles + L.acidophilus
(Sprinklesplus); or (c) Placebo, daily for 2 months. Primary outcome was longitudinal prevalence of diarrhea (number of diarrhea-
days per observed child-days); a surrogate measure for mortality. Other outcome measures were child-days of fever, hemoglobin,
serum ferritin and plasma zinc concentrations. Longitudinal prevalence of diarrhea was significantly less (p<0.05) in the Sprinkles
group (18 ± 20% child-days) than Sprinklesplus (34 ± 30% child-days) and placebo groups (26 ± 20% child-days). A similar trend was
observed for child-days of fever. Micronutrients formulated as Sprinkles apparently potentiated immunity to impact morbidity from
diarrhea and other infections. However, L.acidophilus seemed to have a negative effect.
This study was supported by the HJ Heinz Foundation, Inst Rosell Lellamand and Canadian Institutes of Health Research.