A new trial in Uganda finds that 20 mg daily zinc supplementation can significantly decrease infection rates among young children with sickle cell anaemia, offering a promising, low-cost intervention to improve outcomes.
A new randomised trial in Uganda suggests that daily zinc supplements may help protect young children with sickle cell anaemia from infections, a complication that is especially dangerous in the early years of life. The study, published online in JAMA and led by researchers at Makerere University College of Health Sciences and Indiana University School of Medicine, enrolled 100 children aged 12 to 59 months with confirmed HbSS sickle cell anaemia at Jinja Regional Referral Hospital. Half received 20 mg of oral zinc sulphate each day for six months, while the rest took a placebo, alongside standard care that included pneumococcal vaccination, penicillin prophylaxis, folic acid, malaria prevention and hydroxyurea.
According to the trial results, children given zinc had 80 infections over six months, compared with 124 in the placebo group. That translated into 305.7 infections per 100 person-years versus 480.7 per 100 person-years, a 38% reduction overall. The clearest benefits were seen in upper respiratory infections and in suspected severe bacterial infections, which fell by about two-thirds. Rates of pneumonia and diarrhoea were also lower in the zinc group, although those differences were not statistically significant. The supplement did not reduce vaso-occlusive crises, the painful episodes that are another hallmark of sickle cell disease.
The findings add weight to a long-running question about whether zinc deficiency helps drive infection risk in children with sickle cell anaemia. Earlier Ugandan research using a lower dose of 10 mg a day found no benefit, and the new study was designed to test whether a larger dose would make a difference. Serum zinc levels rose in the treatment group, and the share of children classed as zinc deficient fell from 46% to 26% over the study period.
The authors said the supplement appeared safe and well tolerated, with no side effects severe enough to stop treatment. They also noted that the trial was small, conducted at a single centre and limited to children under five, so it was not large enough to rule out less common harms such as changes in copper levels. Even so, the researchers argued that 20 mg of daily zinc could offer a low-cost way to reduce infection burden in a very vulnerable group, and they pointed out that zinc deficiency rates in North American children with sickle cell disease have been reported at 44% to 57%, suggesting the question may be relevant well beyond Uganda.
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