***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To evaluate the effect of simultaneous zinc and vitamin A supplementation on  diarrhoea and acute lower respiratory infections in children . Study design : R and omised double blind placebo controlled trial . Setting : Urban slums of Dhaka , Bangladesh . Participants and methods : 800 children aged 12 - 35 months were r and omly assigned to one of four intervention groups : 20 mg zinc once daily for 14 days ; 200 000 IU vitamin A , single dose on day 14 ; both zinc and vitamin A ; placebo . The children were followed up once a week for six months , and morbidity information was collected . Results : The incidence and prevalence of diarrhoea were lower in the zinc and vitamin A groups than in the placebo group . Zinc and vitamin A interaction had a rate ratio ( 95 % confidence interval ) of 0.79 ( 0.66 to 0.94 ) for the prevalence of persistent diarrhoea and 0.80 ( 0.67 to 0.95 ) for dysentery . Incidence ( 1.62 ; 1.16 to 2.25 ) and prevalence ( 2.07 ; 1.76 to 2.44 ) of acute lower respiratory infection were significantly higher in the zinc group than in the placebo group . The interaction term had rate ratios of 0.75 ( 0.46 to 1.20 ) for incidence and 0.58 ( 0.46 to 0.73 ) for prevalence of acute lower respiratory infection . Conclusions : Combined zinc and vitamin A synergistically reduced the prevalence of persistent diarrhoea and dysentery . Zinc was associated with a significant increase in acute lower respiratory infection , but this adverse effect was reduced by the interaction between zinc and vitamin A. What is already known on this topic Trials of vitamin A supplementation have failed to show a beneficial effect on morbidity in children Experimental studies have shown that , in the presence of zinc deficiency , vitamin A supplementation fails to reverse vitamin A deficiency Coexistence of deficiencies of zinc and vitamin A could be a reason for the failure of vitamin A supplementation , but data in humans are limited What this paper adds Combined zinc and vitamin A supplementation is more effective in reducing persistent diarrhoea and dysentery than either vitamin A or zinc alone Zinc alone increased respiratory illnesses , but interaction between zinc and vitamin A reduced this adverse OBJECTIVE . The purpose of this work was to evaluate whether education about zinc supplements and provision of zinc supplements to caregivers is effective in the treatment of  acute diarrhea  and whether this strategy adversely affects the use of oral rehydration salts . PATIENTS AND METHODS . Six clusters of 30 000 people each in Haryana , India , were r and omly assigned to intervention and control sites . Government and private providers and village health workers were trained to prescribe zinc and oral rehydration salts for use in diarrheal episodes in 1-month-old to 5-year-old children in intervention communities ; in the control sites , oral rehydration salts alone was promoted . In 2 cross-sectional surveys commencing 3 months ( survey 2 ) and 6 months ( survey 3 ) after the start of the intervention , care-seeking behavior , drug therapy , and oral rehydration salts use during diarrhea , diarrheal and respiratory morbidity , and hospitalization rates were measured . RESULTS . In the 2 surveys , zinc was used in 36.5 % ( n = 1571 ) and 59.8 % ( n = 1649 ) and oral rehydration salts in 34.8 % ( n = 1571 ) and 59.2 % ( n = 1649 ) of diarrheal episodes occurring in the 4 weeks preceding interviews in the intervention areas . In control areas , oral rehydration salts were used in 7.8 % ( n = 2209 ) and 9.8 % ( n = 2609 ) of episodes . In the intervention communities , care seeking for diarrhea reduced by 34 % ( survey 3 ) , as did the prescription of drugs of unknown identity ( survey 3 ) and antibiotics ( survey 3 ) for diarrhea . The 24-hour prevalences of diarrhea and acute lower respiratory infections were lower in the intervention communities ( survey 3 ) . All-cause , diarrhea , and pneumonia hospitalizations in the preceding 3 months were reduced in the intervention compared with control areas ( survey 3 ) . CONCLUSIONS . Diarrhea is more effectively treated when caregivers receive education on zinc supplementation and have ready access to supplies of oral rehydration salts and zinc , and this approach does not adversely affect the use of oral rehydration salts ; in fact , it greatly increases use of the same Objective Oral rehydration solution remains the mainstay of acute gastroenteritis therapy . The aim of this study was to investigate the acceptability of a new zinc-containing hypotonic super-oral rehydration solution ( ORS ) in a gel formulation and its efficacy in reducing the duration and severity of diarrhea in children . Methods This was a r and omized-controlled trial of children ( 5–36 months of age ) observed for diarrhea lasting less than 24 h. Children were r and omized to receive st and ard hypotonic ORS ( group 1 ) or a gel hypotonic super-ORS containing zinc ( group 2 ) . The main study outcome was  ORS  intake in the first 24 h.  ORS intake at 4 h , rate of diarrhea resolution at 72 h of treatment , total duration and severity of diarrhea , hospitalization , and adverse effects were also evaluated . Results Eighty-three children were enrolled ( group 1 : 40 ; group 2 : 43 ) . The amount of ORS consumed at 24 h was significantly higher in group 2 than in group 1 . A similar result was observed at 4 h. The number of children who refused ORS  ( < 10 ml/kg/day ) was lower in group 2 versus group 1 ( P=0.001 ) . The number of children presenting diarrhea after 72 h of treatment was lower in group 2 versus group 1 ( P=0.028 ) . Also , the mean duration of diarrhea was shorter in group 2 than in group 1 ( P=0.001 ) . The hypotonic super-ORS containing zinc in a gel formulation had a positive effect on the severity of diarrhea . No patient required hospitalization . No adverse events were observed in either of the two study groups . Conclusion The new zinc-containing hypotonic super-ORS in a gel formulation is effective in the management of childhood acute gastroenteritis Zinc supplementation is recommended in all acute diarrheas in children from developing countries . We aim ed to assess whether zinc supplementation would be equally effective against all the common organisms associated with acute diarrheas . We used data on 801 children with acute diarrhea recruited in a r and omized , double blind controlled trial ( IS RCT N85071383 ) of zinc and copper supplementation .  Using prespecified subgroup analyses , multidimensionality reduction analyses , tests of heterogeneity , and stepwise logistic regression for tests of interactions , we found that the influence of zinc on the risk of diarrhea for more than 3 days depended on the isolated organism — beneficial in Klebsiella , neutral in Esherichia coli and parasitic infections , and detrimental in rotavirus coinfections . Although we found similar results for the outcome of high stool volume , the results did not reach statistical significance . Our findings suggest that the current strategy of zinc supplementation in all cases of acute diarrheas in children may need appropriate fine tuning to optimize the therapeutic benefit based on the causative organism , but further studies need to confirm and extend our findings Small-quantity lipid-based nutrient supplements ( SQ-LNS ) are promising home fortification products , but the optimal zinc level needed to improve growth and reduce morbidity is uncertain . We aim ed to assess the impact of providing SQ-LNS with varied amounts of zinc , along with illness treatment , on zinc-related outcomes compared with st and ard care . In a placebo-controlled , cluster-r and omized trial , 34 communities were stratified to intervention ( IC ) or non-intervention cohorts ( NIC ) . 2435 eligible IC children were r and omly assigned to one of four groups:1 ) SQ-LNS without zinc , placebo tablet ; 2 ) SQ-LNS containing 5 mg zinc , placebo tablet ; 3 ) SQ-LNS containing 10 mg zinc , placebo tablet ; or 4 ) SQ-LNS without zinc and 5 mg zinc tablet  from 9–18 months of age . During weekly morbidity surveillance , oral rehydration salts were provided for reported diarrhea and antimalarial therapy for confirmed malaria . Children in NIC ( n = 785 ) did not receive SQ-LNS , tablets , illness surveillance or treatment . At 9 and 18 months , length , weight and hemoglobin were measured in all children . Reported adherence was 97±6 % for SQ-LNS and tablets . Mean baseline hemoglobin was 89±15g/L. At 18 months , change in hemoglobin was greater in IC than NIC ( + 8 vs -1g/L , p<0.0001 ) , but 79.1 % of IC were still anemic ( vs. 91.1 % in NIC ) . Final plasma zinc concentration did not differ by group . During the 9-month observation period , the incidence of diarrhea was 1.10±1.03 and of malaria 0.54±0.50 episodes per 100 child-days , and did not differ by group . Length at 18 months was significantly greater in IC compared to NIC ( 77.7±3.0 vs. 76.9±3.4 cm ; p<0.001 ) and stunting prevalence was significantly lower in IC ( 29.3 % ) than NIC ( 39.3 % ; p<0.0001 ) , but did not differ by intervention group within IC . Wasting prevalence was also significantly lower in IC ( 8.7 % ) than in NIC ( 13.5 % ; p = 0.0003 ) . Providing SQ-LNS daily with or without zinc , along with malaria and diarrhea treatment , significantly increased growth and reduced stunting , wasting and anemia prevalence in young children . Trial Registration Clinical Trials.gov In a double‐blind r and omized controlled clinical trial , moderately malnourished Bangladeshi children ( 61–75 % of the median weight/age ) were studied for the effect of zinc and /or vitamin A supplementation on the clinical outcome of persistent diarrhea . Children 6 mo to 2 y of age with diarrhea for more than 14 d were r and omly allocated into 4 groups of 24 receiving a multivitamin syrup and ( i ) zinc ( 20 mg elemental ) , ( ii ) vitamin A , ( iii ) both zinc and vitamin A , or ( iv ) neither , in 2 doses daily for 7 d. Clinical data on recovery and on stool output , consistency and frequency were recorded for 7 d , and weight change from day 1 to day 7 was assessed . The baseline characteristics of the four study groups were comparable . The mean daily stool outputs from days 2 to 7 of therapy were significantly less in the zinc and zinc plus vitamin A groups , but not in the vitamin A group , in comparison with the control group . In children receiving zinc , the cumulative stool weight in the 7 d was 39 % less than in the control group ( p < 0.001 ) and 32 % less than in the vitamin A group ( p= 0.006 ) . The cumulative stool weight in the zinc plus vitamin A group was 24 % less than in the control group ( p < 0.001 ) , but the 14 % lower output than in the vitamin A group was not statistically different The change in body weight over the 7d study period was significantly different between the group receiving zinc and the control group ( + 111 g vs –90 g , p = 0.045 ) . The rate of clinical recovery of children within 7 d was significantly greater in the zinc group ( 88 % ) compared with the control group ( 46 % , p= 0.002 ) or vitamin A group ( 50 % , p= 0 005 ) , but not statistically different from the zinc plus vitamin A group ( 67 % , p= 0.086 ) OBJECTIVE To evaluate the role of zinc and vitamin A supplementation in the recovery of Indigenous children hospitalised for acute diarrhoea . DESIGN A r and omised controlled 2 by 2 factorial trial of supplementation with zinc and vitamin A. SETTING AND PARTICIPANTS Aboriginal children ( aged < 11 years ) hospitalised for acute diarrhoea at Alice Springs Hospital , Northern Territory , April 2001-July 2002 . MAIN OUTCOME MEASURES Duration of diarrhoeal illness ; re-admission for diarrhoeal illness within 120 days . RESULTS Our study involved 392 Aboriginal children with 436 episodes of diarrhoea . Supplementation with zinc , vitamin A , or combined zinc and vitamin A had no significant effect on duration 
    Output:
    
Authors ' conclusions In areas where the prevalence of zinc deficiency or the prevalence of malnutrition is high , zinc may be of benefit in children aged six months or more .
The current evidence does not support the use of zinc supplementation in children less six months of age , in well‐nourished children , and in setting s where children are at low risk of zinc deficiency .