- Design
- Randomised, double-blind, placebo-controlled trial (ZIPS-2), single centre
- Population
- 100 children aged 1 to 4 years with sickle cell anaemia in Uganda
- Primary outcome
- All-cause infections per 100 person-years over 6 months
- Effect
- 305.7 vs 480.7 per 100 person-years; adjusted IRR 0.62 (95% CI 0.45 to 0.86)
ZIPS-2 randomised 100 Ugandan children with sickle cell anaemia to zinc sulfate 20 mg daily or placebo for six months. All received hydroxyurea. Follow-up was complete.
There were 80 infections in the zinc group and 124 in the placebo group, a 38% relative reduction after adjustment. No child stopped treatment because of an adverse event.
Zinc deficiency is common in sickle cell disease, and zinc has known effects on immune function. The trial is small and single-centre, so the size of the effect may shrink in larger studies. It is still a cheap, low-risk intervention with a plausible mechanism and a clear randomised signal.
- Zinc sulfate 20 mg daily for six months was used in children aged one to four.
- Infection rates fell from 481 to 306 per 100 person-years.
- All children were on or started hydroxyurea, so the benefit was on top of it.
- No adverse events led to stopping treatment.
- Sickle cell disease is common in central and tribal India; the trial population differs, but the question is shared.
Why it matters
Infection remains the main killer of young children with sickle cell anaemia despite prophylaxis, and zinc is cheap and widely available.
Don't overread it
This was one 100-child trial at a single Ugandan hospital; multicentre confirmation is still needed.
The statistics, in plain English
An incidence rate ratio of 0.62 means 38% fewer infections. The interval from 0.45 to 0.86 does not cross 1, so chance is an unlikely explanation, but with only 100 children the true effect could be anywhere from modest to large.
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