DAILY zinc supplementation could provide a simple strategy for reducing infections in young children with sickle cell anaemia, according to findings from new study
Researchers found through a randomised clinical trial in Uganda that children receiving 20 mg of zinc daily for 6 months experienced significantly fewer infections than those receiving placebo, highlighting a potentially inexpensive intervention for a population particularly vulnerable to infectious complications.
Children with sickle cell anaemia are at increased risk of serious bacterial and other infections, which remain an important cause of illness and death, particularly among children living in sub-Saharan Africa.
The ZIPS-2 randomised, double-blind, placebo-controlled clinical trial investigated whether daily zinc supplementation could help reduce this burden.
Researchers enrolled 100 children aged 1-4 years with sickle cell anaemia at Jinja Regional Referral Hospital, Uganda. Participants were randomly assigned to receive either 20 mg of zinc sulfate daily or placebo for 6 months.
Half of the children received zinc and half received placebo. At enrolment, 45% were receiving hydroxyurea, and all participants initiated or continued hydroxyurea following enrolment.
The primary outcome was the incidence of all-cause infections during the six month follow-up period.
Researchers recorded 80 infections among children receiving zinc compared with 124 infections in the placebo group.
This corresponded to infection rates of 305.7 per 100 person-years with zinc and 480.7 per 100 person-years with placebo.
After adjusting for baseline age, sex, and hydroxyurea use, children receiving zinc had an incidence rate ratio of 0.62 compared with placebo, indicating an approximately 38% lower rate of infection.
Importantly, follow-up was complete for all 100 children, with no participants lost during the six month study period.
Zinc plays an important role in immune function, and zinc deficiency has previously been reported in people with sickle cell disease. The new findings suggest supplementation could provide an additional approach to infection prevention alongside established sickle cell treatments.
Safety findings were also encouraging. No adverse events requiring discontinuation of zinc or placebo were reported during the trial.
However, the researchers cautioned that further investigation is required before the findings can be applied more broadly. The study was conducted at a single centre in Uganda, included only 100 participants, and was restricted to children younger than 5 years.
Larger, multisite clinical trials will therefore be needed to confirm the benefits and determine whether zinc supplementation is similarly effective in older children and other populations.
Nevertheless, the findings suggest that daily zinc supplementation could represent a relatively straightforward strategy for reducing the substantial infection burden experienced by young children with sickle cell anaemia.
Reference
Namazzi R et al. Daily Zinc Supplementation for Infection Prevention in Children With Sickle Cell Anemia: The ZIPS-2 Randomized Clinical Trial. JAMA.2026. doi:10.1001/jama.2026.14190.
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