Effect of zinc on sputum conversion time of drug sensitive tuberculosis patients in Naypyitaw Union Territory: a quasi-experimental study

Si Thu; Le T. Soe; Aye S. Mon; Swe M. M. Lwin; Aung T. Kyaw; Myo S. Kyi

doi:10.18203/2394-6040.ijcmph20253313

Authors

Si Thu Department of Medical Services, Ministry of Health, Myanmar
Le T. Soe University of Public Health, Yangon, Myanmar https://orcid.org/0000-0002-6359-1392
Aye S. Mon University of Public Health, Yangon, Myanmar
Swe M. M. Lwin University of Public Health, Yangon, Myanmar
Aung T. Kyaw University of Public Health, Yangon, Myanmar
Myo S. Kyi Department of Public Health, Ministry of Health, Myanmar

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20253313

Keywords:

TB, Zinc supplementation, Sputum conversion, Naypyitaw

Abstract

Background: Tuberculosis (TB) remains a major global health problem, particularly in high-burden countries such as Myanmar. Malnutrition and zinc deficiency are common among TB patients and may impair immune response. Zinc supplementation has been proposed as an adjunct to standard anti-TB treatment to accelerate sputum conversion, but evidence remains inconsistent.

Methods: A quasi-experimental study was conducted from January 2024 to December 2025 in Naypyitaw territory, Myanmar, enrolling 310 newly diagnosed drug-sensitive tuberculosis patients. Participants in one district received standard anti-TB therapy plus zinc supplementation (20 mg daily), while those in another district received standard therapy alone. Data on socio-demographic, clinical, behavioral, and health belief variables were collected. Survival analysis and Cox proportional hazards regression with propensity score adjustment was used to compare sputum conversion times between groups.

Results: Zinc supplementation significantly improved sputum conversion time, with 72.9% reaching conversion earlier than 41.9% in the control group (adjusted hazard ratio [aHR]=1.93; 95% CI: 1.31–2.85; p=0.001). Additional factor positively influencing early sputum conversion was initial sputum grading. The findings indicated that zinc supplementation accelerates sputum smear conversion, likely by enhancing host immune defense.

Conclusions: The findings underscored the critical roles of nutritional support in influencing treatment outcomes. Integrating zinc into TB treatment protocols, particularly among malnourished populations, represented a cost-effective and feasible strategy to enhance early microbiological response, improve clinical recovery, and potentially reduce TB transmission risk.

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References

Bagcchi S. WHO's Global Tuberculosis Report 2022. Lancet Microbe. 2023;4:e20. DOI: https://doi.org/10.1016/S2666-5247(22)00359-7

Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis. A general review. Bibliotheca Tuberculosea. 1970;26:28-106.

Krapp F, Véliz JC, Cornejo E, Gotuzzo E, Seas C. Bodyweight gain to predict treatment outcome in patients with pulmonary tuberculosis in Peru. Int J Tuberculosis Lung Dis. 2008;12:1153-9.

Xiong K, Wang J, Zhang J, Hao H, Wang Q, Cai J, et al. Association of Dietary Micronutrient Intake with Pulmonary Tuberculosis Treatment Failure Rate: A Cohort Study. Nutrients. 2020;12. DOI: https://doi.org/10.3390/nu12092491

Karyadi E, Schultink W, Nelwan RH, Gross R, Amin Z, Dolmans WM, et al. Poor micronutrient status of active pulmonary tuberculosis patients in Indonesia. J Nutr. 2000;130:2953-8. DOI: https://doi.org/10.1093/jn/130.12.2953

Chasapis CT, Ntoupa PA, Spiliopoulou CA, Stefanidou ME. Recent aspects of the effects of zinc on human health. Archives Toxicol. 2020;94:1443-60. DOI: https://doi.org/10.1007/s00204-020-02702-9

Asemahagn MA. Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study. BMC Pulmonary Med. 2021;21:118. DOI: https://doi.org/10.1186/s12890-021-01483-w

Alzarea AI, Saifullah A, Khan YH, Alanazi AS, Alatawi AD, Algarni MA, et al. Evaluation of time to sputum smear conversion and its association with treatment outcomes among drug-resistant tuberculosis patients: a retrospective record-reviewing study. Front Pharmacol. 2024;15:1370344. DOI: https://doi.org/10.3389/fphar.2024.1370344

Karyadi E, West CE, Schultink W, Nelwan RH, Gross R, Amin Z, et al. A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status. Am J Clin Nutr. 2002;75:720-7. DOI: https://doi.org/10.1093/ajcn/75.4.720

Fasil W, Kefyalew Addis A, Setegn E, Tom W, Matthew K, Darren G. Effects of zinc and vitamin A supplementation on prognostic markers and treatment outcomes of adults with pulmonary tuberculosis: a systematic review and meta-analysis. BMJ Global Health. 2022; 7:e008625.

Zolfaghari B, Ghanbari M, Musavi H, Bavandpour Baghshahi P, Taghikhani M, Pourfallah F. Investigation of Zinc Supplement Impact on the Serum Biochemical Parameters in Pulmonary Tuberculosis: A Double Blinded Placebo Control Trial. Rep Biochem Mol Biol. 2021;10:173-82. DOI: https://doi.org/10.52547/rbmb.10.2.173

Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberculosis Lung Dis. 2004;8:286-98.

Ramakrishnan K, Shenbagarathai R, Kavitha K, Uma A, Balasubramaniam R, Thirumalaikolundu-subramanian P. Serum zinc and albumin levels in pulmonary tuberculosis patients with and without HIV. Japanese J Infect Dis. 2008;61:202-4. DOI: https://doi.org/10.7883/yoken.JJID.2008.202

Munro S, Lewin S, Swart T, Volmink J. A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health. 2007;7:104. DOI: https://doi.org/10.1186/1471-2458-7-104

Wagnew F, Alene KA, Eshetie S, Wingfield T, Kelly M. Effects of zinc and vitamin A supplementation on prognostic markers and treatment outcomes of adults with pulmonary tuberculosis: a systematic review and meta-analysis. 2022;7. DOI: https://doi.org/10.1136/bmjgh-2022-008625

Visser ME, Grewal HM, Swart EC, Dhansay MA, Walzl G, Swanevelder S, et al. The effect of vitamin A and zinc supplementation on treatment outcomes in pulmonary tuberculosis: a randomized controlled trial. Am J Clin Nutr. 2011;93:93-100. DOI: https://doi.org/10.3945/ajcn.110.001784

Domínguez-Castellano A, Muniain MA, Rodriguez-Baño J, Garcia M, Rios MJ, Galvez J, et al. Factors associated with time to sputum smear conversion in active pulmonary tuberculosis. Int J Tuberculosis Lung Dis. 2003;7:432-8.

Prasad AS. Zinc in human health: effect of zinc on immune cells. Mole Med (Cambridge, Mass). 2008;14:353-7. DOI: https://doi.org/10.2119/2008-00033.Prasad

Hunter J, Arentz S, Goldenberg J, Yang G, Beardsley J, Myers SP, et al. Zinc for the prevention or treatment of acute viral respiratory tract infections in adults: a rapid systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2021;11:e047474. DOI: https://doi.org/10.1136/bmjopen-2020-047474