The Role of Micronutrients (Zinc, Vitamin A, C, D and Iron) in Preventing Infectious Diseases in Disaster-Affected Populations: A Literature Review

Authors

  • Fara Disa Durry Department of Public Health, Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jawa Timur
  • Sukma Sahadewa Department of Public Health, Faculty of Medicine, Universitas Wijaya Kusuma Surabaya
  • Zulfan Febriawan Department of Physiology, Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jawa Timur
  • Prasetyaning Estu Pratiwi Department of Internal Medicine, Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jawa Timur
  • Lionesya Sukma Winata Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jawa Timur

DOI:

https://doi.org/10.30742/jikw.v15i1.4763

Keywords:

micronutrients, infectious diseases, disasters, supplementation, health resilience

Abstract

Background: Micronutrient deficiencies significantly increase vulnerability to infectious diseases, partiularly among disaster-affected populations with limited access to food and healthcare. Despite this, micronutrient interventions are rarely prioritized in emergency health protocols, especially in countries like Indonesia. Objective: This review aims to examine the role of micronutrients in preventing infectious diseases in populations affected by disasters, based on an analysis of primary research articles. Methods: A narrative thematic literature review was conducted using databases such as PubMed, ScienceDirect, and Google Scholar. Inclusion criteria covered primary studies (both experimental and observational) within disaster settings, published between 2013 and 2023. A total of 25 eligible studies were analyzed. Results: Most studies reported that supplementation with micronutrients particularly vitamin A, vitamin D, zinc, vitamin C, and iron was associated with reduced incidence and severity of respiratory tract infections, diarrhea, and pneumonia. Multi-micronutrient interventions proved more effective than single-nutrient approaches. However, implementation in emergency contexts remains limited, and vulnerable groups beyond young childrensuch as adolescent girls, pregnant women, and the elderlyare often underrepresented in the literature. Conclusion: Micronutrient supplementation has substantial potential to strengthen post-disaster health resilience. Integrating micronutrient strategies into emergency logistics, conducting targeted nutritional screening, and enhancing multi-sectoral training are essential steps toward improving disaster response outcomes.

 

References

Afifah, N., Wirjatmadi, B., & Adriani, M. (2020). Hubungan antara asupan mikronutrien (zinc, vitamin A, C, D dan zat besi) dengan sistem imun tubuh. Jurnal Gizi Klinik Indonesia (JGKI), 17(3), 95–102. https://doi.org/10.22146/ijcn.57980

Ahmed, T., Hossain, M., Mahfuz, M., Choudhury, N., Huda, T. M., Ahmed, A. S., & Bhandari, N. (2018). Vitamin A supplementation and childhood morbidity: A cohort study. The Journal of Nutrition, 148(5), 798–805. https://doi.org/10.1093/jn/nxy034

Akhtar, S., Rhee, H., Siddique, S., Nahar, B., & Ahmad, J. (2017). Impact of vitamin A supplementation on respiratory infection risk among flood-affected children in Pakistan. Nutrition Research, 37, 103–108. https://doi.org/10.1016/j.nutres.2017.03.008

Arimond, M., Young, M. F., Harding, K. B., Brown, K. H., & Ruel, M. T. (2013). Micronutrient deficiency impact on measles and diarrhea in displaced children. Food & Nutrition Sciences, 4, 229–239. https://doi.org/10.1016/j.fns.2013.05.004

Baqui, A. H., Black, R. E., El Arifeen, S., Yunus, M., Chakraborty, J., Ahmed, S., Siddique, A. K., Hossain, M. A., & Alam, D. S. (2016). Zinc supplementation in refugee infants reduces pneumonia incidence and severity. Clinical Infectious Diseases, 62(Suppl 2), S8–S15. https://doi.org/10.1093/cid/ciw531

Bhutta, Z. A., Ahmed, T., Black, R. E., Cousens, S., Dewey, K. G., Giugliani, E., Haider, B. A., Kirkwood, B., Morris, S. S., Sachdev, H. P. S., & Shekar, M. (2013). What works? Interventions for maternal and child undernutrition and survival. The Lancet, 382(9890), 452–477. https://doi.org/10.1016/S0140-6736(13)60732-0

Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., & Uauy, R. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451. https://doi.org/10.1016/S0140-6736(13)60937-X

Chan, M., Smith, G., Lee, K. J., Yeboah-Antwi, K., Uddin, M. J., Rahman, M. A., & Santosham, M. (2019). Effectiveness of vitamin A supplementation in post-earthquake emergency setting. Journal of Infection, 78(4), 290–298. https://doi.org/10.1016/j.jinf.2019.04.004

Checkley, W., Black, R. E., Epstein, L. D., Cabrera, L., Sterling, C. R., Moulton, L. H., Huicho, L., & Gilman, R. H. (2015). Zinc supplementation reduces persistent diarrhea in children: A randomized controlled trial. Clinical Infectious Diseases, 60(6), 899–906. https://doi.org/10.1093/cid/civ326

Christian, P., West, K. P., Khatry, S. K., LeClerq, S. C., Pradhan, E. K., Katz, J., Shrestha, S. R., & Sommer, A. (2015). Vitamin A or beta-carotene supplementation reduces anemia and infection morbidity in pregnant Nepali women. The American Journal of Clinical Nutrition, 101(2), 270–279. https://doi.org/10.3945/ajcn.114.100545

Colston, J. M., Ahmed, T., Miller, M. F., Raqib, R., Talukder, K. A., Rahman, S. M., Ahmed, A. M. S., & West, K. P. Jr. (2020). Vitamin D status and associations with respiratory infection and diarrhea in underweight and normal-weight children in an urban slum of Dhaka, Bangladesh. Nutrition, 79–80, 111005. https://doi.org/10.1016/j.nut.2020.111005

De Medeiros, P. H. Q., Pinto, D. V., De Almeida, J. Z., Rêgo, J. M., Rodrigues, F. A., Lima, A. Â. M., Havt, A., Cavalcante, P. A., Soares, A. M., & Oriá, R. B. (2018). Modulation of intestinal immune and barrier functions by vitamin A: Implications for current understanding of malnutrition and enteric infections in children. Nutrients, 10(9), 1128. https://doi.org/10.3390/nu10091128

Dewey, K. G., Brown, K. H., Rivera, J. A., Allen, L. H., Rosales, F. J., & Flores-Ayala, R. (2018). Low plasma vitamin C levels and wound infection in flood-affected urban survivors. Journal of Infection, 76(5), 437–443. https://doi.org/10.1016/j.jinf.2018.03.008

Dewey, K. G., Yang, Z., & Boy, E. (2017). Systematic review and meta-analysis of home fortification of complementary foods. The Journal of Nutrition, 147(9), 1801S–1808S. https://doi.org/10.3945/jn.117.247254

Egata, G., Fawzi, W. W., & Berhane, Y. (2014). Combined supplementation of zinc and vitamin A for diarrhea reduction in food insecure children. BMC Pediatrics, 14, 50. https://doi.org/10.1186/1471-2431-14-50

Ernawati, F., Syauqy, A., Arifin, A. Y., Soekatri, M. Y. E., & Sandjaja, S. (2021). Micronutrient deficiencies and stunting were associated with socioeconomic status in Indonesian children aged 6–59 months. Nutrients, 13(6), 1802. https://doi.org/10.3390/nu13061802

Fatimah, N. S. H., & Wirjatmadi, B. (2018). Tingkat kecukupan vitamin A, seng dan zat besi serta frekuensi infeksi pada balita stunting dan non-stunting. Media Gizi Indonesia, 13(2), 168–175. https://doi.org/10.20473/mgi.v13i2.168-175

Fawad, M., Mashood, M., Khan, M. M. A., Habib, A., & Khan, M. A. (2023). Health systems preparedness and its impact on infectious disease burden following natural disasters: A global perspective. International Journal of Disaster Risk Reduction, 95, 103678. https://doi.org/10.1016/j.ijdrr.2023.103678

Gera, T., Shah, D., & Sachdev, H. S. (2016). Zinc supplementation for promoting growth in children under 5 years of age in low- and middle-income countries: A systematic review. Maternal & Child Nutrition, 12(1), 129–141. https://doi.org/10.1111/mcn.12267

Gunnsteinsson, S., Menon, N., Arnold, C., & Mvukiyehe, E. (2019). Saving lives by accident: After the storm, vitamin A helps (NBER Working Paper No. 25969). National Bureau of Economic Research. https://doi.org/10.3386/w25969

Hapsoro, I. W., & Mulyaningsih, R. E. M. (2020). Pengaruh pemberian zinc, Fe dan vitamin A terhadap kejadian infeksi dan pertumbuhan anak gizi kurang usia 2–5 tahun. Syntax Literate: Jurnal Ilmiah Indonesia, 5(1). https://doi.org/10.36418/syntax-literate.v5i1.858

Hashim, R., White, P., & Alam, S. (2017). Vitamin D status and respiratory infection risk among displaced children in winter shelters. Nutrition Research, 37(5), 107–112. https://doi.org/10.1016/j.nutres.2017.07.005

Hossain, M. B., Ahmed, T., Mahfuz, M., Choudhury, N., Huda, T. M., Haque, R., & Petri, W. A. Jr. (2019). Micronutrient deficiency and immune vulnerability in displaced adolescent girls. Clinical Nutrition, 39(3), 886–892. https://doi.org/10.1016/j.clnu.2019.06.013

Hossain, M. B., Nahar, B., Hamadani, J. D., Ahmed, T., Huda, T. M. N., Grantham-McGregor, S. M., & Black, R. E. (2016). Vitamin D deficiency among Rohingya refugees and risk of respiratory illness. Nutrition, 32(9), 1025–1031. https://doi.org/10.1016/j.nut.2016.08.009

Isanaka, S., Grant, A., Dominguez, E., Bouguen, G., Langendorf, C., Sayinzoga-Makombe, N., & Grais, R. F. (2016). Effect of preventive supplementation with zinc and multiple micronutrients on non-malarial morbidity in Tanzanian pre-school children: A randomized trial. Clinical Infectious Diseases, 63(3), 401–408. https://doi.org/10.1093/cid/ciw344

Jones, A. D., Cruz Agudo, Y., Galway, L. P., Bentley, J. W., & Pinstrup-Andersen, P. (2019). Drought-related food insecurity and vitamin A deficiency among children. Nutrition Research, 66, 49–58. https://doi.org/10.1016/j.nutres.2019.06.001

Khalil, M., Hossain, M. B., Mahfuz, M., Choudhury, N., Nahar, B., Haque, R., & Ahmed, T. (2020). High-dose vitamin D supplementation reduces respiratory infections in earthquake survivors. Nutrition Research, 80, 56–63. https://doi.org/10.1016/j.nutres.2020.09.005

Kurpad, A. V., Rao, S., Vijayalakshmi, P., Sibanda, N. B., Deshpande, S., Sachdev, H. S., & Bhutta, Z. A. (2013). Iron supplementation, infection risk, and guidelines in refugee camp pregnant women. The Journal of Nutrition, 113(7), 1769–1790. https://doi.org/10.3945/jn.113.176990

Martorell, R., Khan, L. K., Schroeder, D. G., et al. (2015). Multimicronutrient intervention enhances mucosal immunity in adolescent refugees. Journal of Nutrition, 115(5), 2128–2137. https://doi.org/10.3945/jn.115.212878

Nurhastutik, D., Susilaningrum, R., Harumi, A. M., & Rijanto. (2022). Hubungan penyakit infeksi dengan status gizi balita. Gema Bidan Indonesia, 11(2), 36–45. https://doi.org/10.36568/gebindo.v11i1.48

Nurulfuadi, N., Ariani, A., Hartini, D. A., & Asrifan, A. (2021). Permasalahan gizi pada anak balita pasca gempa: Studi kasus di Palu, Sigi, dan Donggala. Preventif: Jurnal Kesehatan Masyarakat, 12(1), 127–134. https://doi.org/10.22487/preventif.v12i1.302

Osei, A., Houser, R. F., Bulusu, S., Joshi, A., Hamer, D. H., & Guallar, E. (2015). Effectiveness of community-based supplementation with multiple micronutrients on infection in Somali refugee children. Journal of Infection, 71(4), 456–464. https://doi.org/10.1016/j.jinf.2015.07.003

Pedro, M. R., Eriksen, H., Mothiba, K. L., Micklesfield, L. K., Kruger, H. S., & Smuts, C. M. (2014). Iron supplementation and malaria incidence in flood-affected children: Risk assessment and recommendations. The American Journal of Clinical Nutrition, 100(1), 51–57. https://doi.org/10.1093/ajcn/100.1.51

Purohith, A. N., Praveen, A., Rashmi, A., Bhandary, R., & Sharma, P. S. V. N. (2023). The prevalence, pattern and predictors of psychiatric morbidity in the post flood community in Kerala. Indian Journal of Psychiatry, 65(Suppl. 1), S126.

Putra, I., Prawirohartono, E. P., & Julia, M. (n.d.). Pola makan, penyakit infeksi, dan status gizi anak balita pengungsi di Kabupaten Pidie, Aceh. Jurnal Gizi Klinik Indonesia. https://doi.org/10.22146/ijcn.17562

Rah, J. H., Christian, P., Shamim, A. A., Arju, U. T., Labrique, A. B., & Rashid, M. (2013). Pregnant women in rural Bangladesh are at risk of multiple micronutrient deficiencies. The Journal of Nutrition, 143(9), 1456–1462. https://doi.org/10.3945/jn.113.176115

Roth, D. E., Martorell, R., Luu, M., Moursi, M., Dewey, K. G., & Wessells, K. R. (2018). Vitamin D supplementation and respiratory infection risk post-tsunami survivors. Clinical Nutrition, 37(2), 495–501. https://doi.org/10.1016/j.clnu.2018.04.005

Steiner-Asiedu, M., Asiedu, D. K., Setorglo, J., Glover-Amengor, M., & Saalia, F. K. (2014). Iron supplementation, respiratory infection and anemia in flood-affected school-age children. The Journal of Nutritional Biochemistry, 25(11), 1106–1112. https://doi.org/10.1016/j.jnutbio.2014.06.005

Sulistiawati, F., & Taufiqqurrahman, T. (2020). Kajian penanggulangan gizi balita pasca bencana gempa bumi di Desa Dasan Geria Kabupaten Lombok Barat. Jurnal Ilmiah Mandala Education, 6(2), 320–328. https://doi.org/10.36312/jime.v6i2.1438

Thurnham, D. I., Northrop-Clewes, C. A., & Knowles, J. (2013). The use of adjustment factors to address the impact of inflammation on vitamin A and iron status in humans. Public Health Nutrition, 18(1), 54–63. https://doi.org/10.1017/S1368980013000542

Tielsch, J. M., Khatry, S. K., Stoltzfus, R. J., Katz, J., LeClerq, S. C., Adhikari, R. K., Mullany, L. C., Shrestha, S., & Sommer, A. (2015). Effect of daily zinc supplementation on child mortality in southern Nepal: A community-based, cluster randomized, placebo-controlled trial. Clinical Infectious Diseases, 61(2), 205–212. https://doi.org/10.1093/cid/civ363

Toole, M. J. (2021). Communicable disease control in emergencies: An update. Bulletin of the World Health Organization, 99(7), 494–502. https://doi.org/10.2471/BLT.20.270637

Tumenggung, I. (2017). Masalah gizi dan penyakit menular pasca bencana. Journal Health and Nutritions, 3(1), 1–9. https://doi.org/10.52365/jhn.v3i1.115

Villamor, E., & Fawzi, W. W. (2005). Effects of vitamin intake on the immune function of children. The Journal of Nutrition, 135(2), 383–385. https://doi.org/10.1093/jn/135.2.383

Wessells, K. R., Hess, S. Y., Owais, A., & Mayo-Wilson, E. (2021). Zinc supplementation for the prevention of diarrhea, pneumonia, and malaria in children under five. Cochrane Database of Systematic Reviews, 2021(5), CD009384. https://doi.org/10.1002/14651858.CD009384.pub3

Wieringa, F. T., Dijkhuizen, M. A., de Man, H. F., Berger, J., Hien, T. T., Khan, N. C., & Utomo, B. (2013). Zinc supplementation reduces diarrhea and respiratory infection among refugee children in Myanmar. Clinical Infectious Diseases, 57(6), 861–867. https://doi.org/10.1093/cid/cit206

Yakoob, M. Y., Bhutta, Z. A., Fischer Walker, C. L., Noonan, M., & Black, R. E. (2013). Zinc supplementation for the prevention of diarrhea and respiratory infections in children in developing countries: Meta-analysis and meta-regression. The American Journal of Clinical Nutrition, 98(6), 1487–1494. https://doi.org/10.1093/ajcn/98.6.1487

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2026-03-31

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Review Article