Zinc supplementation in the treatment of diarrhoeal disease

Child Health and Nutrition &

Immunization Plus

Dr. Anil Kumar

Intro

• Acute diarrhea remains a leading cause of childhood deaths despite the undeniable success of oral rehydration therapy (ORT).

• In developing countries, the scenario is worse due to infection, malnutrition, and illiteracy.

Intro

• One out of every five children who die of diarrhea worldwide is an Indian.

• Daily around 1,000 children die of diarrhea in India, which means 41 children lose their lives every hour

Intro

• Giving oral fluids using an oral rehydration solution (ORS) saves children's lives, but does not seem to have any effect on the length of time the children suffer with diarrhea.

• Hence, new revised recommendation of zinc salt along with low osmolarity ORS

Dosage

• The WHO and UNICEF, therefore, recommend 20 mg zinc supplements daily, for 10 – 14 days, for children(6 months to 5 years) with acute diarrhea, and 10 mg per day for infants under six months(0- 5 months of age {crushed in breast milk}), to curtail the severity of the episode and prevent further occurrences in the ensuing 2 -3 months.

Zinc in acute diarrhea

• Reduces duration of diarrhoea episode by up to 25%

• Decrease by about 25% the proportion of episodes lasting more than seven days

• It is associated with a 30% reduction in stool volume

• Conclusion: significant beneficial impact on the clinical course of acute diarrhoea: reduces both severity and duration

Zinc in persistent

diarrhoea

• Zinc-supplemented children had:– 24% lower probability of continuing diarrhoea

– 42% lower rate of treatment failure or death

• Conclusion: zinc supplementation reduces the duration and severity of persistent diarrhoea

Zinc in bloody

diarrhoea

• Positive impact of the prevalence of dysentery in the month following the supplementation

• Improves seroconversion to shigellaciddal antibody response and increases the proportions of circulating B lymphocytes and plasma cells and the IgA-specific immunoglobulin response

• Conclusion: zinc supplementation should be given as an adjunct to antibiotic treatment of bloody diarrhoea

Cost-effectiveness

studies

• zinc supplementation significantly improved the cost-effectiveness of standard management of diarrhoea for dysenteric as well as non-dysenteric illness.

• Sufficient evidence to recommend the inclusion of zinc into standard case management of both types of acute diarrhoea

The new WHO-UNICEF recommended

policies for health professionals on

the treatment of diarrhoea

• Counsel mother to begin administering suitable home fluids immediately upon onset of diarrhoea in a child

• Treat dehydration with new low osmolarity ORS solution (or with intravenous electrolyte solution in cases of severe dehydration)

• Emphasize continued feeding or increased breastfeeding during, and increases feeding after, the diarrhoeal episode

• Use antibiotics only when appropriate, i.e., in the presence of bloody diarrhoea or shigellosis, and abstain from administering anti-diarrhoeal drugs

• Provide children with 20 mg per day of zinc supplementation for 10-14 days (10 mg per day for infants under six months old)

• Advise mothers of the need to increase fluids and continue feeding during future diarrheoal episodes

Zinc and

Low-

osmolarity

ORS:

effective,

safe and

reliable

Muito Obrigado!

Thank You Very Much in

Portuguese

RMNCH+A Strategy