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Zinc supplementation in the
treatment of diarrhoeal disease
Dr. Anil Kumar
Child Health and Nutrition &
Immunization Plus
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
Lowosmolarity
ORS:
effective,
safe and
reliable
Muito Obrigado!
Thank You Very Much in
Portuguese
RMNCH+A Strategy

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Zinc in Diarrhea in infants and children

  • 1. Zinc supplementation in the treatment of diarrhoeal disease Dr. Anil Kumar Child Health and Nutrition & Immunization Plus
  • 2.
  • 3. 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.
  • 4. 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
  • 5. 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
  • 6.
  • 7. 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.
  • 8. 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
  • 9. 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
  • 10. 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
  • 11.
  • 12. 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
  • 13. 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
  • 15. Muito Obrigado! Thank You Very Much in Portuguese