Pediatric zinc

FROM DISCOVERY TO DELIVERY Zinc in the management of diarrhoea Dr. B. K. Iyer 3 Mar 2011

The important question for today ,[object Object],3 Mar 2011 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Global Revised Diarrhoea Treatment Strategy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3 Mar 2011 Source: WHO/UNICEF. Joint statement on the clinical management of acute diarrhea. 2004.

Why changes in ORS formulation? ,[object Object],[object Object],[object Object],[object Object],3 Mar 2011 Source: Kosek et al. Bulletin of the WHO 2003; 81:197-204 ,[object Object],[object Object],[object Object],Standard formulation of ORS New formulation of ORS Sodium 90 MEq/L Sodium 75 mEq/L Osmolarity of 311 mmol/L Osmolarity 245 mmol/L

Why the need to give zinc? ,[object Object],[object Object],3 Mar 2011 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Zinc deficiency regions 3 Mar 2011 Hotz & Brown. Food Nutr Bull 2004. < 14.9% < 15-24.9% > 25%

Zinc deficiency outcomes ,[object Object],3 Mar 2011 ,[object Object],[object Object],[object Object]

Zinc in diarrhoea management ,[object Object],[object Object],[object Object],3 Mar 2011 Source: Kosek et al. Bulletin of the WHO 2003; 81:197-204 ,[object Object],[object Object],[object Object],[object Object]

Zinc in diarrhoea management - trials 3 Mar 2011 13 trials in acute diarrhoea 5 trials in persistent diarrhoea Age groups = 3 to 60 months Trials evaluating the therapeutic effect of zinc supplementation on acute diarrhoea have been subjected to a meta-analysis Hospital based studies Community based studies Studies in which Zinc was mixed with ORS Additional studies on zinc supplementation in acute diarrhoea have been divided in 3 groups

Zinc in diarrhoea management - role ,[object Object],[object Object],3 Mar 2011 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Zinc in diarrhoea management-outcome 3 Mar 2011 Recovery from diarrhoea Continuation of diarrhoea for >7 days Stool volume / frequency Morbidity / Mortality Outcomes of Zinc interventions in diarrhoea have been studies on the following parameters

Evidence-based interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],3 Mar 2011 The Zinc Investigators Collaborative Group: Therapeutic effects of oral Zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis and randomized controlled trials. Am J Clin Nut 2000; 72:1516-22

Zinc in acute diarrhoea 3 Mar 2011 Effect on recovery Study No. of subjects Relative Hazards (95% CI) Sazawal, 1995 931 0.79 (0.69, 0.90)* Hidayat, 1998 1368 0.92 (0.83, 1.02) Roy, 1997 101 0.85 (0.57, 1.28) Strand, 2002 891 0.79 (0.68, 0.93)* Bahl, 2002 805 0.89 (0.80, 0.99)* Baqui, 2002 1252 0.75 (0.65, 0.90)* Bhatnagar, 2004 266 0.76 (0.59, 0.97)* Combined estimate (Meta-analysis) 0.84 (0.78 to 0.89)*

Zinc in acute diarrhoea 3 Mar 2011 Effect on continuation > 7 days Study No. of subjects Odds ratio (95% CI) Sazawal, 1995 931 0.85 (0.60, 1.19) Hidayat, 1998 1368 0.72 (0.48, 1.07) Roy, 1997 101 0.77 (0.33, 1.79) Strand, 2002 891 0.57 (0.38, 0.86)* Bahl, 2002 805 0.61 (0.33, 1.12) Bhatnagar, 2004 266 0.09 (0.01, 0.73)* Combined estimate (Meta-analysis) 0.66 (0.52 to 0.83)*

Zinc in acute diarrhoea 3 Mar 2011 Effect on stool frequency Study No. of subjects Difference in means/ Rate ratio(95% CI) Sazawal, 1995 931 -2.0 (-3.6, -0.4)* Sachadev, 1988 50 -1.7 (-4.1, 0.7)* Cuevas, 2001 74 -5.9 (-9.5, -2.3)* Strand, 2002 891 0.91 (0.85, 0.97)* Bahl, 2002 805 0.73 (0.63, 0.84)*

Zinc in acute diarrhoea 3 Mar 2011 Effect on stool volume Study No. of subjects Difference in means/ Ratio of GM(95% CI) Roy, 1997 101 -91g Dutta, 2000 80 -900 (-1200, -590)* Bhatnagar, 2004 266 0.69 (0.48, 0.99)*

Zinc in acute diarrhoea [for 14 days] 3 Mar 2011 Effect on mortality and hospitalization Study Intervention Controls Rate Ratio (95% CI) Child-years of follow up 5866 6015 0.49 (0.25 to 0.94)* Diarrhoea hospitalizations 8.15 10.34 0.76 (0.59 to 0.98)* ALRI hospitalizations 5.05 5.99 0.81 (0.53 to 1.23) Baqui et al, 2002

Zinc in acute diarrhoea [community based trial] ,[object Object],[object Object],[object Object],[object Object],3 Mar 2011

Zinc in diarrhoea [community based efficacy studies] ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3 Mar 2011

Zinc add-vantages ,[object Object],[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 Indicated for diarrhea, regardless of duration or type (acute or persistent; bloody or watery) Reduces mortality in children Reduces admissions to hospitals for diarrhoea

Zinc bonus advantages ,[object Object],[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 34% reduction in incidence of diarrhoea 26% reduction the incidence of pneumonia

Zinc – specifications for use in diarrhoea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3 Mar 2011

Zinc – specifications for use in diarrhoea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002

Zinc in diarrhoea- questions that need answers ,[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 ,[object Object],[object Object],[object Object],[object Object],[object Object],Yes Yes Yes Yes

Zinc in diarrhoea- questions that need answers ,[object Object],[object Object],[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 ,[object Object],[object Object]

Zinc in diarrhoea- questions that need answers ,[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 ,[object Object],[object Object]

Zinc in diarrhoea- questions that need answers ,[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 ,[object Object],[object Object],[object Object]

Zinc in diarrhoea- questions that need answers ,[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 Yes, but studies have revealed that efficacy does not remain the same and hence there is no combination of the 2.

Zinc in diarrhoea- questions that need answers ,[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 ,[object Object],[object Object],[object Object],Source: WHO/UNICEF JOINT STATEMENT - CLINICAL MANAGEMENT OF ACUTE DIARRHOEA, MAY 2004

Zinc in diarrhoea- questions that need answers ,[object Object],3 Mar 2011 Source: BMJ VOLUME 325 9 NOVEMBER 2002 Studies show that - To enable the "protective" benefit of Zinc on preventing future episodes for 2 to 3 months. it is important to insist on compliance for 10 to 14 days therapy. Source: WHO/UNICEF JOINT STATEMENT - CLINICAL MANAGEMENT OF ACUTE DIARRHOEA, MAY 2004

Probiotics and zinc in infantile diarrhoea ,[object Object],[object Object],3 Mar 2011 Source: Journal of the American College of Nutrition, Vol. 24, No. 5, 370-375 (2005)

Conclusions ,[object Object],[object Object],[object Object],3 Mar 2011 Source: Robberstad, Strand, Sommerfelt, and Black. Bull WHO 2004. Baqui, Black, Arifeen. J Health Pop Nutr (In Press).

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],3 Mar 2011

References ,[object Object],[object Object],[object Object],[object Object],[object Object],3 Mar 2011

References ,[object Object],[object Object],[object Object],[object Object],3 Mar 2011

References ,[object Object],[object Object],[object Object],3 Mar 2011

Pediatric zinc

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie Pediatric zinc

Ähnlich wie Pediatric zinc (20)

Mehr von BALASUBRAMANIAM IYER

Mehr von BALASUBRAMANIAM IYER (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Pediatric zinc