Zinc in Diarrhea in infants and children


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Zinc in Diarrhea in infants and children

  1. 1. Zinc supplementation in the treatment of diarrhoeal disease Dr. Anil Kumar Child Health and Nutrition & Immunization Plus
  2. 2. 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.
  3. 3. 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
  4. 4. 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
  5. 5. 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.
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. Zinc and Lowosmolarity ORS: effective, safe and reliable
  12. 12. Muito Obrigado! Thank You Very Much in Portuguese
  13. 13. RMNCH+A Strategy