present in the body in very small quantities. increases skin, and mucosal resistance to infection. increases skin, and mucosal resistance to infection. Zinc cannot be stored in the body, and nearly 50%of zinc excretion takes place through the gastrointestinal tract and is increased during episodes of diarrhea. Breast milk not sufficient source > 6 month Inadequate intake of complementary foods
Zinc in childhood diarrhoea
WHAT IS ZINC?What are it’s benefits?
What is Zinc?• Zinc is a micro-nutrient and promotes immunity.• It is an important antioxidant and preserves cellular membrane integrity.• Promotes the growth and development of the nervous system.• Rich sources of Zinc are foods of animal origin, such as meat and fish.• Zinc is also present in nuts, seeds, legumes, and whole grain cereal, but the high phytate content of these foods interferes with its absorption.• Zinc cannot be stored in the body, and zinc excretion through the gastrointestinal tract is increased during episodes of diarrhea.• Young children who have frequent episodes of diarrhea and have diets low in animal products and high in phytate-rich foods are most at risk of Zinc deficiency.
ZINC- Benefits• Zinc reduces the fluid and salt loss in stools by improving mucosal permeability.• Accelerated regeneration of mucosa• Increased levels of brush-border enzymes• Enhanced cellular immunity• Higher levels of secretory antibodies• Zinc improves absorption of ORS.• Reduces the severity and duration of illness.• Reduces need for antibiotics.• Reduces the chances of complications.• Full dose for 14 days protects against diarrhea and pneumonia for next 3 months.• Acts as a general tonic-improves appetite and promotes growth.
Research Studies on efficacy of Zinc• A study conducted by an international team of scientists working in Bangladesh and led by researchers from the Johns Hopkins Bloomberg School of Public Health.• The researchers treated 8,070 children with diarrhea living in areas of Bangladesh.• Groups of children were randomized by region to receive zinc in addition to standard treatments and compared to children who did not receive zinc.• The children in the zinc areas received 20 mg elemental zinc daily for 14 days during each episode of diarrhea in addition to ORS therapy.
Research Studies- Contd.• The researchers found the incidence of diarrhea was significantly less and non-injury deaths were 50 percent less in children who received zinc compared to those who did not.• In addition, it was found that oral rehydration solution therapy (ORS) use, which is one of the standard treatments for diarrheal disease, increased by 20 percent among the children who received zinc. Antibiotic use decreased by 60 percent among the same group. These findings are published in the November 9, 2002, of the British Medical Journal.
Evidence of Efficacy of ZINC• 15% faster recovery during the episode of diarrhea*.• 16 % decrease in duration of diarrhea*.• 24% decrease in frequency of episodes lasting more than 7 days*.• 9-23% decrease in frequency of stools*.• Up to 31% reduction in stool output during the episode of diarrhea**.• 42% reduction in treatment failure or death in persistent diarrhea *ACUTE CHILDHOOD DIARRHEA: A REVIEW OF RECENT ADVANCES IN THE STANDARD MANAGEMENT Seema Alam, Rajeev Khanna, Uzma Firdaus Pediatric Gastroenterology Section, Department of Pediatrics, JNMC, AMU, Aligarh **Zinc with ORT reduces the stool output and duration of diarrhea in hospitalized children -a randomized controlled trial;S Bhatnagar et al, Dept of Paediatrics at AIIMS and Kasturba Hospital ,New Delhi ***Zinc Investigators’ Collaborative Group. AJCN 2000.
Long Term Effects of Zinc• Zinc supplementation for 10-14 has longer term effects on childhood illnesses in the 2-3 months after treatment• 34% reduction in prevalence of diarrhoea• 26% reduction in incidence of pneumonia Zinc Investigators’ Collaborative Group. Pediatrics. 1999.
Cost Effectiveness of ORS and Zinc Supplementation• Decreases the duration and severity of the episode• Decreases the need for expensive hospitalization• Decreases the use of unnecessary antibiotics and other drugs• Further cost-benefit analyses are underway Robberstad, Strand, Sommerfelt, and Black. Bull WHO 2004. Baqui, Black, Arifeen. J Health Pop Nutr. 2004.
Current total costs of treating acase of diarrhea higher than the cost of Zinc treatment Reported total costs of treating a case of diarrhea,Location for differing levels ofof perceived severitytreatmen Mild Moderate SeveretAt home <Rs. 50 Rs. 50-100 ORS sachets are sold for Rs 5-7 in the private sector ($0.10-$0.14). Zinc treatment for 10-14 day regimen costs ~Rs.28-33 in the private sector ($0.56-$0.66) Source: Formative research in preparation for promotion of zinc treatment for childhood diarrhea: Cross-country comparison of diarrhea treatment practices and implications for programs; June 2004Private Rs.100-200 Rs. 300-500 Rs.500-1500
Dosage of Zinc• Available as ZINC Tablets.• Given for 14 days for full benefits.• 20 milligrams per day for children older than six months.• 10 mg per day in those younger than six months.
Administration of ZINC Age Tablet Preparation DurationLess than 2 Not required months2 months – 6 ½ tablet Dissolved in 1 14 days months (10 mg) tsp of breast milk6 months- 5 1 tablet Dissolved in 1 14 days years (20 mg) tsp of breast milk/ORS/clean drinking water