The document discusses the evidence for using zinc supplementation in the treatment of childhood diarrhea. Zinc supplementation is now recommended as part of the global diarrhea treatment strategy based on multiple clinical trials showing it reduces diarrhea duration and severity. Zinc addresses diarrhea by maintaining gut integrity and functioning of the immune system. Proper dosage and duration of zinc treatment is important to gain its protective benefits against future diarrhea episodes. Ensuring widespread access to affordable zinc formulations is now a priority in developing countries.

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

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

9. 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

11. 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

13. 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)*

14. 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)*

15. 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)*

16. 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)*

17. 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