The document discusses the use of zinc supplementation in the treatment of diarrhoeal disease in children. It notes that while oral rehydration therapy saves lives, it does not reduce the duration of diarrhea. The WHO and UNICEF now recommend daily zinc supplements of 20 mg for 10-14 days for children ages 6 months to 5 years and 10 mg per day for infants under 6 months when experiencing acute diarrhea. Zinc has been shown to reduce the duration and severity of acute, persistent, and bloody diarrhea episodes as well as decrease stool volume and the proportion of episodes lasting over 7 days. The document concludes that zinc supplementation should be provided along with standard diarrhea treatment based on its significant beneficial impacts.

1. Zinc supplementation in the
treatment of diarrhoeal disease
Dr. Anil Kumar
Child Health and Nutrition &
Immunization Plus

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

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

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

14. Zinc and
Lowosmolarity
ORS:
effective,
safe and
reliable

15. Muito Obrigado!
Thank You Very Much in
Portuguese

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