Abstract:

Background: In Zambia, diarrhea is one of the commonest diseases that affect under five children. It represents 12% of all causes of under-five mortality; and only 60% of children with diarrhea received oral rehydration treatment in 2012.

Objective: To assess if training of community health workers and establishment of women’s support groups will enhance the use of zinc sulphate as adjuvant therapy for childhood diarrheal diseases and decrease child mortality in underserved areas. We therefore conducted a literature review of published clinical trials that were conducted in developing countries.

Search methods: We searched Medline through PubMed database and COCHRANE CRCT database. Our main focus was to identify literatures reporting on the effectiveness of oral zinc in reducing duration and severity of childhood diarrheal episodes; literatures published in developing countries, in English and French languages. We restricted our search to clinical trials. There was no time limit attached to our search.

Main results: After literature screening, 112 articles were excluded for not being clinical trials whilst 24 did not meet the main focus of our study. Only 28 articles were selected. Analysis reported a wide variety of diarrheal-related outcomes depending on number of considerations.

conclusion: Zinc supplementation in children reduces duration and/or severity of diarrheal episodes hence decreases child mortality.

Keywords: “diarrhea”, “child”, “zinc” and “therapeutic use”.

References:

[1].    Aung T, Montagu D, Su Khin H, Win Z, San AK, McFarland W; ORS + Zinc Study Group. Impact of a social franchising program on uptake of oral rehydration solution plus zinc for childhood diarrhea in Myanmar: a community-level randomized controlled trial. J Trop Pediatr. 2014 Jun;60(3):189-97.

[2].    Alam DS, Yunus M, El Arifeen S, Chowdury HR, Larson CP, Sack DA, et al. Zinc treatment for 5 or 10 days is equally efficacious in preventing diarrhea in the subsequent 3 months among Bangladeshi children. J Nutr. 2011 Feb;141(2):312-5.

[3].    Bhandari N, Bahl R, Taneja S, Strand T, Molbak K, Ulvik RJ, et al. Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young north Indian children. Pediatrics. 2002 Jun ;109(6) : e86.

[4].    Bhandari N, Mazumder S, Taneja S, Dube B, Agarwal RC, Mahalanabis D, et al. Effectiveness of zinc supplementation plus oral rehydration salts compared with oral rehydration salts alone as a treatment for acute diarrhea in a primary care setting: a cluster randomized trial Pediatrics. 2008 May;121(5): e1279-85.

[5].    Bhavnagar S, Bahl R, Sharma PK, Kumar GT, Saxena SK, Bhan MK. Zinc with oral rehydration therapy reduces stool output and duration of diarrhea in hospitalized children: a randomized controlled trial. J Pediatr Gastroenterol Nutr. 2004 Jan;38(1):34-40.

[6].    Bhutta ZA, Nizami SQ, Isani Z. Zinc supplementation in malnourished children with persistent diarrhea in Pakistan. Pediatrics. 1999 Apr;103(4): e42.

[7].    Central Statistical Office MoH, Tropical Diseases Research centre, University of Zambia. Zambia Demographic and Health Survey 2007. Lusaka 2013-14. Available from: countryoffice.unfpa.org/Zambia/drive/2007_zdhs_final_report.pdf.

[8].    CDC. Global Diarrhea Burden. Atlanta, USA2013 [15 March 2015]; Available from: www.cdc.gov/healthywater/global/diarrhea-burden.html

[9].    Dalgic N, Sancar M, Bayraktar B, Pullu M, Hasim O. Probiotic, zinc and lactose-free formula in children with rotavirus diarrhea: are they effective? Pediatr Int. 2011 Oct;53(5):677-82.

[10].Fischer Walker, C.L., and R.E. Black: Zinc for the Treatment of Diarrhoea: Effect on diarrhoea morbidity, mortality and incidence of future episodes’, International Journal of Epidemiology, vol. 39, 2010, pp. i63–i69.

[11].Feikin DR, Bigogo G, Audi A, Pals SL, Aol G, Mbakaya C, et al. Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western Kenya. PLoS One. 2014;9(5): e94436.

[12].Fischer Walker CL1 BR, Baqui AH. Does age affect the response to zinc therapy for diarrhoea in Bangladeshi infants? J Health Popul Nutr. 2008 Mar;26(1):105-9.

[13].Faruque AS, Mahalanabis D, Haque SS, Fuchs GJ, Habte D. Double-blind, randomized, controlled trial of zinc or vitamin A supplementation in young children with acute diarrhoea. Acta Paediatr. 1999 Feb;88(2):154-60.

[14].Gupta DN, Rajendran K, Mondal SK, Ghosh S, Bhattacharya SK. Operational feasibility of implementing community-based zinc supplementation: impact on childhood diarrheal morbidity. Paediatr Infect Dis J. 2007 Apr;26(4):306-10.

[15].Gupta DN, Mondal SK, Ghosh S, Rajendran K, Sur D, Manna B. Impact of zinc supplementation on diarrhoeal morbidity in rural children of West Bengal, India. Acta Paediatr. 2003 May;92(5):531-6.

[16].Khatun UH MM, Black RE, Sarkar NR, Wahed MA, Fuchs G, Roy SK. A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh. Acta Paediatr. 2001 Apr;90(4):376-80.

[17].Khan WU, Sellen DW. Zinc supplementation in the management of diarrhoea. Geneva: World Health Organization; 2011 [31 March 2015]; Available from: http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/.

[18].Luabeya KK, Mpontshane N, Mackay M, Ward H, Elson I, Chhagan M, et al. Zinc or multiple micronutrient supplementation to reduce diarrhea and respiratory disease in South African children: a randomized controlled trial. PLoS One. 2007; 2(6): e541.

[19].Larson CP, Hoque AB, Larson CP, Khan AM, Saha UR. Initiation of zinc treatment for acute childhood diarrhoea and risk for vomiting or regurgitation: a randomized, double-blind, placebo-controlled trial. J Health Popul Nutr 2005; 23:311-19.

[20].Long KZ, Rosado J, Montoya YdL, Solano M, Hertzmark E, DuPont HL, et al. Effect of vitamin A and zinc supplementation on gastrointestinal parasitic infections among Mexican children. Pediatrics. 2007 Oct;120(4): e846-55.

[21].Munos, M.K., C.L. Fischer Walker and R. E. Black: The Effect of Oral Rehydration Solution and Recommended Home Fluids on Diarrhoea Mortality, International Journal of Epidemiology

[22]., vol. 39, 2010, pp. i75–i87.

[23].MOH. Zambia National Health Strategic Program 2011 to 2015. Lusaka, Zambia: Zambia Ministry of Health 2011.

[24].Neonatal and Child health profile [database on the Internet]. World Health Organization. 2012 [cited 15 March 2015]. Available from: http:// www.who.int/maternal child.../zmb.pd.

[25].National community health worker strategy in Zambia Available at: https://www.advancingpartners.org/sites/default/files/cadres/policies/zambia_nchw_strategy-august-_2010_final.pdf

[26].National Community Health Worker Strategy in Zambia-2010 Available at: https://www.advancingpartners.org/sites/default/files/cadres/policies/zambia_nchw_strategy-august-_2010_final.pdf

[27].Patel AB, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni H. Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trial. BMC Med. 2009 May;5(7):22.

[28].Patel AB, Dhande LA, Rawat MS. Therapeutic evaluation of zinc and copper supplementation in acute diarrhea in children: double blind randomized trial. Indian Pediatr. 2005 May;42(5):433-42.

[29].Penny ME, Peerson JM, Marin RM, Duran A, Lanata CF, Lonnerdal B, et al. Randomized, community-based trial of the effect of zinc supplementation, with and without other micronutrients, on

[30].Polat TB, Uysalol M, Cetinkaya F. Efficacy of zinc supplementation on the severity and duration of diarrhea in malnourished Turkish children. Pediatr Int. 2003 Oct;45(5):555-9.

[31].Roy SK, Hossain MJ, Khatun W, Chakraborty B, Chowdhury S, Begum A, et al. Zinc supplementation in children with cholera in Bangladesh: randomised controlled trial. BMJ. 2008 Feb;2(336 (7638)):266-8.

[32].Rawal P, Thapa BR, Prasad R, Prasad KK, Nain CK, Singh K. Zinc supplementation to patients with celiac disease--is it required? J Trop Pediatr. 2010 Dec;56(6):391-7.

[33].Roy SK, Tomkins AM, Haider R, Behren RH, Akramuzzaman SM, Mahalanabis D, et al. Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhoea. Eur J Clin Nutr. 1999 Jul;53(7):529-34.

[34].Roy SK, Tomkins AM, Akramuzzaman SM, Behrens RH, Haider R, Mahalanabis D, et al. Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea. Arch Dis Child. 1997 Sep;77(3):196-200.

[35].Sazawal S, Black RE, Bhan MK, Jalla S, Sinha A, Bhandari N. Efficacy of zinc supplementation in reducing the incidence and prevalence of acute diarrhea--a community-based, double-blind, controlled trial. Am J Clin Nutr. 1997 Aug;66(2):413-8.

[36].Sazawal S, Black RE, Bhan MK, Jalla S, Bhandari N, Sinha A, et al. Zinc supplementation reduces the incidence of persistent diarrhea and dysentery among low socioeconomic children in India. J Nutr. 1996 Feb;126(2):443-50.

[37].Strand TA, Chandyo RK, Bahl R, Sharma PR, Adhikari RK, Bhandari N, et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics 2002 May; 109 (5):898-903.

[38].Sazawal S, Black RE, Bhan MK, Bhandari N, Sinha A, Jalla S. Zinc supplementation in young children with acute diarrhea in India. N Engl J Med. 1995 Sep 28;333(13):839-44.

[39].Strand TA, Chandyo RK, Bahl R, Sharma PR, Adhikari RK, Bhandari N, et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics. 2002 May;109(5):898-903.

[40].UNICEF Zambia 2010- Health, Nutrition, & HIV and AIDS. United Nation Children's Funds; 2010 [02 April 2015]; Available from: www.unicef.org/zambia/health_nutrition.html.

[41].United Nations Children Fund, The State of the World’s Children 2012: Children in an urban world, UNICEF, New York, 2012, p. 99. the duration of persistent childhood diarrhea in Lima, Peru. J Pediatr. 1999 Aug;135(2 Pt 1):208-17.

[42].WHO., UNICEF. Diarrhoea: why children are still dying and what can be done. Geneva: World Health Organization, United Nation Children's Funds; 2009. Available from: http://www.who.int/maternal_child_adolescent/documents/9789241598415/en/.

[43].WHO. Diarrhoeal disease fact sheet. Geneva: World Health Organization; 2013 [28 March 2015]; Available from: www.who.int/mediacentre/factsheets/fs330/en/.

[44].Wadhwa N, Natchu UC, Sommerfelt H, Strand TA, Kapoor V, Saini S, et al. ORS containing zinc does not reduce duration or stool volume of acute diarrhea in hospitalized children. J Pediatr Gastroenterol Nutr. 2011 Aug;53(2):161-7.

[45].who/unicef joint statement clinical management of acute diarrhea; World Health Organization, United Nation Children's Funds; 2004 Available from: www.unicef.org/publications/files/ENAcute_Diarrhoea_reprint.pdf

[46].UNICEF Zambia: Maternal, Newborn, and Child Health; United Nation Children's Funds; 2010 Available from: http://www.unicef.org/zambia/5109_8457.html

[47].WHO | MDG 4: reduce child mortality Available at: www.who.int/topics/millennium_development_goals/child_mortality/en/

[48].  Zambia census projections 2011-2035 Available at: http://www.zamstats.gov.zm/report/Census/2010/National/Zambia%20Census%20Projection%202011%20-%202035.pdf