Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under–five in Uttar Pradesh, India

Abstract

BackgroundThere is limited evidence on adherence to the recommended dose and duration of zinc supplementation for diarrheal episodes in children under five years of age. In selected districts of Uttar Pradesh, India, we sought to assess adherence to the nationally advised zinc treatment regimen (ie, 10 mg/day for ages 2–6 months and 20 mg/day for ages 7–59 months for 14 days) among caregivers of zinc–prescribed children.MethodsWe identified and conducted follow–up visits to children advised zinc for the treatment of diarrhea. At the initial visit, we collected data on the treatment instructions received from providers. Caregivers were asked to record treatments administered on a pictorial tracking form and were asked to retain all packaging for collection at follow–up. We quantified the average dose and duration of zinc therapy and built logistic regression models to assess the factors associated with caregiver adherence to national guidelines.ResultsCaregivers administered zinc for an average of 10.7 days (standard deviation (SD) = 3.9 days; median = 13 days), and 47.8% continued treatment for the complete 14 days. Among children receiving zinc syrups and tablets respectively, the age appropriate dose was received by 30.8% and 67.3%. Adherence to age appropriate dose and continuation of zinc for 14 days were highly associated with having received appropriate provider instructions.ConclusionsOur results indicate moderate–to–good adherence to national zinc treatment guidelines for diarrhea among caregivers in rural India. Our findings also highlight the importance of provider guidance in ensuring adherence to zinc dose and duration. Programs aiming to scale–up zinc treatment for childhood diarrhea should train providers to successfully communicate dosing instructions to caregivers, while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

“…The mean number of days zinc was taken was 11.28±3.81 days in our study while in the study by Lamberti LM et al, it was 10.7 days. 11 The compliance to full zinc therapy of 14 days was 62.14% and similar to our study, Lamberti LM et al, reported that 47.8% continued treatment for the complete 14 days and they also observed that among children receiving zinc syrups and tablets respectively, the age-appropriate dose was received by 30.8% and 67.3%. 11 Ahmed S et al, in their study observed that 62% of the children completed a full 10-day course of zinc treatment by taking one tablet a day that had been completely dissolved in a small amount of water (good compliance).…”

“…11 The compliance to full zinc therapy of 14 days was 62.14% and similar to our study, Lamberti LM et al, reported that 47.8% continued treatment for the complete 14 days and they also observed that among children receiving zinc syrups and tablets respectively, the age-appropriate dose was received by 30.8% and 67.3%. 11 Ahmed S et al, in their study observed that 62% of the children completed a full 10-day course of zinc treatment by taking one tablet a day that had been completely dissolved in a small amount of water (good compliance). 9 There was 63% excess risk for poor compliance to zinc if father stays at home with the family [OR = 1.63 (95%CI; 1.09, 2.46) p = 0.019] in their study.…”

“…Similar to this study, in the study by Lamberti LM et al, done in Uttar Pradesh, the mean age was 17.7 months and gender wise distribution (42.5% males) of study subjects was almost equal similar to this study. 11 But in their study, 89.3% of subjects took zinc tablets while 11.5% took zinc in the form of syrup. The mean number of days zinc was taken was 11.28±3.81 days in our study while in the study by Lamberti LM et al, it was 10.7 days.…”

“…Lamberti LM et al, in their study also observed that 69.5% of subjects discontinued treatment as the child recovered while in 27.1% of subjects, the child took another treatment. 11 In 12.5%, the reason for discontinuation was URI. There was no statistically significant difference between the groups classified based on further episodes of diarrhea with respect to compliance to zinc therapy and the number of days zinc was taken.…”

‘Know‐Can’ gap: gap between knowledge and skills related to childhood diarrhoea and pneumonia among frontline workers in rural Uttar Pradesh, India

“…They are often the first contact point for caregivers for any childhood disease, and parents often seek care only from these practitioners with very little diversion to government service providers . Both ASHAs and RMPs are, therefore, key actors in the early detection and appropriate management of childhood diarrhoea and pneumonia, but the quality of their services is often inadequate because of insufficient training, education, awareness and patient volume .…”