Efficacy of zinc in young infants with acute watery diarrhea

Brooks, W. Abdullah; Santosham, Mathuram; Roy, Swapan Kumar; Faruque, A. S. G.; Wahed, M. A.; Nahar, Kamrun; Khan, Ashraful Islam; Khan, Aftab; Fuchs, George J.; Black, Robert E.

doi:10.1093/ajcn.82.3.605

Cited by 19 publications

(29 citation statements)

References 19 publications

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“…Three included trials presented results divided in two or more subgroups, and specifically: one trial presented two intervention groups of zinc 20 mg and zinc 5 mg, and one control group (Brooks 2005a); one trial presented data for three different study sites (Fischer Walker 2006); one trial presented the results as children with low and normal zinc serum levels (Polat 2003). For these three trials there was no way to combine mean values and standard deviation (SD) values, and thus we entered the data separately as Brooks 2005a (20 mg), Brooks 2005a (5 mg), Fischer Walker 2006 ETH, Fischer Walker 2006 IND, Fischer Walker 2006 PAK, Polat 2003 (low Zn), and Polat 2003 (normal Zn).…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 13 used the definition for acute diarrhoea that we used in this Cochrane Review (Faruque 1999; Dutta 2000; Strand 2002; Al-Sonboli 2003; Polat 2003; Bhatnagar 2004a; Brooks 2005a; Fischer Walker 2006; Boran 2006; Dutta 2011; Crisinel 2015; Passariello 2015; Tran 2015), two trials defined diarrhoea as the presence of either four (Sazawal 1995), or five (Bahl 2002), unformed stools in 24 hours, one trial defined diarrhoea as acute onset of change in stool frequency and consistency (Karamyyar 2013), one shigellosis trial included participants with bloody mucoid diarrhoea (dysentery) or febrile diarrhoea less than five days' duration (Roy 2008a). …”

Section: Resultsmentioning

confidence: 99%

“…Seventeen trials only enrolled children over six months of age (Sachdev 1988; Sachdev 1990; Sazawal 1995; Bhutta 1999; Faruque 1999; Penny 1999; Khatun 2001; Bahl 2002; Strand 2002; Boran 2006; Roy 2008a; Fajolu 2008; Patel 2009; Dutta 2011; Karamyyar 2013; Passariello 2015; Tran 2015). Fourteen trials included children of different ages greater than one month (Roy 1997; Roy 1998; Dutta 2000; Al-Sonboli 2003; Polat 2003; Bhatnagar 2004a; Larson 2005; Shimelis 2008; Patro 2010; Dalgic 2011; Jin 2013; Crisinel 2015; Patel 2015; Jiang 2016). …”

Section: Resultsmentioning

confidence: 99%

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Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

172

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Background In developing countries, diarrhoea causes around 500,000 child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Objectives To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library 2016, Issue 5), MEDLINE, Embase, LILACS, CINAHL, m RCT, and reference lists up to 30 September 2016. We also contacted researchers. Selection criteria Randomized controlled trials (RCTs) that compared oral zinc supplementation with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery. Data collection and analysis Both review authors assessed trial eligibility and risk of bias, extracted and analysed data, and drafted the review. The primary outcomes were diarrhoea duration and severity. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta‐analyses (using either a fixed‐effect or random‐effects model) and assessed heterogeneity. We assessed the certainty of the evidence using the GRADE approach. Main results Thirty‐three trials that included 10,841 children met our inclusion criteria. Most included trials were conducted in Asian countries that were at high risk of zinc deficiency. Acute diarrhoea There is currently not enough evidence from well‐conducted RCTs to be able to say whether zinc supplementation during acute diarrhoea reduces death or number of children hospitalized ( very low certainty evidence ). In children older than six months of age, zinc supplementation may shorten the average duration of diarrhoea by around half a day (MD −11.46 hours, 95% CI −19.72 to −3.19; 2581 children, 9 trials, low certainty evidence ), and probably reduces the number of children whose diarrhoea persists until day seven (RR 0.73, 95% CI 0.61 to 0.88; 3865 children, 6 trials, moderate certainty evidence ). In children with signs of malnutrition the effect appears greater, reducing the duration of diarrhoea by around a day (MD −26.39 hours, 95% CI −36.54 to −16.23; 419 children, 5 trials, high certainty evidence ). Conversely, in children younger than six months of age, the available evidence suggests zinc supplementation may have no effect on the mean duration of diarrhoea (MD 5.23 hours, 95% CI −4.00 to 14.45; 1334 children, 2 trials, low certainty evidence ), or the num...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

172

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“…Fourth, our findings on zinc’s impact on prevention might have been biased towards the null by including children younger than six months of age. There is no evidence that zinc use among children <6 months of age shortens duration of diarrhea episodes or prevents subsequent episodes [5], [32]–[34].…”

Section: Discussionmentioning

confidence: 99%

Village-Randomized Clinical Trial of Home Distribution of Zinc for Treatment of Childhood Diarrhea in Rural Western Kenya

et al. 2014

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BackgroundZinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities.MethodsWe randomized 16 Kenyan villages (1,903 eligible children) to receive a 10-day course of zinc and two oral rehydration solution (ORS) sachets every two months at home and 17 villages (2,241 eligible children) to receive ORS at home, but zinc at the health–facility only. Children’s caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI) reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children’s age.ResultsThere were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed), 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001). There were no differences in ORS use between zinc (59.6%) and comparison villages (58.8%). Among children with fever or cough without diarrhea, zinc use was low (<0.5%). There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46–0.99), but not presenting at clinic.ConclusionsIn this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low.Trial RegistrationClinicalTrials.gov NCT00530829

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“…A second ICDDR, B study in urban Dhaka administered a weekly dose of zinc in a double-blind, placebo-controlled, individually-randomized trial to determine if this would reduce rates of diarrhoea and pneumonia. This strategy resulted in a remarkable >80% reduction in overall mortality (65). The reduction in deaths was explained by a reduction in pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Infectious Diseases and Vaccine Sciences: Strategic Directions

Luby

Brooks

Zaman

et al. 2009

J Health Popul Nutr

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Despite substantial progress, infectious diseases remain important causes of ill-health and premature deaths in Bangladesh. Bangladesh has experienced a >90% reduction in the incidence of deaths due to childhood diarrhoea over the last 25 years. Further reductions can be achieved through the introduction of effective vaccines against rotavirus and improvements in home hygiene, quality of drinking-water, and clinical case management, including appropriate use of oral rehydration solution and zinc. Pneumonia is now the leading cause of childhood deaths in Bangladesh, and the pneumonia-specific child mortality is largely unchanged over the last 25 years. Reductions in mortality due to pneumonia can be achieved through the introduction of protein conjugate vaccines against Haemophilus influenza type b and Streptococcus pneumoniae, improvements in case management, including efforts to prevent delays in providing appropriate treatment, and the wider use of zinc. Tuberculosis is responsible for an estimated 70,000 deaths each year in Bangladesh. Although services for directly-observed therapy have expanded markedly, improved case finding and involvement of private practitioners will be important to reduce the burden of disease.

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Efficacy of zinc in young infants with acute watery diarrhea

Abstract: Zinc supplementation did not affect diarrhea duration or stool volume in young infants. Young infants tolerated both zinc doses. A beneficial effect on subsequent illness cannot be ruled out.

Cited by 19 publications

References 19 publications

Oral zinc for treating diarrhoea in children

Oral zinc for treating diarrhoea in children

Village-Randomized Clinical Trial of Home Distribution of Zinc for Treatment of Childhood Diarrhea in Rural Western Kenya

Infectious Diseases and Vaccine Sciences: Strategic Directions

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