Impact of zinc supplementation in malnourished children with acute watery diarrhoea

Abstract

A double-blind, randomized, controlled clinical trial was conducted on 80 malnourished children with acute dehydrating diarrhoea to evaluate the efficacy of oral supplementation of zinc as an adjunct therapy to oral rehydration solution (ORS). After decoding it was observed that 44 children received zinc sulphate (177 mg/kg/day in three divided doses equivalent to 40 mg elemental zinc) in a syrup form and 36 children received only syrup placebo. Clinical parameters and microbiological findings of stool samples were comparable in the two groups at the time of enrollment. All the children (100 per cent) in the zinc supplemented group and 32 (89 per cent) children in the placebo group recovered within 5 days of hospitalization (p = 0.04). The zinc supplemented group had a significantly shorter duration of diarrhoea (70.4 +/- 10.0 vs. 103.4 +/- 17.1 h; p = 0.0001), passed less liquid stool (1.5 +/- 0.7 vs. 2.4 +/- 0.7kg; p=0.0001), consumed less oral rehydration solution (2.5 +/- 1.0 vs. 3.6 +/- 0.8 litre; p = 0.0001) and other liquids (867.0 +/- 466.1 vs. 1354.7 +/- 675.6 ml; p = 0.0001) as compared to the placebo group. Our findings suggest that zinc supplementation as an adjunct therapy to ORS has beneficial effects on the clinical course of dehydrating acute diarrhoea.

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review.

“…Five trials 50,51,54,55,57 were included that investigated children with acute diarrhoea, defined as diarrhoea lasting < 2, < 3, < 4 or ≤ 10 days. The key characteristics of these RCTs can be seen in Table 15, with further details of the trials in Appendix 9.…”

“…50,57 One study 50 received funding from WHO and one 57 was funded jointly by a commercial organisation and an international health research institution. For three studies 51,54,55 the primary source of financial support was not stated, although Alam and colleagues 51 received funding for materials from a local medical college/university.…”

“…50,57 Dutta and colleagues 54 defined SAM as being < 60% of the Harvard standard W/A without oedema. In the fifth trial, Dutta and colleagues 55 included different grades of malnourished children and used the IAP 1972 classification system. 45 They did not specifically define SAM.…”

“…The comparator in these three studies was a standard WHO-ORS. In the fourth trial, 55 all participants received a standard WHO-ORS initially with either a zinc-supplemented syrup or a placebo syrup [this study is included in this section rather than in Which methods for correcting micronutrient deficiencies are effective? (Q8, rank 10) because the focus of the study was on treatment of diarrhoea].…”

“…Eight trials [50][51][52][53][54][55][56][57] were included that investigated the efficacy of treatments for children with SAM who also had diarrhoea. Within this section, similar trials have been grouped together for ease of comparison between studies.…”