Impact of zinc supplementation on persistent diarrhoea in malnourished Bangladeshi children

Abstract

To evaluate the impact of zinc supplementation on the clinical recovery and body weight of children with persistent diarrhoea, a randomized, double-blind, controlled trial was conducted in 190 children with persistent diarrhoea aged between 3 and 24 months. Children were randomly allocated to receive either zinc (20 mg d(-1)) syrup with multivitamin (2 x RDA) or multivitamin alone in three divided daily doses for 2 weeks. The trial was conducted in a diarrhoeal disease hospital in Dhaka, Bangladesh. Duration until clinical recovery (d), impact on body weight and serum zinc level after 2 weeks of zinc supplementation were recorded. The duration of illness was significantly reduced (33%) with zinc supplementation among children who were underweight (< or =70% wt/age, p = 0.03). Supplemented male children also had a significant reduction (27%) in duration for recovery compared with unsupplemented children (p = 0.05). From baseline to convalescence, zinc-supplemented children maintained their serum zinc concentration (13.4 vs 13.6 micromol l(-1)), whereas unsupplemented children had a decrease in serum zinc after the 2 weeks of diarrhoea (13.6 vs 11.8 micromol l(-1),p < 0.03). The mean body weight of the children in the supplemented group was maintained (5.72 vs 5.70 kg, p = 0.62) during hospitalization, unlike that of the control group, in which there was a reduction in body weight (5.75 vs 5.67 kg, p = 0.05). Five children in the unsupplemented group and one child in the zinc-supplemented group died during the 2 weeks of supplementation (p = 0.06). Zinc supplementation in persistent diarrhoea significantly reduced the length of the recovery period in malnourished children and prevented a fall in body weight and serum zinc concentration, indicating that zinc is a beneficial therapeutic strategy in this high-risk childhood illness.

Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhoea

“…The clinical benefits of zinc supplementation in these children with persistent diarrhoea were early recovery especially in underweight and male children described earlier (16). A significantly higher number of children also dropped out from the placebo group due to prolonged suffering.…”

“…The participants were children of both sexes, aged 3–24 months, who were previously treated with zinc or placebo during persistent diarrhoea (16). Children who attended the Clinical Research and Service Centre (now Dhaka Hospital) of ICDDR,B, during 1987–1989, were included in the study.…”

Oral zinc for treating diarrhoea in children

“…Five trials were on children with persistent diarrhoea (Sachdev 1990; Roy 1998; Bhutta 1999; Penny 1999; Khatun 2001). …”

Zinc Treatment to Under-five Children: Applications to Improve Child Survival and Reduce Burden of Disease

“…Several controlled zinc-treatment trials over the past decade have demonstrated the beneficial role of zinc in the prevention and treatment of diarrhoea (1-3,6-9,44,45). Meta-analyses of these trials estimate that children, aged three months to five years, who receive zinc for the treatment of a diarrhoeal illness (20 mg/day for 10 days), recover faster and experience a 30% reduction in the likelihood of developing prolonged diarrhoea.…”

“…Since then, several randomized hospital- and community-based trials have consistently demonstrated the efficacy of zinc treatment for acute or persistent diarrhoea in children aged less than five years (under-five children) (3-6). Pooled analyses of published data demonstrate that zinc reduces the duration and severity of acute diarrhoea and the likelihood of a prolonged episode (7,8).…”