Zinc supplementation in children with acute diarrhoea

Fajolu, Iretiola; Emokpae, AM; Ao, Oduwole; Bo, Silva; Ro, Abidoye; J, Renner

doi:10.4314/nqjhm.v18i2.44997

Cited by 4 publications

(11 citation statements)

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“…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%

“…Only three trials were conducted in Europe (Patro 2010; Crisinel 2015; Passariello 2015), two in South America (Al-Sonboli 2003; Penny 1999), two in Africa (Fajolu 2008; Shimelis 2008), one multicentre trial in Asia and Africa (Fischer Walker 2006), and one trial in Australia (Tran 2015). Thus, participants were from Bangladesh (Roy 1997; Roy 1998; Faruque 1999; Khatun 2001; Brooks 2005a; Larson 2005; Roy 2008a), India (Sachdev 1988; Sachdev 1990; Sazawal 1995; Dutta 2000; Bahl 2002; Bhatnagar 2004a; Fischer Walker 2006 IND; Patel 2009; Patel 2015), Pakistan (Bhutta 1999; Fischer Walker 2006 PAK), Nepal (Strand 2002), China (Jin 2013; Jiang 2016), Turkey (Polat 2003; Boran 2006; Dalgic 2011), Brazil (Al-Sonboli 2003), Peru (Penny 1999), Ethiopia (Fischer Walker 2006 ETH; Shimelis 2008), Nigeria (Fajolu 2008), Poland (Patro 2010), Italy (Passariello 2015), Switzerland (Crisinel 2015), and Australia (Tran 2015). …”

Section: Resultsmentioning

confidence: 99%

“…Seven trials used different doses depending on age (zinc < 20 mg in infants and ≥ 20 mg in older children), but they did not report results separately for each treatment group (Faruque 1999; Bahl 2002; Strand 2002; Bhatnagar 2004a; Boran 2006; Crisinel 2015; Passariello 2015). We classified these trials as 'not assignable' and could not include them in the sensitivity analysis for zinc dose.…”

Section: Resultsmentioning

confidence: 99%

“…Eight trials used zinc acetate (Roy 1997; Roy 1998; Faruque 1999; Khatun 2001; Strand 2002; Brooks 2005a; Roy 2008a; Dalgic 2011), five used zinc gluconate (Sazawal 1995; Penny 1999; Bahl 2002; Jin 2013; Jiang 2016), and three did not specify (Shimelis 2008; Dutta 2011; Passariello 2015), while all the remaining trials used zinc sulphate.…”

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%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

172

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Zinc supplements for preventing otitis media

Gulani

Sachdev

2014

Cochrane Database of Systematic Reviews

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Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review

et al. 2018

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BackgroundAlthough acute diarrhea often leads to acute dehydration and electrolyte imbalance, children with diarrhea also suffer long term morbidity, including recurrent or prolonged diarrhea, loss of weight, and linear growth faltering. They are also at increased risk of post-acute mortality. The objective of this systematic review was to identify interventions that address these longer term consequences of diarrhea.MethodsWe searched Medline for randomized controlled trials (RCTs) of interventions conducted in low- and middle-income countries, published between 1980 and 2016 that included children under 15 years of age with diarrhea and follow-up of at least 7 days. Effect measures were summarized by intervention. PRISMA guidelines were followed.ResultsAmong 314 otherwise eligible RCTs, 65% were excluded because follow-up did not extend beyond 7 days. Forty-six trials were included, the majority of which (59%) were conducted in Southeast Asia (41% in Bangladesh alone). Most studies were small, 76% included less than 200 participants. Interventions included: therapeutic zinc alone (28.3%) or in combination with vitamin A (4.3%), high protein diets (19.6%), probiotics (10.9%), lactose free diets (10.9%), oral rehydration solution (ORS) formulations (8.7%), dietary supplements (6.5%), other dietary interventions (6.5%), and antimicrobials (4.3%). Prolonged or recurrent diarrhea was the most commonly reported outcome, and was assessed in ORS, probiotic, vitamin A, and zinc trials with no consistent benefit observed. Seven trials evaluated mortality, with follow-up times ranging from 8 days to 2 years. Only a single trial found a mortality benefit (therapeutic zinc). There were mixed results for dietary interventions affecting growth and diarrhea outcomes in the post-acute period.ConclusionDespite the significant post-acute mortality and morbidity associated with diarrheal episodes, there is sparse evidence evaluating the effects of interventions to decrease these sequelae. Adequately powered trials with extended follow-up are needed to identify effective interventions to prevent post-acute diarrhea outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5092-7) contains supplementary material, which is available to authorized users.

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Zinc supplementation in children with acute diarrhoea

Cited by 4 publications

References 0 publications

Oral zinc for treating diarrhoea in children

Oral zinc for treating diarrhoea in children

Zinc supplements for preventing otitis media

Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review

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