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Zinc for Treatment of Diarrhoea

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More Intervention Effect Estimate Summaries

Reference
Fischer Walker CL and Black RE.  Zinc for the treatment of diarrhea:  effect on diarrhea morbidity, morality and incidence of future episodes. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i63-69.

Background

  • When given 10-14 days during and following the diarrhoeal episode, zinc has been shown to decrease the duration and severity of the episode (1), as well as decrease the incidence of diarrhea and pneumonia episodes in the subsequent 2-3 months for children 1- 59 mos of age (2).
  • WHO recommends 20 mg/day for children 6-59 months of age and 10 mg/day for infants 1-5 months of age (3).
  • Few studies have been designed or powered to detect differences in all-cause mortality or diarrhea-specific mortality.  Outcomes such as diarrhea hospitalizations and episodes lasting beyond 7 days focus on the episodes which are more severe and thus far more likely to result in death.

Intervention Effect

Zinc treatment (10 -40 mg/day) on diarrhea mortality for children >7 days to 59 months of age

  • 23% difference (15-31%) in hospitalization rates [two large cRCTs].  
  • Because diarrhea mortality data were limited (fewer than 50 deaths) we used a severe morbidity outcome to estimate the effect on mortality. 

Zinc treatment (10-40 mg/day) on other morbidities for children >7 days to 59 months of age

  • Prevalence of diarrhea was reduced by 19% - estimate is not statistically significant
  • Prevalence of severe acute lower respiratory infection (ALRI)/pneumonia was reduced by 23% - estimate is not statistically significant.

Intervention Recommendation

  • The evidence supporting zinc for the treatment of diarrhea includes 12 high-quality randomized efficacy and effectiveness trials with demonstrated reductions in severe morbidity and mortality.
  • Because all estimates are consistent, this increases confidence that 23% is a realistic estimate for a reduction in mortality that would be expected when scaling up zinc for the treatment of diarrhea.

References from Fischer Walker Paper Cited Here

  1. Zinc Investigators’ Collaborative Group.  Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials.  Am J Clin Nutr 2000; 72: 1516-22.
  2. Zinc Investigators’ Collaborative Group.  Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr 1999; I35: 689-97.
  3. WHO/UNICEF. Joint Statement: Clinical Management of Acute Diarrhoea (WHO/FCH/CAH/04.07).  Geneva and New York: World Health Organization, Department of Child and Adolescent Health and Development, and United Nations Children’s Fund, Programme Division, 2004.

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