zinc in diarrhea in infants and children
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Zinc supplementation in the treatment of diarrhoeal disease
Child Health and Nutrition &
Immunization Plus
Dr. Anil Kumar
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Intro
• Acute diarrhea remains a leading cause of childhood deaths despite the undeniable success of oral rehydration therapy (ORT).
• In developing countries, the scenario is worse due to infection, malnutrition, and illiteracy.
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Intro
• One out of every five children who die of diarrhea worldwide is an Indian.
• Daily around 1,000 children die of diarrhea in India, which means 41 children lose their lives every hour
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Intro
• Giving oral fluids using an oral rehydration solution (ORS) saves children's lives, but does not seem to have any effect on the length of time the children suffer with diarrhea.
• Hence, new revised recommendation of zinc salt along with low osmolarity ORS
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Dosage
• The WHO and UNICEF, therefore, recommend 20 mg zinc supplements daily, for 10 – 14 days, for children(6 months to 5 years) with acute diarrhea, and 10 mg per day for infants under six months(0- 5 months of age {crushed in breast milk}), to curtail the severity of the episode and prevent further occurrences in the ensuing 2 -3 months.
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Zinc in acute diarrhea
• Reduces duration of diarrhoea episode by up to 25%
• Decrease by about 25% the proportion of episodes lasting more than seven days
• It is associated with a 30% reduction in stool volume
• Conclusion: significant beneficial impact on the clinical course of acute diarrhoea: reduces both severity and duration
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Zinc in persistent
diarrhoea
• Zinc-supplemented children had:– 24% lower probability of continuing diarrhoea
– 42% lower rate of treatment failure or death
• Conclusion: zinc supplementation reduces the duration and severity of persistent diarrhoea
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Zinc in bloody
diarrhoea
• Positive impact of the prevalence of dysentery in the month following the supplementation
• Improves seroconversion to shigellaciddal antibody response and increases the proportions of circulating B lymphocytes and plasma cells and the IgA-specific immunoglobulin response
• Conclusion: zinc supplementation should be given as an adjunct to antibiotic treatment of bloody diarrhoea
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Cost-effectiveness
studies
• zinc supplementation significantly improved the cost-effectiveness of standard management of diarrhoea for dysenteric as well as non-dysenteric illness.
• Sufficient evidence to recommend the inclusion of zinc into standard case management of both types of acute diarrhoea
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The new WHO-UNICEF recommended
policies for health professionals on
the treatment of diarrhoea
• Counsel mother to begin administering suitable home fluids immediately upon onset of diarrhoea in a child
• Treat dehydration with new low osmolarity ORS solution (or with intravenous electrolyte solution in cases of severe dehydration)
• Emphasize continued feeding or increased breastfeeding during, and increases feeding after, the diarrhoeal episode
• Use antibiotics only when appropriate, i.e., in the presence of bloody diarrhoea or shigellosis, and abstain from administering anti-diarrhoeal drugs
• Provide children with 20 mg per day of zinc supplementation for 10-14 days (10 mg per day for infants under six months old)
• Advise mothers of the need to increase fluids and continue feeding during future diarrheoal episodes
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Zinc and
Low-
osmolarity
ORS:
effective,
safe and
reliable
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Muito Obrigado!
Thank You Very Much in
Portuguese
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