Effectiveness of zinc supplementation plus oral rehydration salts for diarrhoea in infants aged less than 6 months in Haryana state, India

Mazumder, Sarmila; Taneja, Sunita; Bhandari, Nita; Dube, Brinda; Agarwal, RC; Mahalanabis, Dilip; Fontaine, Olivier; Black, Robert E.

doi:10.2471/blt.10.075986

Cited by 31 publications

(21 citation statements)

References 23 publications

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“…Zinc has been proven to significantly reduce morbidity and mortality from diarrhoea in young children [37], [38], [39] and was incorporated in the diarrhoea management guidelines since 2005 [40]. In the current study, extremely few children (<1%) were reported to have received Zinc for diarrhoea treatment.…”

Section: Discussionmentioning

confidence: 79%

Care-Seeking and Management of Common Childhood Illnesses in Tanzania – Results from the 2010 Demographic and Health Survey

2013

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BackgroundMalaria, pneumonia and diarrhoea continue to kill millions of children in Africa despite the available and effective treatments. Correct diagnosis and prompt treatment with effective drugs at the first option consulted for child care is crucial for preventing severe disease and death from these illnesses. Using the 2010 Demographic and Health Survey data, the present study aims to assess care-seeking and management of suspected malaria, pneumonia and diarrhoea at various health care facilities in Tanzania.MethodsWe analyzed data for 8176 children born within a 5 years period preceding the survey.The information was collected by interviewing 5519 women aged 15–49 years in 10,300 households selected from 475 sample points throughout Tanzania.ResultsThe most common first option for child care was PHC facilities (54.8%), followed by private pharmacies (23.4%). These were more commonly utilized in rural compared to urban areas: 61.2% versus 34.5% for PHC facilities, and 26.5% versus 17.7% for pharmacies. Women in urban areas and those with higher level of education more commonly utilized higher level hospitals and private facilities as their first option for child care. Only one in four children with fever had received a blood test during the illness with lowest proportion being reported among children solely attended at PHC facilities. Use of abandoned antimalarial drugs for the treatment of suspected malaria was also observed in public health facilities and antibiotics use for diarrhoea treatment was high (49.0%).ConclusionsPHC facilities and pharmacies most commonly provided sub-optimal care. These facilities were more commonly utilized as the first option for child care in rural areas and among the poor and non-educated families. These are groups with the highest child mortality, which calls for interventions’ targeting improvement of care at these facilities to further reduce child mortality from treatable illnesses in Tanzania.

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Section: Discussionmentioning

confidence: 79%

Care-Seeking and Management of Common Childhood Illnesses in Tanzania – Results from the 2010 Demographic and Health Survey

2013

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“…However, the issue is not closed because in some trials, there does seem to be benefit for younger infants. Mazumder et al [18] analyzed the subgroup of children aged <6 months in their cluster randomized community effectiveness trial in India. Caregivers in the intervention clusters were trained to give zinc in addition to ORS and the study measured the prevalence of diarrhea in cross-sectional surveys at 3 and 6 months.…”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

“…Studies using lower doses have tended to be negative [37]. There is some suggestion that doses of 20 mg are more effective in the younger age group [18]. Some positive trials have given ≥40 mg elemental zinc [6,20,35] with success and without apparent adverse effects, but taken together, there is no evidence that higher doses of zinc are related to greater reduction in duration of diarrhea [14].…”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

Zinc Supplementation in Public Health

Penny

2013

Ann Nutr Metab

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Zinc is necessary for physiological processes including defense against infections. Zinc deficiency is responsible for 4% of global child morbidity and mortality. Zinc supplements given for 10-14 days together with low-osmolarity oral rehydration solution (Lo-ORS) are recommended for the treatment of childhood diarrhea. In children aged ≥6 months, daily zinc supplements reduce the duration of acute diarrhea episodes by 12 h and persistent diarrhea by 17 h. Zinc supplements could reduce diarrhea mortality in children aged 12-59 months by an estimated 23%; they are very safe but are associated with an increase in vomiting especially with the first dose. Heterogeneity between the results of trials is not understood but may be related to dose and the etiology of the diarrhea infection. Integration of zinc and Lo-ORS into national programs is underway but slowly, procurement problems are being overcome and the greatest challenge is changing health provider and caregiver attitudes to diarrhea management. Fewer trials have been conducted of zinc adjunct therapy in severe respiratory tract infections and there is as yet insufficient evidence to recommend addition of zinc to antibiotic therapy. Daily zinc supplements for all children >12 months of age in zinc deficient populations are estimated to reduce diarrhea incidence by 11-23%. The greatest impact is in reducing multiple episodes of diarrhea. The effect on duration of diarrheal episodes is less clear, but there may be up to 9% reduction. Zinc is also efficacious in reducing dysentery and persistent diarrhea. Zinc supplements may also prevent pneumonia by about 19%, but heterogeneity across studies has not yet been explained. When analyses are restricted to better quality studies using CHERG (Child Health Epidemiology Reference Group) methodology, zinc supplements are estimated to reduce diarrheal deaths by 13% and pneumonia deaths by 20%. National-level programs to combat childhood zinc deficiency should be accelerated.

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“…We found two efficacy studies (Gupta et al 2003;Sur et al 2003) and one effectiveness study (Bhandari et al 2008) on the prevention of diarrhea and six efficacy studies on the treatment of diarrhea (Bhatnagar et al 2004;Dutta et al 2000;Fischer Walker et al 2006;Mazumder et al 2010;Patel et al 2009;Trivedi, Chudasama, and Patel 2009). The impact of zinc (Bhatnagar et al 2004;Dutta et al 2000;Fischer Walker et al 2006;Mazumder et al 2010;Trivedi, Chudasama, and Patel 2009) and zinc and copper treatment (Patel et al 2009) in diarrhea were examined among children. Some studies also examined the effect of zinc supplementation on decreasing the prevalence of diarrhea (Gupta et al 2003;Mazumder et al 2010;Sur et al 2003).…”

Section: Prevention and Treatment Of Diarrheamentioning

confidence: 99%

The Operational Evidence Base for Delivering Direct Nutrition Interventions in India: A Desk Review

et al. 2013

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The International Food Policy Research Institute (IFPRI), established in 1975, provides evidence-based policy solutions to sustainably end hunger and malnutrition and reduce poverty. The Institute conducts research, communicates results, optimizes partnerships, and builds capacity to ensure sustainable food production, promote healthy food systems, improve markets and trade, transform agriculture, build resilience, and strengthen institutions and governance. Gender is considered in all of the Institute's work. IFPRI collaborates with partners around the world, including development implementers, public institutions, the private sector, and farmers' organizations, to ensure that local, national, regional, and global food policies are based on evidence. IFPRI is a member of the CGIAR Consortium.

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Effectiveness of zinc supplementation plus oral rehydration salts for diarrhoea in infants aged less than 6 months in Haryana state, India

Cited by 31 publications

References 23 publications

Care-Seeking and Management of Common Childhood Illnesses in Tanzania – Results from the 2010 Demographic and Health Survey

Care-Seeking and Management of Common Childhood Illnesses in Tanzania – Results from the 2010 Demographic and Health Survey

Zinc Supplementation in Public Health

The Operational Evidence Base for Delivering Direct Nutrition Interventions in India: A Desk Review

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