Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh

Sk, Roy; Raqib, Rubhana; Khatun, Wajiha; Azim, Tasnim; Chowdhury, Rajib Nayan; Fuchs, G; Sack, David A.

doi:10.1038/sj.ejcn.1602795

Cited by 52 publications

(33 citation statements)

References 22 publications

(24 reference statements)

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“…Eight trials did not report the definition of acute diarrhoea (Sachdev 1988; Roy 1997; Larson 2005;Fajolu 2008; Shimelis 2008; Patel 2009; Patro 2010; Jiang 2016). …”

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%

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Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

170

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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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“…Eight trials did not report the definition of acute diarrhoea (Sachdev 1988; Roy 1997; Larson 2005;Fajolu 2008; Shimelis 2008; Patel 2009; Patro 2010; Jiang 2016). …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

170

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“…Study characteristics are shown in Table 1 (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). Only three studies had a population of fewer than 100 patients, and all studies were conducted in countries considered to be "emerging and developing economies" (48).…”

Section: Resultsmentioning

confidence: 99%

Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis

Galvão

Silva²,

Pontes³

et al. 2013

Rev Panam Salud Publica

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Galvao TF, Thees MFRS, Pontes RF, Silva MT, Pereira MG. Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis. Rev Panam Salud Publica. 2013;33(5):370-7. Suggested citationZinc supplementation for treating diarrhea in children: a systematic review and meta-analysis Results. Eighteen of 1 041 studies retrieved were included in the review (n = 7 314 children). Zinc was beneficial for reducing the duration of diarrhea in hours (mean difference [MD] = -20.12, 95% confidence interval [CI] = -29.15 to -11.09, I² = 91%). The effect was greater in malnourished children

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“…The lack of benefit in RV diarrhea is in contrast to the positive effect of zinc supplementation with or without a probiotic in RV diarrhea in Turkey [29] and in hospitalized patients in India [30]. Diarrhea caused by Vibrio cholera [31] and Shigella [32] responds to zinc. It is possible that differences in the etiology of the diarrhea episode may explain some of the heterogeneity between studies, but, clearly, further studies of pathogens isolated from diarrheal episodes and laboratory research are needed to understand the mechanisms involved in the interaction between zinc and pathogens.…”

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

confidence: 97%

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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Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh

Cited by 52 publications

References 22 publications

Oral zinc for treating diarrhoea in children

Oral zinc for treating diarrhoea in children

Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis

Zinc Supplementation in Public Health

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