Comparison of Mean Change in Frequency of Stool with Zinc Supplementation versus Placebo in Children with Acute Diarrhoea
DOI:
https://doi.org/10.51273/esc23.251929Keywords:
Acute Diarrhoea, Zinc Supplementation, Loose StoolsAbstract
OBJECTIVES: To determine the role of zinc supplementation in children with watery diarrhoea. The objective was to compare the mean change in frequency of stool with zinc supplementation versus placebo in children with acute diarrhoea in addition to standard treatment.
METHOD: It was a randomized controlled trial conducted in Paediatric Department, Punjab Rangers Teaching Hospital, Lahore over 6 months. 68 children of both genders aged under 5 years who presented with acute diarrhoea were sub-divided into two equal groups; Group -A received oral zinc with standard management while those in Group-B received standard management alone. Frequency of stools was recorded after 72 hours, mean change calculated and then compared between the groups.
RESULTS: Mean duration of acute diarrhoea was 3.81±1.56 days. Both the study groups were comparable in terms of mean frequency of stools at presentation (7.71±2.76 vs. 7.79±2.67; p-value=0.894). However, after 72 hours, the mean frequency of stools was significantly lower in children receiving additional zinc supplementation as compared to placebo (3.94±2.84 vs. 5.50±2.77; p-value=0.025). The mean change in the frequency of stools was significantly higher in the zinc group as compared to placebo group (3.76±0.89 vs. 2.29±0.63; p-value<0.001).
CONCLUSION: In this study, zinc supplementation was found superior to conventional management of children presenting with acute diarrhoea evident from considerably greater reduction in the mean frequency of stools. The low cost, wide-spread availability and ease of administration advocate the preferred use of zinc in the management of such patients.
References
Kotloff KL, Nataro P, Blackwelde WC. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 2013;382:209-222.
Bulled N, Singer M, Dillingham R. The syndemics of childhood diarrhoea: a biosocial perspective on efforts to combat global inequitiesin diarrhoea-relatedmorbidity andmortality.GlobalPublicHealth 2014; 9(7): 841-53.
MaaresM,HaaseH.Aguide to human zinc absorption: general overview and recent advances of in vitro intestinal models. Nutrients 2020;12(3):762-9.
Wessells KR, Brown KH, Kounnavong S, Barffour MA, Hinnouho GM, Sayasone S, et al. Comparison of two forms of daily preventive zinc supplementation versus therapeutic zinc supplementation for diarrhea on young children’s physical growth and risk of infection: study design and rationale for a randomized controlled trial. BMC Nutr 2018;4(1):39-45.
CohenA, Colford JJ. Effects of boiling drinking water on diarrhea and pathogen-specific infections in low and middle-income countries: a systematic review and meta-analysis. Am J Trop Med Hygiene 2017;97(5): 1362-77.
SachdevHP,MittalNK,MittalSK,YadavH0S.Acontrolled trial on utility of oral zinc supplementation in acute dehydrating diarrhea in infants.J Pediatr Gastroenterol Nutr 2008;7:877-81.
Solomons NW. Update on zinc biology. Ann Nutr Metabol 2013;62(1):8-17.
KeatsEC,DasJK, SalamRA,LassiZS,ImdadA,Black RE, et al. What works for maternal and child undernutrition: a review of the evidence. 2020.
Chirla S, Datla S. Efficacy of zinc therapy in acute diarrhea inchildren.IntJContempPediatr2018;5(6):22-8.
Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E. Diarrhoea: why children are still dying and what can be done. Lancet 2010;375(9718):870-2.
LukacikM,ThomasRL,Aranda JV.Effects of oral zinc in the treatment of acute and persistent diarrhea. Pediatrics 2008;121(2):326-36.
AlexanderK,CarzolioM,GoodinD,VanceE.Climate change is likely to worsen the public health threat of diarrheal disease inBotswana.IntJEnvironRes Public Health 2013;10(4):1202-30.
Laghari GS, Hussain Z, Shahzad H. Effect of zinc supplementation on the frequency and consistency of stool inchildrenwith acutediarrhea.Cureus 2019;11(3):1-5.
Ehsan A, Saeed S, Ehsan F. Association of hygiene practices and diarrhea prevalence in children: a comparative study among children of educated and uneducated mothers. Pak Armed Forces Med J 2019; 69(3): 617-24.
Mujawar QM, NaganoorR,AliMD,MalagiN,Thobbi AN. Efficacy of dioctahedral smectite in acute watery diarrhea in Indian children: a randomized clinical trial.J Trop Pediatr 2012;58(1):63-7.
PickeringAJ,CriderY, Sultana S, SwarthoutJ, Goddard FG, Islam SA, et al. Effect of in-line drinking water chlorination at the point of collection on child diarrhoea inurbanBangladesh:adouble-blind,cluster-randomised controlled trial.Lancet Global Health 2019;7(9): e1247-56.
Sarker SA, Sultana S,Reuteler G, Moine D, Descombes P,Charton F, et al.Oral phage therapy of acute bacterial diarrhea with two coliphage preparations: a randomized trial in children from Bangladesh. EBioMedicine 2016;
:124-37.
Sathiadas MG, Mubarak FN, Arulmoli SK. Clinical manifestations and microbiology of Shigella diarrhoea
in children admitted to Teaching Hospital, Jaffna, Sri Lanka. Sri Lankan J Infect Dis 2016;6(2):94-100.
StrandTA,ChandyoRK,BahlR,SharmaPR,Adhikari RK, Bhandari N, et al. Effectiveness and efficacy of zinc forthe treatmentof acutediarrhea inyoungchildren. Pediatrics 2002;109(5):898-903.
Dhingra U, Kisenge R, Sudfeld CR, Dhingra P, Somji S, DuttaA, et al.Lower-dose zinc for childhood diarrhea—a randomized,multicentertrial. N EnglJ Med 2020; 383(13):1231-41.
Qureshi S, Resham S, Hashmi M, Naveed AB, Haq Z, Ali SA.Aretrospective review on antibiotic use in acute
watery diarrhea in children in a tertiary care hospital ofKarachi,Pakistan.PloSOne2021;16(7): e0253712.
Patel A, Dibley MJ, Mamtani M, Badhoniya N, Kul karniH.Zincandcoppersupplementationinacutediarrhea
in children: a double-blind randomized controlled trial.BMC Med 2021;7(1):1-2.24. Palihawadana P, Kang G, Navaratnasingam J, GalagodaG, Abeynayake J, Gunasekera M, et al. Rotavirusinfection among hospitalized children under five years of age with acute watery diarrhea in Sri Lanka. Vaccine 2018;36(51):7846-50.
Sobouti B, Noorbakhsh S, Ashraf H, Ashraf-Talesh S. Use of probiotic for the treatment of acute rotavirus
diarrhea in children: a randomized single-blind controlled trial. Int J Children Adolesc 2016;2(4):5-9.
Downloads
Published
How to Cite
Issue
Section
