Zinc supplementation during diarrhoea among children

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Bryce Mathews
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1 Health Workers Information Series No. 3 Zinc supplementation during diarrhoea among children NIHFW 1 Norway India Partnership Initiative (NIPI)

2 Acknowledgements This handout has been prepared by National Child Health Resource Centre (NCHRC) of National Institute of Health and Family Welfare (NIHFW) for use by the frontline workers. We gratefully acknowledge the support provided by Indian Academy of Paediatrics (IAP) for technical review of the material. We also thank NIPI UNOPS for evolving the idea to develop this resourse material and for providing financial support for the initiative. 2

3 Zinc supplementation during diarrhoea among children 1. What do you understand by diarrhoea? Passage of watery stools 3 or more times a day is known as diarrhoea. For defi ning diarrhoea, the consistency of stool is important. If a child who usually passes one formed stool in a day, passes even one loose stool that is also considered as diarrhoea. 2. What is the magnitude of diarrhoea in India? Diarrhoea is a major cause of morbidity and mortality among children in developing countries including India. On an average a child less than 5 years of age suffers from diarrhoea almost 2 times in a year. 3. Why is it important for children to be given zinc? Zinc is a trace element that is essential for normal growth and development of infants and children. Zinc plays an important role in cellular growth of the body and improves the immunity of the body and resistance against infections. 3

4 4. What are the benefi ts of giving zinc to a child suffering from diarrhoea? The use of zinc tablets along with oral rehydration therapy (ORT) decreases the severity and duration of diarrhoea. Zinc administration during diarrhoea decreases hospital admission rates by 15-20% and child mortality by 3-5%. It can decrease the incidence of subsequent episodes of diarrhoea and possibly also pneumonia over next 3 months. 5. What is the recommended dose of zinc for a child with diarrhoea? Government of India has recommended the following dose of zinc: i. For children between 2-6 months: Children aged between 2-6 months should be given 10 mg of elemental zinc per day for a total period of 14 days from the day of onset of diarrhoea. A tablet of zinc contains 20 mg of elemental zinc. Therefore half tablet should be given to the children in this age group. ii. For children above 6 months: One full tablet should be given to all children with diarrhoea above 6 months of age. It should be started when diarrhoea starts and continued for a total period of 14 days. 6. How should the zinc tablets be administrated to a young child? Zinc comes in the form of dispersible tablets which easily gets converted into syrup on addition of breast milk or water. For infants below 6 months of age the tablet can be given by dissolving the tablet in breast milk and for infants above 6 4

5 months of age it can be given by dissolving the tablet in breast milk or water. 7. What are the food items which contain zinc? WHEAT ATTA Zinc is present in good amount in meat, egg, grains, nuts and oilseeds. As the plant foods do not contain good amount of zinc, therefore vegetarians are more prone to zinc deficiency. 8. Is there a deficiency of zinc among children in our country? In diet zinc is available to our body mainly from animal food. India being predominantly vegetarian country, so deficiency of zinc is very common in our country especially among children who usually do not consume enough food. India comes in the zone of high risk for zinc deficiency in children under 5 years. 9. When I am already giving ORS to child with diarrhoea, should I also give zinc? Yes, all children should receive zinc from the first day of onset of diarrhoea along with ORS. Intestinal zinc losses during diarrhoea aggravates pre- existing zinc deficiency. 10. When I give zinc to a child suffering from diarrhoea, do I still need to continue giving ORS? Giving ORS is very important in diarrhoea. ORS helps in replacing the lost salts and nutrients from the body during the diarrhoeal episodes. It is very important that ORS be continued for a child along with zinc tablets. 11. Is it safe to give zinc and what could be the adverse effects of zinc supplementation? Zinc supplementation is safe and effective. Zinc supplementation is found to have no long-term harm. Some children experienced vomiting and a slight decrease in copper status after consuming zinc. 5 Zinc Tablets

6 12. Can zinc be given to a malnourished child who is suffering from diarrhoea? Yes, a malnourished child can safely be given zinc. 13. Can zinc be given to a child who has persistent diarrhoea and dysentery? Yes, zinc can and should be given to all children with persistent diarrhoea and dysentery. 14. A child has recovered from diarrhoea after 3 days. Is it necessary to give zinc tablets for 14 days? Yes, to have the full benefi ts of zinc therapy, it has to be given for complete 14 days, even if there is recovery before the specifi ed period. 6

7 Notes 7

8 vkjksx;e~ lq[kleink National Child Health Resource Centre National Institute of Health and Family Welfare Baba Gang Nath Marg, Munirka, New Delhi Phones: / / / Fax: Website: ii

WHO/UNICEF JOINT STATEMENT

WHO/UNICEF JOINT STATEMENT CLINICAL MANAGEMENT OF ACUTE DIARRHOEA Two recent advances in managing diarrhoeal disease newly formulated oral rehydration salts (ORS) containing lower concentrations of glucose