Children who are malnourished

Editors:

Elham Reshid and Hailemariam Shimelis

Some 800,000 children under 5 die from diarrheal disease every year, making it one of the largest killers of children. Diarrhea can last several days, and can leave the body without water and salts that are necessary for survival.

Children who are malnourished or have impaired immunity are most at risk of life threatening diarrhea. Oral rehydration salt (ORS), which is used to treat diarrheal episodes, contains salts and sugar that helps the child to replace water and electrolytes lost during diarrheal episodes. In addition to ORS, a 10-14 day course of zinc supplements has been considered for reducing the duration of diarrheal episode as well as its incidence and severity in the subsequent months.

This recommendation is based on several studies that demonstrated daily supplementation of zinc had an effect on the clinical course of acute diarrhea. Meta-analysis stud-ies that examined the impact of zinc supplements on the management of diarrhea have shown that zinc supplementation had a significant and beneficial impact on the clinical course of acute diarrhea, reducing both its duration and severity.

Among the proposed mechanisms of action of zinc in acute diarrhea derives from a regulation of intestinal fluid transport, mucosal integrity, immunity, gene expression, and oxidative stress. A complex homeostatic network is also able to regulate zinc status at cellular and extracellular level.

All these data support the use of zinc in the treatment of acute diarrhea, but further clinical studies are needed to explore the selective effects of zinc against specific pathogens responsible for diarrhea.

Hence, UNICEF and WHO recommend health professionals to add zinc supplements to the ORS regimen in order to treat and alleviate acute diarrheal episodes.

Click for pdf here.

References

* http://www.unicef.org/innovation/projects/improved-treatment-diarrhoea-using-zinc-and-ors

* http://www.who.int/bulletin/volumes/88/10/10-075986/en/

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113371/

* Curr Opin Gastroenterol. 2011 Jan;27(1):8-12.