Effect of Zinc supplementation in treatment of acute diarrhoea among 2-59 months children treated in Black Lion Hospital, Addis Ababa, Ethiopia

Abstract

Abstract Background: Diarrhoeal disease is one of the major causes of morbidity and mortality in under five children. Worldwide, there are about 1.3 million under five children deaths attributable to diarrhea. Health status in Ethiopia is one of the lowest in the world with estimated health service coverage of 60%; and diarrhoeal disease remains one of the major causes of under five morbidity and mortality. Treatment with ORS does not affect the duration and severity of diarrhoea, hence acceptance of ORS is low and diarrhoea still remains the major cause of child morbidity and mortality. Diarrhoea is a commonly associated problem in children with Zinc deficiency and also leads to excess zinc losses. Objective: To assess variations in the usage of antimicrobial and/or antidiarreals in children with acute watery diarrhoea randomized to receive zinc supplementation as compared to those who do not receive it; and assess the adherence to zinc supplementation given with ORS in the management of an episode of acute watery diarrhoea. Methodology: This is part of a multicentre, multi-disciplinary, randomized and open effectiveness trial conducted in out-patient settings in Addis Ababa, Black Lion Hospital at the Department of Paediatrics. The sample size has been calculated for a two-tailed alpha of 0.05 and power of 0.2. Children aged 2-59 months and who presented with acute watery diarrhoea for less than 7 days were recruited. Results: There were 188 children randomized to the Zinc plus ORS arm and 226 children to the ORS arm. There were 193 (46.6%) females and 221 (53.4%) males. Fifty two percent of the cases were between 2-11 months of age and decreasing trend of proportion of older children was observed in the study population (P=0.0001). Zinc adherence rate was 95%. Seventy three (39.3%) patients from Zinc + ORS group and 71 (32.3%) patients from ORS group took ORS when they came for the first follow up visit (P-value=0.115). From the total study subjects 16.1% took antibiotic or antidiarhael tablets before randomization which was significantly higher than the second follow up visit observation with only 1.7% (P=0.0001). Only 3 (1.7%) patients from Zinc arm and 4 (1.8%) patients from ORS arms took antibiotic/anti diarrhoeal on the second follow up visits. Conclusion: Proper counselling of care takers significantly reduces unnecessary use of antibiotic/anti diarrhoea drugs in the treatment of childhood diarrhoea. Zinc supplementation in the treatment of childhood diarrhoea is well tolerated by patients and there is good compliance of care takers. However, we could not observe any significant difference in antibiotic/antidiarheal drug use between ORS and ORS plus Zinc groups. [Ethiop.J.Health Dev. 2008;22(2):187-190]