DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20201153

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Ajayprakash Veerapandiyan, Deepti Pandit, Sujatha Sridharan, L. Umadevi

Abstract


Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.

Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those >6 months of age and 10mg/day in those <6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value <0.05 was considered statistically significant.

Results: The mean age was 19.49±14.41 months. The compliance to complete 14-day zinc therapy was 62.14%.  The mean number of days zinc was taken was 11.28±3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).

Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.


Keywords


Acute diarrheal disease, Acute gastroenteritis, Compliance, World Health Organization - Oral rehydration solution, Young children, Zinc syrup

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References


Mokomane M, Kasvosve I, de Melo E, Pernica JM, Goldfarb DM. The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management. Ther Adv Infect Dis. 2018;5(1):29-43.

GBD Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18(11):1211-28.

Khan AM, Larson CP, Faruque AS, Saha UR, Hoque AB, Alam NU, et al. Introduction of routine zinc therapy for children with diarrhoea: evaluation of safety. J Health Popul Nutr. 2007;25(2):127-33.

Gebremedhin S, Mamo G, Gezahign H, Kung'u J, Adish A. The effectiveness bundling of zinc with Oral Rehydration Salts (ORS) for improving adherence to acute watery diarrhea treatment in Ethiopia: cluster randomised controlled trial. BMC Public Health. 2016;16:457.

Bajait C, Thawani V. Role of zinc in pediatric diarrhea. Indian J Pharmacol. 2011;43(3):232-5.

Fischer Walker CL, Fontaine O, Young MW, Black RE. Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. Bull World Health Organ. 2009;87(10):780-6.

IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

Akhtar S. Zinc status in South Asian populations--an update. J Health Popul Nutr. 2013;31(2):139-49.

Ahmed S, Nasrin D, Ferdous F, Farzana FD, Kaur G, Chisti MJ, et al. Acceptability and compliance to a 10-Day regimen of zinc treatment in diarrhea in rural Bangladesh. Food Nutr Sci. 2013;4(04):357.

Charyeva Z, Cannon M, Oguntunde O, Garba AM, Sambisa W, Bassi AP, et al. Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria. J Health Popul Nutr. 2015;34:4.

Lamberti LM, Walker CL, Taneja S, Mazumder S, Black RE. Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under-five in Uttar Pradesh, India. J Glob Health. 2015;5(2):020410.

Nasrin D, Larson CP, Sultana S, Khan TU. Acceptability of and adherence to dispersible zinc tablet in the treatment of acute childhood diarrhoea. J Health Popul Nutr. 2005;23(3):215-21.