Article type
Abstract
Background:
Diarrhea is the second leading cause of death among children and improved management strategies can potentially help achieve the Sustainable Development Goals under-5 mortality target. Zinc is a micronutrient that plays a role in immune system strengthening and regulation of intestinal epithelial cells and can reduce the duration and severity of diarrhea. We conducted a systematic review of randomized controlled trials(RCTs) to assess the effectiveness of zinc compared to no zinc for the management of acute and persistent diarrhea in children.
Methods:
We conducted a literature search on PubMed, Cochrane, Scopus, CINAHL, Clinicaltrials.gov, and WHO ICTRP till July 2023. Studies were included if they were published after the year 2000 and assessed the use of zinc in the management of acute and persistent diarrhea in children aged less than 10 years. We conducted a meta-analysis using RevMan 5.4; ROB2 tool was used to assess the risk of bias in studies and quality of evidence was assessed using GRADE approach. This review was commissioned by WHO for revision of their guidelines for childhood diarrhea management.
Results:
We included thirty-eight RCTs in this review. Findings suggested that in children with acute diarrhea, zinc supplementation resulted in improved recovery from diarrhea at last follow-up [Risk Ratio(RR): 1.07 (95% confidence interval(CI): 1.03, 1.1)] and a reduction in the duration of diarrhea [Mean Difference(MD) hours: -13.27 (95% CI -17.66, -8.89)] when compared to placebo. Vomiting was experienced by a significant number of children in the zinc group compared to placebo [RR: 1.46 (95% CI: 1.22, 1.76)], however, there were few vomiting episodes in low-dose zinc group compared to high-dose [RR 0.80 (95% CI 0.72, 0.89)]. In children with persistent diarrhea, zinc supplementation led to a greater proportion of children who recovered from diarrhea [RR: 1.75 (95% CI: 1.34, 2.30)].
Conclusion:
The review concluded that zinc should continue to be recommended in children under the age of 10 years with acute or persistent diarrhea but low certainty of evidence concludes that dose should be reduced. However, further multi-country clinical trials are required to assess the appropriate duration to reduce adverse effects.
Diarrhea is the second leading cause of death among children and improved management strategies can potentially help achieve the Sustainable Development Goals under-5 mortality target. Zinc is a micronutrient that plays a role in immune system strengthening and regulation of intestinal epithelial cells and can reduce the duration and severity of diarrhea. We conducted a systematic review of randomized controlled trials(RCTs) to assess the effectiveness of zinc compared to no zinc for the management of acute and persistent diarrhea in children.
Methods:
We conducted a literature search on PubMed, Cochrane, Scopus, CINAHL, Clinicaltrials.gov, and WHO ICTRP till July 2023. Studies were included if they were published after the year 2000 and assessed the use of zinc in the management of acute and persistent diarrhea in children aged less than 10 years. We conducted a meta-analysis using RevMan 5.4; ROB2 tool was used to assess the risk of bias in studies and quality of evidence was assessed using GRADE approach. This review was commissioned by WHO for revision of their guidelines for childhood diarrhea management.
Results:
We included thirty-eight RCTs in this review. Findings suggested that in children with acute diarrhea, zinc supplementation resulted in improved recovery from diarrhea at last follow-up [Risk Ratio(RR): 1.07 (95% confidence interval(CI): 1.03, 1.1)] and a reduction in the duration of diarrhea [Mean Difference(MD) hours: -13.27 (95% CI -17.66, -8.89)] when compared to placebo. Vomiting was experienced by a significant number of children in the zinc group compared to placebo [RR: 1.46 (95% CI: 1.22, 1.76)], however, there were few vomiting episodes in low-dose zinc group compared to high-dose [RR 0.80 (95% CI 0.72, 0.89)]. In children with persistent diarrhea, zinc supplementation led to a greater proportion of children who recovered from diarrhea [RR: 1.75 (95% CI: 1.34, 2.30)].
Conclusion:
The review concluded that zinc should continue to be recommended in children under the age of 10 years with acute or persistent diarrhea but low certainty of evidence concludes that dose should be reduced. However, further multi-country clinical trials are required to assess the appropriate duration to reduce adverse effects.