title: Zinc supplementation in children with cholera in Bangladesh: randomised controlled trial Oral zinc for the treatment of acute gastroenteritis in Polish children: a randomized, double-blind, placebo-controlled trial. Zinc, vitamin A, and micronutrient supplementation in children with diarrhea: a randomized controlled clinical trial of combination therapy versus monotherapy. Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trial Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea ORS Containing Zinc Does Not Reduce Duration or Stool Volume of Acute Diarrhea in Hospitalized Children Effect of Zinc Added to Multivitamin Supplementation Containing Low-dose Vitamin A on Plasma Retinol Level in Children—A Double-blind Randomized, Controlled Trial Zinc Supplementation in Malnourished Children With Persistent Diarrhea in Pakistan Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa Efficacy of zinc supplementation on the severity and duration of diarrhea in malnourished Turkish children. Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh Zinc supplementation in young children with acute diarrhea in India. Initiation of zinc treatment for acute childhood diarrhoea and risk for vomiting or regurgitation: a randomized, double-blind, placebo-controlled trial. Zinc and copper supplementation are not cost-effective interventions in the treatment of acute diarrhea. Zinc Supplementation in Acute Diarrhea is Acceptable, Does Not Interfere with Oral Rehydration, and Reduces the Use of Other Medications: A Randomized Trial in Five Countries Double‐blind, randomized, controlled trial of zinc or vitamin A supplementation in young children with acute diarrhoea Impact of zinc supplementation in children with acute diarrhoea in Turkey Zinc supplementation reduced cost and duration of acute diarrhea in children. Impact of zinc supplementation in malnourished children with acute watery diarrhoea. Zinc With Oral Rehydration Therapy Reduces Stool Output and Duration of Diarrhea in Hospitalized Children: A Randomized Controlled Trial Therapeutic Zinc and Copper Supplementation in Acute Diarrhea Does Not Influence Short-Term Morbidity and Growth: Double-Blind Randomized Controlled Trial Zinc Therapy for Diarrhoea Improves Growth Among Bangladeshi Infants 6 to 11 Months of Age
abstract: Objective To investigate the impact of zinc supplementation in children with cholera . Design Double blind , r and omised , placebo controlled trial . Setting Dhaka Hospital , Bangladesh . Participants 179 children aged 3 - 14 years with watery diarrhoea and stool dark field examination positive for Vibrio cholerae and confirmed by stool culture . Intervention Children were r and omised to receive 30 mg elemental zinc per day ( n=90 ) or placebo ( n=89 ) until recovery . All children received erythromycin suspension orally in a dose of 12.5 mg/kg every six hours for three days . Main outcome measures Duration of diarrhoea and stool output . Results 82 children in each group completed the study . More patients in the zinc group than in the control group recovered by two days ( 49 % v 32 % , P=0.032 ) and by three days ( 81 % v 68 % , P=0.03 ) . Zinc supplemented patients had 12 % shorter duration of diarrhoea than control patients ( 64.1 v 72.8 h , P=0.028 ) and 11 % less stool output ( 1.6 v 1.8 kg/day , P=0.039 ) . Conclusion Zinc supplementation significantly reduced the duration of diarrhoea and stool output in children with cholera . Children with cholera should be supplemented with zinc to reduce its duration and severity . Trial registration Clinical trials NCT00226616 OBJECTIVE To evaluate the efficacy and safety of zinc in the treatment of acute gastroenteritis ( AGE ) in children in Pol and . STUDY DESIGN Children aged 3 to 48 months with AGE were enrolled in a r and omized , double-blind , placebo-controlled trial in which they received zinc sulfate ( 10 or 20 mg/day depending on age ) or placebo for 10 days . A total of 141 of 160 children recruited were available for intention-to-treat analysis . The primary outcome was the duration of diarrhea . RESULTS In the experimental group ( n = 69 ) compared with the control group ( n = 72 ) , there was no significant difference in the duration of diarrhea ( P > .05 ) . Similarly , there was no significant difference in the groups in secondary outcome measures such as stool frequency on days 1 , 2 , and 3 , vomiting frequency , intravenous fluid intake , and the number of children with diarrhea lasting > 7 days . CONCLUSION Children living in a country where zinc deficiency is rare do not appear to benefit from the use of zinc in the treatment of AGE OBJECTIVE To compare the clinical efficacy of supplementation of zinc , zinc plus vitamin A , and zinc plus combination of micronutrients and vitamins ( iron , copper , selenium , vitamin B(12 ) , folate , and vitamin A ) on acute diarrhea in children . STUDY DESIGN This was a double-blind , r and omized , placebo-controlled trial . Children aged 6 to 24 months with diarrhea and moderate dehydration were r and omized to receive zinc plus placebo vitamin A ( group 1 ) , zinc plus other micronutrients plus vitamin A ( group 2 ) , zinc plus vitamin A ( group 3 ) , or placebo ( group 4 ) as an adjunct to oral rehydration solution .  Duration , volume of diarrhea , and consumption of oral rehydration solution were compared as outcome variables within the supplemented groups and with the placebo group . RESULTS The 167 study subjects included 41 in group 1 , 39 in group 2 , 44 in group 3 , and 43 in group 4 . All 3 supplemented groups demonstrated a significant reduction in outcome variables ( P < .0001 ) compared with the placebo group . Group 3 had the lowest reduction of outcome variables and group 2 had a speedy recovery , but differences among the supplemented groups were not statistically significant . CONCLUSIONS Supplementation with a combination of micronutrients and vitamins was not superior to zinc alone , confirming the clinical benefit of zinc in children with diarrhea Background Diarrhea causes an estimated 2.5 million child deaths in developing countries each year , 35 % of which are due to acute diarrhea . Zinc and copper stores in the body are known to be depleted during acute diarrhea . Our objectives were to evaluate the efficacy of zinc and copper supplementation when given with st and ard treatment to children with acute watery or bloody diarrhea . Methods We conducted a double-blind r and omized controlled clinical trial in the Department of Pediatrics at Indira G and hi Government Medical College Nagpur , India . Eight hundred and eight children aged 6 months to 59 months with acute diarrhea were individually r and omized to placebo ( Pl ) , zinc ( Zn ) only , and zinc and copper ( Zn+Cu ) together with st and ard treatment for acute diarrhea . Results The mean duration of diarrhea from enrolment and the mean stool weight during hospital stay were 63.7 hours and 940 grams , respectively , and there were no significant differences in the adjusted means across treatment groups . Similarly , the adjusted means of the amount of oral rehydration solution or intravenous fluids used , the proportion of participants with diarrhea more than 7 days from onset , and the severity of diarrhea indicated by more than three episodes of some dehydration or any episode of severe dehydration after enrolment , did not differ across the three groups . Conclusion The expected beneficial effects of zinc supplementation for acute diarrhea were not observed . Therapeutic Zn or Zn and Cu supplementation may not have a universal beneficial impact on the duration of acute diarrhea in children . Trial registration The study was registered as an International St and ard R and omized Controlled Trial ( IS RCT N85071383 ) OBJECTIVE To evaluate the impact of zinc supplementation on the clinical course , stool weight , duration of diarrhoea , changes in serum zinc , and body weight gain of children with acute diarrhoea . DESIGN R and omised double blind controlled trial . Children were assigned to receive zinc ( 20 mg elemental zinc per day ) containing multivitamins or control group ( zinc-free multivitamins ) daily in three divided doses for two weeks . SETTING A diarrhoeal disease hospital in Dhaka , Bangladesh . PATIENTS 111 children , 3 to 24 months old , below 76 % median weight for age of the National Center for Health Statistics st and ard with acute diarrhoea . Children with severe infection and /or oedema were excluded . MAIN OUTCOME MEASURES Total diarrhoeal stool output , duration of diarrhoea , rate of weight gain , and changes in serum zinc levels after supplementation . RESULTS Stool output was 28 % less and duration 14 % shorter in the zinc supplemented group than placebo ( p = 0.06 ) . There were reductions in median total diarrhoeal stool output among zinc supplemented subjects who were shorter ( less than 95 % height for age ) , 239 v 326 g/kg ( p < 0.04 ) , and who had a lower initial serum zinc ( < 14 mmol/l ) , 279 v 329 g/kg ( p < 0.05 ) ; a shortening of mean time to recovery occurred ( 4.7v 6.2 days , p < 0.04 ) in those with lower serum zinc . There was an increase in mean serum zinc in the zinc supplemented group ( + 2.4 v −0.3 μmol/l , p < 0.001 ) during two weeks of supplementation , and better mean weight gain ( 120 v 30 g , p < 0.03 ) at the time of discharge from hospital . CONCLUSIONS Zinc supplementation is a simple , acceptable , and affordable strategy which should be considered in the management of acute diarrhoea and in prevention of growth faltering in children specially those who are malnourished . Key messages 20 mg of daily zinc supplementation reduced diarrhoeal stool in shorter children Zinc reduced diarrhoeal stool in those with low serum zinc Zinc reduced duration of diarrhoea in children with low serum zinc Zinc increased body weight of children during acute diarrhoeal episode Malnourished children are likely to benefit more from zinc Background and Aim : The World Health Organization recommends oral zinc ( tablets or syrups ) as adjunct therapy with oral rehydration solution ( ORS ) for acute childhood diarrhea . Mixing zinc with ORS can be an attractive approach for simultaneous provision of these 2 effective interventions . This double-masked r and omized controlled trial evaluated the efficacy of ORS containing 40 mg/L elemental zinc per liter ( zinc-ORS ) in reducing stool weight and duration of diarrhea . Patients and Methods : Five hundred northern Indian children ages 1 to 35 months with diarrhea < 7 days ’ duration were r and omized to zinc-ORS or ORS . The primary outcomes were total stool output and time to recovery . Results : The median total stool output was 2.12 g · kg−1 · h−1 ( interquartile range [ IQR ] 0.9–3.76 ) in the zinc-ORS group compared with 1.78 g · kg−1 · h−1 ( IQR 0.83–3.45 ) in the ORS group . The time to recovery was also similar in the 2 groups ( hazard ratio 1.06 [ 95 % confidence interval 0.88–1.27 ] ) . In subjects who received zinc-ORS , the median ( IQR ) zinc intakes were 27 ( 16–46 ) mg on day 1 , 15 ( 6–27 ) mg on day 2 , and negligible thereafter . Conclusions : The World Health Organization – recommended daily dose of zinc for diarrhea was not achieved in most children beyond the first day of treatment . This is the likely explanation for the lack of improvement in outcomes from zinc-ORS when compared with ORS alone . Our findings do not support a change from using zinc syrup or dispersible tablets for treatment of acute diarrhea in children In a community-based double-blind r and omized trial in children aged 6–35 months , both intervention and control groups received a multi-vitamin syrup containing vitamin A , while the intervention group had zinc gluconate ( equivalent to 10 mg of elemental zinc ) additional in the syrup . There was a significant decrease in diarrhoea and pneumonia in the intervention group . This study was undertaken to investigate if addition of zinc to vitamin A had improved plasma retinol levels , which , in turn , was responsible for the effects observed in the intervention group . In a r and omly-selected sub sample of 200 children—100 each from the intervention and the control group , plasma retinol levels after 120 days of supplementation were measured . There was no difference in the mean plasma retinol levels [ the difference in the mean 0.46 μg/dL ( 95 % confidence interval -1.42–2.36 ) ] between the two groups following supplementation . No difference in plasma retinol levels was observed in the subgroups based on baseline nutritional status and plasma zinc levels . Addition of zinc to low-dose vitamin A in this study did not improve the vitamin A status of children and can not explain morbidity effects of the intervention Objective . To evaluate the potential benefit of dietary supplementation of a rice-lentil ( Khitchri ) and yogurt diet with 3 mg/kg/d of elemental zinc ( as zinc sulfate ) in hospitalized malnourished children ( age 6–36 months ) with persistent diarrhea for 14 days . Methodology . R and omized , double-blind placebo-controlled trial . Setting . Nutrition Research Ward at the National Institute of Child Health , Karachi , Pakistan , where children were admitted for 14 days of inpatient supervised rehabilitation . Main Outcome Measures . Primary outcome : overall weight gain by day 14 . Secondary outcomes : overall energy intake , stool output , time to diarrheal recovery and weight gain ( ≥3 days ) , plasma zinc , copper , prealbumin , and insulin-like growth factor-1 . Results . Of 87 children r and omized for supplementation with either zinc or placebo , the two groups were comparable at admission in terms of severity and duration of diarrhea , as well as nutritional and anthropometric parameters . The overall weight gain , stool volume , stool frequency , as well as the time taken for diarrheal recovery or steady weight gain , were comparable for both supplemented children and controls . Supplemented children had a significant improvement in plasma zinc levels and serum alkaline phosphatase by day 14 of therapy in comparison with controls . Plasma copper levels were low in both groups at admission and although an increase was seen in control children , levels decreased further after zinc supplementation . There was no significant difference between the two groups for hemoglobin , serum albumin , prealbumin , and plasma insulin-like growth factor-1 increments during the course of therapy . Evaluation of primary and secondary outcome criteria among the subset of children with plasma zinc levels < 60 μg/d at admission did not reveal any significant differences . Conclusions . Although there was satisfactory recovery in malnourished children with persistent diarrhea receiving the Khitchri-yogurt diet , there was no evidence of improved weight gain or acceleration of recovery from diarrhea with zinc supplementation . In contrast , the reduction in plasma copper levels in zinc-supplemented malnourished children suggests that caution should be exercised in supplementing severely malnourished children with zinc alone Background / Objective : The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children . Potential modifying factors , such as stunting , need to be addressed . The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence , and whether this differs between the strata of stunted or HIV-infected children . Methods : We analyzed data from a r and omized , controlled , double-blinded trial ( Clinical Trials.gov NCT00156832 ) of prophylactic micronutrient supplementation to children aged 6–24 months . Three cohorts of children : 32 HIV-infected children , 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers , received vitamin A , vitamin A plus zinc or multiple micronutrients , which included vitamin A and zinc . The main outcome was incidence of diarrhoea . Poisson regression was used in intent-to-treat analyses . Stratified analyses followed testing for statistical interaction between intervention and stunting . Results : We observed no significant differences in overall diarrhoea incidence among treatment arms . Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone ( 2.04 and 2.23 vs 3.92 episodes/year , respectively , P=0.024 ) . No meaningful subgroup analyses could be done in the cohort of HIV-infected children . Conclusions : Compared with vitamin A alone , supplementation with zinc and with zinc and multiple micronutrients , reduced diarrhoea morbidity in stunted rural South African children . Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups BACKGROUND Intervention trials have shown that zinc may be efficacious in treating acute diarrhea in children of developing countries . A double-blind placebo-controlled study was design ed to evaluate the effects of zinc supplementation on the clinical course and duration of diarrhea in malnourished Turkish children . METHODS The study group comprised 40 subjects with low zinc levels ( Group 1a ) and 52 subjects with normal zinc levels ( Group 1b ) . The control group was also comprised of two subgroups : 36 subjects with low zinc levels ( Group 2a ) and 54 subject with normal zinc levels ( Group 2b ) . Forty-three percent of children in the study group and 40 % of controls had low serum zinc levels ( < 14 micromol/L ) , and 43 % of subjects in both groups had very low serum zinc concentrations ( < 10 micromol/L ) . The study group were given 20 mg zinc per day for 10 days and the control group were given 750 mg glucose per day as a placebo for 10 days . RESULTS The mean duration of diarrhea was shorter and the percentage of children with consistent diarrhea for more than 3 - 7 days was lower in the study subgroups than in the control subgroups . Prolonged diarrhea was present in 12 % of children in the study group , and in 44 % and 37 % of children in the hypozincemic and normozincemic control subgroups , respectively . The was no significant difference among the four subgroups of children in the number of cases with post-enrollment diarrhea of a duration of>14 days . Stool frequency over the first 4 days after enrollment was lower in children in the study group . CONCLUSION It was concluded that zinc supplementation in malnourished children with acute diarrhea may reduce the severity and duration of diarrhea , especially in children with low zinc levels Objective : To assess the impact of zinc supplementation on clinical recovery , weight gain and subsequent growth and morbidity in moderately malnourished children with shigellosis . Design : A r and omized , double-blind , controlled trial . Setting : Dhaka hospital of ICDDR , B : Centre for Health and Population Research , Dhaka , Bangladesh . Subjects : Fifty-six moderately malnourished children , aged 12–59 months with culture-proven shigellosis . Methods : Subjects were r and omly allocated to receive zinc ( 20 mg/day elemental ) in multivitamin syrup ( intervention ) or multivitamin syrup without zinc ( control ) in two equally divided doses daily for 2 weeks . All children received pivmecillinam in a dose of 15 mg/kg every 6 h for 5 days . After supplementation , children were followed in their respective homes every 2 weeks for 6 months . Results : Children receiving zinc recovered from acute illness significantly faster than the control children ( P<0.05 ) . The medians time ( days ) to recovery and disappearances of blood and mucous were significantly 50 % shorter in the zinc-supplemented group compared to the control group . The mean body weight of zinc supplemented children increased significantly from 8.8 kg on admission to 9.2 kg ( P<0.01 ) at recovery , which was not observed in the control children ( from 9.3 to 9.6 kg ; P=0.12 ) . During the 6-month follow-up period , zinc-supplemented children had significantly fewer mean episodes of diarrhoea compared to the control children ( 2.2 vs 3.3 ; P=0.03 ) . Conclusion : Zinc supplementation significantly shortens the duration of acute shigellosis , promotes better weight gain during recovery and reduces diarrhoeal morbidity during the subsequent 6 months BACKGROUND In developing countries the duration and severity of diarrheal illnesses are greatest among infants and young children with malnutrition and impaired immune status , both factors that may be associated with zinc deficiency . In children with severe zinc deficiency , diarrhea is common and responds quickly to zinc supplementation . METHODS To evaluate the effects of daily supplementation with 20 mg of elemental zinc on the duration and severity of acute diarrhea , we conducted a double-blind , r and omized , controlled trial involving 937 children , 6 to 35 months of age , in New Delhi , India . All the children also received oral rehydration therapy and vitamin supplements . RESULTS Among the children who received zinc supplementation , there was a 23 percent reduction ( 95 percent confidence interval , 12 percent to 32 percent ) in the risk of continued diarrhea . Estimates of the likelihood of recovery according to the day of zinc supplementation revealed a reduction of 7 percent ( 95 percent confidence interval , -9 percent to + 22 percent ) in the risk of continued diarrhea during days 1 through 3 and a reduction of 38 percent ( 95 percent confidence interval , 27 percent to 48 percent ) after day 3 . When zinc supplementation was initiated within three days of the onset of diarrhea , there was a 39 percent reduction ( 95 percent confidence interval , 7 percent to 61 percent ) in the proportion of episodes lasting more than seven days . In the zinc-supplementation group there was a decrease of 39 percent ( 95 percent confidence interval , 6 percent to 70 percent ) in the mean number of watery stools per day ( P = 0.02 ) and a decrease of 21 percent ( 95 percent confidence interval , 10 percent to 31 percent ) in the number of days with watery diarrhea . The reductions in the duration and severity of diarrhea were greater in children with stunted growth than in those with normal growth . CONCLUSION For infants and young children with acute diarrhea , zinc supplementation results in clinical ly important reductions in the duration and severity of diarrhea The childhood diarrhoea-management guidelines of the World Health Organization/United Nations Children 's Fund ( WHO/UNICEF ) now include zinc treatment , 20 mg per day for 10 days . To determine if a dispersible zinc sulphate tablet formulation is associated with increased risk of vomiting or regurgitation following the initial , first treatment dose , a double-blind , placebo-controlled  r and omized clinical trial was carried out in the Dhaka hospital of ICDDR , B : Centre for Health and Population Research ( n=800 ) and in an adjacent NGO outpatient clinic ( n=800 ) . Children were r and omized to one of three groups : no treatment , placebo , or zinc sulphate tablet ( 20 mg ) . They were then observed for 60 minutes , and all vomiting or regurgitation episodes were recorded . When compared with placebo , zinc treatment result ed in an attributable risk increase of 14 % for vomiting and 5.2 % for regurgitation . The median time to vomiting among those receiving zinc was 9.6 minutes and was limited to one episode in 91.2 % of the cases . Overall , the proportion of 60-minute post-treatment vomiting attributable to zinc , placebo , and the illness episode was estimated to be 40 % , 26 % , and 34 % respectively . The dispersible zinc sulphate tablet formulation at a dose of 20 mg is associated with increased risks of vomiting and regurgitation . Both are transient side-effects BACKGROUND Diarrhea is one of the principal causes of morbidity and mortality among children in the developing world . Cumulative costs of treating diarrhea would be high and would further increase if zinc was used as an adjunct to treatment of acute diarrhea . OBJECTIVE To determine the impact of zinc supplementation on the mean predicted costs of treating acute diarrhea and the incremental cost-effectiveness ( CE ) as compared with placebo , from the provider 's ( government ) and patient 's perspective . STUDY DESIGN AND SETTING In a r and omized , double-blind , placebo-controlled clinical trial , 808 children aged 6 - 59 months with acute diarrhea were individually r and omized to placebo ( Pl ) , zinc ( Zn ) only , and zinc and copper ( Zn + Cu ) together with st and ard treatment of acute diarrhea . The actual re source utilization and cost data were collected for all participants . The incremental CE ratio and its 95 % confidence interval ( 95 % CI ) were assessed . RESULTS The relative CE for treating acute diarrhea was 1.5 ( 95 % CI : 1.50 , 1.52 ) times more when supplemented with zinc and 1.7 ( 95 % CI : 1.69 , 1.71 ) times more when supplemented with Zn + Cu with no additional beneficial effect . CONCLUSION This study showed that zinc or zinc with copper supplementation were not cost-effective in the treatment of acute diarrhea in this study population Objective : Assess the impact of zinc supplementation with locally developed culturally specific educational statements ( messages ) on oral rehydration solution ( ORS ) and antibiotics or antidiarrheal use in children with acute watery diarrhea as well as to assess adherence and side effects of zinc . Methods : This was a r and omized effectiveness trial conducted in outpatient health facilities of six sites in five countries , namely , Fortaleza ( Brazil ) , Addis Adaba ( Ethiopia ) , Cairo ( Egypt ) , Lucknow and Nagpur ( India ) , and Manila ( Philippines ) . Participants were 2,002 children aged 2 to 59 months . Intervention was zinc ( 20 mg orally , once daily for 14 days ) with ORS ( zinc group ) compared with ORS alone ( control group ) . Primary outcomes were  ORS use on day 3 to 5 ; adherence to zinc ; and any use of an antibacterial/antidiarrheal up to day 14 . Results : One thous and ten and 992 children enrolled in zinc and control groups , respectively . Loss to follow-up on days 3 to 5 and 15 to 17 was 1.2 % and 2.8 % in the zinc group and 0.8 % and 1.7 % in the control group . In five of six sites , ORS use in cases with continued diarrhea on days 3 to 5 was the same in the two groups or higher in zinc group . Overall adherence to zinc supplementation was 83.8 % ( 95 % confidence interval [ CI ] 81 - 86 ) . There was no difference in vomiting by group . In consideration of the six countries overall , less antibiotic/antidiarrheal use occurred in the zinc group ( absolute difference , 3.8 % [ 95 % CI 1.7 - 5.9 ] ) . Conclusions : In the management of acute watery diarrhea , zinc plus ORS along with culturally appropriate , site-specific messages in local language does not affect overall  ORS  use generally and decreases antibiotic/antidiarrheal use ; children had good adherence without side effects In a double‐blind , controlled trial with a factorial design , 684 patients ( aged 6 months to 2 y ; excludes 6 early dropouts ) with acute watery diarrhoea of 3 d or less and some dehydration , who were attending a hospital , were r and omly assigned to 4 groups to receive : ( a ) vitamin A 4500 μg retinol equivalent daily for 15 d ; ( b ) 14.2 mg elemental zinc as acetate for the first 417 patients and 40 mg of the remaining 273 patients r and omized to this group for 15 d ; ( c ) both vitamin A 4500 μg retinol equivalent and zinc at the above doses daily for 15 d ; or ( d ) placebo mixtures for 15 d. Patients were observed in the hospital for 24 h and followed up at home for 15 d. All received ascorbic acid 30 mg with each dose of medicine or placebo . Zinc supplementation was associated with a reduced duration of diarrhoea ( 13 % , p= 0.03 ) and markedly reduced rate ( 43 % , p=  0.017 ) of prolonged diarrhoea ( < 7 d ) . Vitamin A supplementation was associated with a nonsignificant trend for reduced rate of prolonged diarrhoea ( p= 0.089 ) . In conclusion , zinc supplementation as adjunct therapy had a substantial impact on the rate of prolonged diarrhoea and some impact on duration and may be beneficial in children with diarrhoea in developing countries Objective : Zinc deficiency is prevalent in children in developing countries . Supplemental zinc provides therapeutic benefits in diarrhoea . Our aim was to evaluate the effect of daily zinc supplementation for 14 days on diarrhoea duration , severity , and morbidity in children . Methods : In a r and omised , open label non-placebo controlled trial , we assessed the efficacy of providing zinc sulfate to 6–60 month old children with acute diarrhoea for 2 weeks followed by 3 months of morbidity surveillance . Children were r and omly assigned to zinc ( n = 150 ) and control ( n = 130 ) groups and received 15–30 mg elemental zinc daily . Results : Supplemented children had significantly improved plasma zinc levels by day 14 of therapy . Zinc deficiency was observed in 2.6 % of the treatment and 3.3 % of the control group . The mean duration of diarrhoea after starting supplementation was 3.02±2 days in the zinc group and 3.67±3.2 days in the control group . There was no significant difference in diarrhoea duration by treatment group ( p>0.05 ) . The number of stools after starting supplementation was 5.8±3.7 and 5.1±3.9 on day 1 , 2.9±1.6 and 3.0±2.2 on day 2 , and 1.8±1.1 and 1.6±0.9 on day 3 in the zinc and control groups , respectively . There was no significant difference in diarrhoea severity by treatment group ( p>0.05 ) . No significant effect was found on the incidence and prevalence of diarrhoea in the zinc compared with the control group . Conclusion : Our data indicate that supplementing children with acute diarrhoea in Turkey with 3 RDA of elemental zinc for 14 days improved neither diarrhoea duration nor severity despite significant increments in plasma zinc OBJECTIVE To determine whether zinc with oral rehydration solution ( ORS ) is more cost effective than ORS alone in the treatment of acute diarrhea .  STUDY DESIGN AND SETTING Cost-effectiveness analysis among patients consulting the emergency room of a government institution . METHOD Cost of treatment and outcome of participants of a r and omized trial of zinc+ORS vs. ORS alone for acute diarrhea were investigated . Included were subjects 2 - 59 months with diarrhea < 7 days and no dehydration . The direct medical , nonmedical and indirect costs were obtained , using the societal perspective . The incremental cost-effectiveness ratio ( ICER ) was calculated . RESULTS Sixty patients were given zinc+ORS  and 57 were given ORS alone .  Mean duration of diarrhea was 17 hours shorter and mean total cost of treatment was 5 % cheaper in the zinc than ORS group . The ICER showed that with use of zinc , the society saves $ 2.4 per day of diarrhea < 4 days and spends $ 0.03 per case of diarrhea averted < 4 days from consult , although the confidence interval included the null value of zero . CONCLUSION Use of zinc with ORS reduced the total cost and duration of acute diarrhea . The ICER suggests cost effectiveness of zinc supplementation but there is a need to further assess the role of zinc supplementation in a larger population A double-blind , r and omized , controlled clinical trial was conducted on 80 malnourished children with acute dehydrating diarrhoea to evaluate the efficacy of oral supplementation of zinc as an adjunct therapy to oral rehydration solution ( ORS ) . After decoding it was observed that 44 children received zinc sulphate ( 177 mg/kg/day in three divided doses equivalent to 40 mg elemental zinc ) in a syrup form and 36 children received only syrup placebo .  Clinical parameters and microbiological findings of stool sample s were comparable in the two groups at the time of enrollment . All the children ( 100 per cent ) in the zinc supplemented group and 32 ( 89 per cent ) children in the placebo group recovered within 5 days of hospitalization ( p = 0.04 ) . The zinc supplemented group had a significantly shorter duration of diarrhoea ( 70.4 + /- 10.0 vs. 103.4 + /- 17.1 h ; p = 0.0001 ) , passed less liquid stool ( 1.5 + /- 0.7 vs. 2.4 + /- 0.7 kg ; p=0.0001 ) , consumed less oral rehydration solution ( 2.5 + /- 1.0 vs. 3.6 + /- 0.8 litre ; p = 0.0001 ) and other liquids ( 867.0 + /- 466.1 vs. 1354.7 + /- 675.6 ml ; p = 0.0001 ) as compared to the placebo group . Our findings suggest that zinc supplementation as an adjunct therapy to ORS has beneficial effects on the clinical course of dehydrating acute diarrhoea Objectives The authors evaluated the effect of zinc treatment as an adjunct to oral rehydration therapy on stool output and diarrheal duration in children with acute noncholera diarrhea with dehydration . Methods This double-blind , r and omized , controlled trial was conducted at two urban hospitals in New Delhi . A total of 287 dehydrated male patients , ages 3 to 36 months , with diarrhea for ≤ 72 hours were enrolled . They were assigned to zinc or placebo by a r and omization scheme stratified by age ( ≤ or > 12 months ) and weight for height ( 65%–80 % or > 80 % National Centre for Health Statistics median ) . Participants in the zinc group received 15 mg ( ≤12 months ) or 30 mg ( > 12 months ) elemental zinc daily in three divided doses for 14 days . The main outcome measures were stool output and diarrheal duration . Results Zinc treatment reduced total stool output ( ratio of geometric means , 0.69 ; 95 % confidence interval [ CI ] : 0.48 , 0.99 ) and stool output per day of diarrhea ( ratio of geometric means , 0.76 ; 95 % CI : 0.59 , 0.98 ) . The risk of continued diarrhea was lower ( relative hazards , 0.76 ; 95 % CI : 0.59 , 0.97 ) and the proportion of diarrheal episodes lasting ≥ 5 days ( odds ratio , 0.49 ; 95 % CI : 0.25 , 0.97 ) or ≥ 7 days was less ( odds ratio , 0.09 ; 95 % CI : 0.01 , 0.73 ) in the zinc group . Conclusions This study demonstrates a beneficial effect of zinc administered during acute diarrhea on stool output , diarrheal duration , and proportion of episodes lasting more than 7 days . The effects are large enough to merit routine use of zinc during acute diarrhea in developing countries Our objective was to evaluate the effect of zinc and copper supplementation in  acute diarrhea  on morbidity and growth during 12 weeks of follow-up . In a double-blind r and omized controlled clinical trial of 724 children aged 6–59 months , none of the 11 evaluated outcomes showed significant association with zinc or zinc and copper supplementation . Thus , therapeutic zinc supplementation may not always yield short-term benefits Objectives : We assessed the effect of zinc for the treatment of diarrhoea implemented at the community level on physical growth among children 6 to 35 months of age . Methods : The service areas of 30 community health workers in the Matlab field site of International Centre for Diarrhoeal Disease Research , Bangladesh , were r and omly allocated to the intervention or comparison study arm . Between November 1998 and October 2000 , caretakers of 3- to 59-month-old children with diarrhoea in both intervention and comparison areas were offered oral rehydration solution and feeding advice , and severe episodes were referred for facility-based care . The caretakers of the children in the intervention area were additionally offered 20 mg/day elemental zinc for 14 days as adjunct treatment for each diarrhoea episode . Weight and length of children who were 6 to 11 months of age at the beginning of the study were measured every 2 months for 2 years . Rates of length and weight gains were compared between children living in intervention and control arms using a latent growth model . Results : Characteristics of children living in control and intervention areas were similar , except that more children living in intervention areas were underweight at baseline ( 44 vs 35 % ; P = 0.02 ) . Children living in intervention clusters gained slightly more weight and length than children in the control clusters ( 86.4 g/year and 2.8 mm/year , respectively ) . Conclusions : The therapeutic use of zinc along with oral rehydration solution for community-based diarrhoea management may have a small positive benefit on the rates of growth among children younger than 3 years of age
target: Diarrhea prevalence on days 3 , 5 , and 7 was lower in the zinc group .
  The incidence of vomiting was significantly greater in the group that received zinc than in the control group .
  CONCLUSIONS Oral zinc supplementation significantly decreases diarrhea duration and has a greater effect on malnourished children .
background: OBJECTIVE To up date the available evidence about zinc use for treating diarrhea in children and to assess its effect on the malnourished population , a subgroup that has not been fully explored in previous analyses .