Background

Diarrhea is a major cause of morbidity and mortality in low-to middle-income countries. Along with appropriate rehydration regimens, coadministration of zinc supplement is also recommended for the treatment of diarrhea. Although Kenyan pediatric treatment protocols recommend the use of zinc supplement for all children with diarrhea, its benefit among young children aged 1-5 months and those who are well-nourished still remain unclear.

Aim

To determine the effectiveness of zinc supplementation for children with different nutritional and age categories, hospitalized for diarrhea

Patient Profile

• Children (age 1-59 months) with diarrhea, admitted to 14 public hospitals in Kenya (n=15055)

Methods

Study Design

• Observational study

Study Groups and Treatment Strategies

Outcomes

• To ascertain the impact of zinc treatment on time to discharge in the study groups

Results

• Nearly 60% of the study population was discharged by fifth day of their hospitalization.
• Mortality was 9% in age group 1-5 months and 5% in age group 6-59 months (Table 1).

• Children prescribed zinc were discharged from the hospital sooner as compared to those not prescribed zinc. The estimated sub-distribution hazard ratios (SHR) for being discharged in the zinc group were 1.25 (95% confidence interval (CI) = 1.07, 1.46) for children aged 1-5 months and 1.17 (95% CI = 1.10, 1.24) for those aged 6-59 months.
• As per a pooled analysis conducted across the two age groups, the overall effectiveness of zinc was 1.17 (95% CI = 1.11, 1.24), indicating that a child being prescribed zinc had on average a 17% higher chance of being discharged at any point in time than a child not prescribed zinc.
• Zinc treatment was associated with shorter time to discharge in both well and under-nourished children.

Conclusion

• Zinc supplement may reduce the time to discharge for children aged 1-59 months, hospitalized for diarrhea, irrespective of their nutritional status.
• The findings support the continued use of routine zinc supplementation in all children aged 1-59 months hospitalized with diarrhea in Kenya and probably elsewhere in Africa.

J Glob Health. 2019 Dec;9(2):020416. doi: 10.7189/jogh.09.020416.