COMPARATIVE STUDY OF EFFICIENCY OF ZINC INTEGRATION IN ACUTE DIARRHEA

Shahin Ali Dabour 1 ,Yasser Mahmoud Esmail 2 , Effat Hussien Assar 3 and Mona Fawzy Abd Elmaksood 4 . 1. Shahin Ali Dabour Prof.of Pediatric at Benha university 2. Yasser Mahmoud Esmail Prof.of clinical Pathology at Benha university 3. Effat Hussien Assar Lecturer of Pediatrics at Benha university 4. Mona Fawzy Abd Elmaksood Pediatrician at Benha fever Hospital ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


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WHO has estimated that rotavirus infection was responsible for 37% of diarrhea-related deaths in children < 5 years in 2008.(5).
The aim of management is to help the child to maintain or regain hydration and to recover from diarrhea with careful attention to adequate oral rehydration and judicious re-feeding .(6) Preventive elements included Rota and measles vaccination, promotion of early and exclusive breast-feeding with vitamin A supplementation, promotion of hand washing with soap, improvement of water supply including treatment and safe storage of household water, and promotion of community-wide sanitation.(7) Supplementations with zinc and probiotics have been shown to reduce severity and duration of diarrhea; however evidence does not support the use of antisecretary, antimotility and binding agents.Education of parents about hand hygiene, safe weaning and safe drinking water etc., can help in reducing incidence of this important health problem .(8 Zinc supplementation is a critical new intervention for treating diarrheal episodes in children.Recent studies suggest that administration of zinc along with oral rehydration solutions (ORS) can reduce the duration and severity of diarrheal episodes for up to three months .(9)

Aim of the work:-
To show the efficiency of different forms of zinc supplementation in comparison to ORS without zinc in treatment of acute diarrhea in children.

Patient and method:-
This study was carried out on cases admitted at pediatric department at Benha Fever Hospital.The study was done on 100 0f infant/ children with acute diarrhea.These patients were with some dehydration according to World health organization criteria.It include two groups study group:Consists of 80 infant /children of both sexes with acute diarrhea They was subdivided into two subgroups:Group (1): 40 infants/children with acute diarrhea and received zinc syrup (sulfozinc).(Thezinc supplement bottle containing zinc sulphate equivalent to 10mg/5ml of elemental zinc) given 10mg/ day for patient 6 months or less and 20mg/ day for patients above 6 month.Group (2):40 infants/children with Acute diarrhea will receive ORS with zinc (Rehydro-zinc sachets, which every sachet contains 11 mg zinc acetate anhydrous).Each sachet dissolved in 200 ml water child received 10ml/kg after every defection .and so each patient received 2 -8 mg zinc according to weight after each defecation.controlgroup(Group(3): 20 infants/children presented with diarrhea will receive ORS (Hydrosafe sachet),.Each sachet dissolved in 200 ml water .child received 10 ml/kg after every defecation.All patient were subjected to detailed history taking ,full clinical examination and i nvestigation include serum zinc level ,ABG( arterial blood gas),CRP(C-reactive protein),Serum sodium ,potassium, both sexes are included.and excluded from this study Infant/Children with any gastrointestinal abnormalities.infant/Childrentaking zinc for therapeutic purposes Data Analysis:-The collected data were tabulated and analyzed using SPSS version 16 soft ware (Spss Inc, Chicago, ILL Company).Categorical data were presented as number and percentages while quantitative data were expressed as mean ± standard deviation, and range.Chi square test ( X2), or Fisher's exact test (FET), were used to analyze categorical variables.Quantitative data were tesxxted for normality using Kolomogrov Smirnove test, using Paired "t" test and ANOVA if normally distributed, or Krauskal Wallis test (KWT) if not normally distributed.Significant ANOA was followed by posthoc multiple comparisons using Bonferroni test to detect the significant pairs.The accepted level of significance in this work was stated at 0.05 (P <0.05 was considered significant.

Result:-
Regarding the demographic criteria of our study population there were 21 male,19 female for group (1) , 21 male,19 female for were( 2)8 male,12 female for group (3)   Mean frequency of diarrhea post treatment

Discussion:-
Diarrhea is defined as acute when lasting for 14 days or less, but when diarrhea lasts for 30 days or more, it is considered chronic diarrhea.(10) Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days (11).
Rotavirus, norovirus, adenovirus, and astrovirus are known to cause viral gastroenteritis (12) Introduction of zinc to community programs resulted in increased use of oral rehydration solution (ORS), decreased use of unnecessary antibiotics, and a reduced need for medical visits for acute diarrhea (13).
In our study, the serum zinc level at admission and before treatment in children with acute diarrhea in group  2009) disagreed with our study as their study found no significant difference in mean diarrhea duration between first group received zinc and second received ORS as in their study mean diarrhea duration (1.5± 0.9 vs 1.4 ± 0.7; p>0.05) as their study done on 808 of childrent aged 6-59 month

Conclusion:-
From our study ,it could be recommended that: Supplementation of zinc useful for treating acute diarrhea as it reduce duration , frequency of diarrhea in children /infant with acute diarrhea.