PSI presentation

1. WHAT IS ZINC?
What are it’s benefits?

2. What is Zinc?
• Zinc is a micro-nutrient and promotes immunity.
• It is an important antioxidant and preserves cellular membrane
integrity.
• Promotes the growth and development of the nervous system.
• Rich sources of Zinc are foods of animal origin, such as meat and
fish.
• Zinc is also present in nuts, seeds, legumes, and whole grain
cereal, but the high phytate content of these foods interferes with its
absorption.
• Zinc cannot be stored in the body, and zinc excretion through the
gastrointestinal tract is increased during episodes of diarrhea.
• Young children who have frequent episodes of
diarrhea and have diets low in animal products and
high in phytate-rich foods are most at risk of Zinc
deficiency.

3. ZINC- Benefits
• Zinc reduces the fluid and salt loss in stools by
improving mucosal permeability.
• Accelerated regeneration of mucosa
• Increased levels of brush-border enzymes
• Enhanced cellular immunity
• Higher levels of secretory antibodies
• Zinc improves absorption of ORS.
• Reduces the severity and duration of illness.
• Reduces need for antibiotics.
• Reduces the chances of complications.
• Full dose for 14 days protects against diarrhea and
pneumonia for next 3 months.
• Acts as a general tonic-improves appetite and
promotes growth.

4. Research Studies on
efficacy of Zinc
• A study conducted by an international team of scientists
working in Bangladesh and led by researchers from the
Johns Hopkins Bloomberg School of Public Health.
• The researchers treated 8,070 children with diarrhea
living in areas of Bangladesh.
• Groups of children were randomized by region to receive
zinc in addition to standard treatments and compared to
children who did not receive zinc.
• The children in the zinc areas received 20 mg elemental
zinc daily for 14 days during each episode of diarrhea in
addition to ORS therapy.

5. Research Studies-
Contd.
• The researchers found the incidence of diarrhea was
significantly less and non-injury deaths were 50 percent
less in children who received zinc compared to those
who did not.
• In addition, it was found that oral rehydration
solution therapy (ORS) use, which is one of the
standard treatments for diarrheal disease, increased by
20 percent among the children who received zinc.
Antibiotic use decreased by 60 percent among the same
group. These findings are published in the November 9,
2002, of the British Medical Journal.

6. Evidence of Efficacy of
ZINC
• 15% faster recovery during the episode of diarrhea*.
• 16 % decrease in duration of diarrhea*.
• 24% decrease in frequency of episodes lasting more
than 7 days*.
• 9-23% decrease in frequency of stools*.
• Up to 31% reduction in stool output during the episode
of diarrhea**.
• 42% reduction in treatment failure or death in persistent
diarrhea
*ACUTE CHILDHOOD DIARRHEA: A REVIEW OF RECENT ADVANCES IN THE STANDARD MANAGEMENT
Seema Alam, Rajeev Khanna, Uzma Firdaus
Pediatric Gastroenterology Section, Department of Pediatrics, JNMC, AMU, Aligarh
**Zinc with ORT reduces the stool output and duration of diarrhea in hospitalized children -a randomized controlled trial;S Bhatnagar et al, Dept
of Paediatrics
at AIIMS and Kasturba Hospital ,New Delhi
***Zinc Investigators’ Collaborative Group. AJCN 2000.

7. Long Term Effects of Zinc
• Zinc supplementation for 10-14 has
longer term effects on childhood
illnesses in the 2-3 months after
treatment
• 34% reduction in prevalence of
diarrhoea
• 26% reduction in incidence of
pneumonia
Zinc Investigators’ Collaborative Group. Pediatrics. 1999.

8. Cost Effectiveness of ORS and
Zinc Supplementation
• Decreases the duration and severity of the
episode
• Decreases the need for expensive
hospitalization
• Decreases the use of unnecessary
antibiotics and other drugs
• Further cost-benefit analyses are
underway
Robberstad, Strand, Sommerfelt, and Black. Bull WHO 2004.
Baqui, Black, Arifeen. J Health Pop Nutr. 2004.

9. Current total costs of treating a
case of diarrhea higher than the
cost of Zinc treatment
Reported total costs of
treating a case of diarrhea,
Location for differing levels of
of perceived severity
treatmen Mild Moderate Severe
t
At home <Rs. 50 Rs. 50-100
ORS sachets are sold for Rs 5-7 in the private sector ($0.10-$0.14). Zinc treatment for 10-14 day
regimen costs ~Rs.28-33 in the private sector ($0.56-$0.66)
Source: Formative research in preparation for promotion of zinc treatment for childhood diarrhea:
Cross-country comparison of diarrhea treatment practices and implications for programs; June
2004
Private Rs.100-200 Rs. 300-500 Rs.500-1500

10. Dosage of Zinc
• Available as ZINC Tablets.
• Given for 14 days for full benefits.
• 20 milligrams per day for children older
than six months.
• 10 mg per day in those younger
than six months.

11. Administration of
ZINC
Age Tablet Preparation Duration
Less than 2 Not required
months
2 months – 6 ½ tablet Dissolved in 1 14 days
months (10 mg) tsp of breast
milk
6 months- 5 1 tablet Dissolved in 1 14 days
years (20 mg) tsp of breast
milk/ORS/clean
drinking water