Zinc treatment

Featured resources

Clinical management of acute diarrhoea (2004)
World Health Organization (WHO), UNICEF
This official statement updates previous WHO/UNICEF recommendations on the management of acute diarrhea, taking into consideration new research findings that indicate the success of interventions incorporating reduced-osmolarity ORS and zinc supplementation.

Diarrhoea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers (2005)
US Agency for International Development (USAID) Micronutrient Program
These guidelines were developed to advise clinic-based health workers on implementing the latest WHO/UNICEF recommendations for ORS and zinc supplementation in the clinical management of diarrhoea.

Guidelines for new diarrhea treatment protocols for community-based healthcare workers (2005)
USAID Micronutrient Program
These guidelines were developed to advise community health care workers who assist parents with home treatment of children with diarrhea with regard to the latest WHO/UNICEF recommendations.

Implementing the new recommendations on the clinical management of diarrhoea - guidelines for policy makers and programme managers (2006)
WHO
This manual advises policy makers and program managers on implementing and/or scaling up use of the new ORS formulation and zinc supplementation for the clinical management of diarrheal disease, as recommended by WHO and UNICEF.

Literature on zinc research (2006)
International Centre for Diarrhoeal Disease Research, Bangladesh
A comprehensive list of research articles and related literature on the benefits of zinc supplementation, including information on the use of zinc for children in developing-country settings.

Zinc publications and reference materials
USAID Micronutrient Program
Stemming from years of work conducted through the USAID program aimed at exploring the health benefits of zinc supplementation, this website contains many helpful resource and research materials.

General information

The role of zinc in child health (2004)
The International Zinc Nutrition Consultative Group
This report provides an overview of the rationale for providing zinc supplements to reduce severe diarrheal episodes and as an overall intervention for child health in the developing world.

Zinc: From research to programs (2004)
USAID Micronutrient Program
This presentation summarizes research findings on the effects of zinc supplementation on diarrhea and also discusses advances in policy addressing diarrhea treatment.

Treatment guidelines

Introducing zinc in a diarrheal control program: A manual for conducting formative research (revised 2004)
Nichter M, Acuin C, Vargas A.
Originally developed to inform a multicenter zinc trial in Asia and Africa, this guide is a useful resource for planning zinc intervention trials, as well as the introduction of zinc and other supplements and/or medicines into clinic or community settings.

Monograph for zinc sulfate tablets (2005)
US Pharmacopeia
This proposed monograph is under consideration by the US Pharmacopeia to ensure quality manufacturing standards for zinc tablets.

The Treatment of diarrhoea: A manual for physicians and other senior health workers (2005)
WHO
Developed for physicians treating infectious diarrhea in young children, this manual has been updated to include guidelines for the use of reduced-osmolarity ORS and zinc supplements.

Zinc supplementation for the treatment of diarrhea: Moving from research to practice (2005)
USAID Micronutrient Program
This report provides a brief history of ORS and the inclusion of zinc supplementation; outlines case studies proving the benefits of zinc for diarrhea treatment; and discusses programmatic challenge points.

Research

Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries (2004)
Robberstad B, Strand T, Black R, Sommerfelt H. Bulletin of the  World Health Organization. 82(7):523-531. 
This study analyzed the cost-effectiveness of adding zinc to diarrheal disease treatment interventions, as compared to the cost-effectiveness of oral rehydration solution as a stand-alone treatment.

Effect of zinc supplementation between 1 and 6 mo of life on growth and morbidity of Bangladeshi infants in urban slums (2002)
Osendarp S, Santosham M, Black R, Wahed M, van Raaij J, Fuchs G. American Journal of Clinical Nutrition. 76(6):1401–1408.
The authors of this study evaluated the effect of zinc supplementation on growth and morbidity in poor Bangladeshi infants.

Effect of zinc supplementation on clinical course of acute diarrhoea (2001)
Bahl R, Baqui A, Bahn M, et al. Journal of Health, Population and Nutrition. 19(4):338-346.
This report reviews published studies addressing the efficacy of zinc supplementation in reducing severity of diarrheal disease episodes. The report concludes that sufficient evidence supports the use of zinc supplementation and also encourages further study.

Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children (2002)
Strand T, Chandyo R, Bahl R. Pediatrics. 109(5):898–903.
This study in India evaluated the administration of three Recommended Daily Allowances of zinc among children with acute diarrhea in Nepal and recorded substantial reduction of diarrheal duration. The investigators also determined that the effect of zinc was not dependent on or enhanced by concomitant vitamin A administration.

Formative research in preparation for promotion of zinc treatment for childhood diarrhea: Cross-country comparison of diarrhea treatment practices and implications for programs (2004)
Winch P, FitzGerald M. USAID Micronutrient Program
This summary of research was prepared for a discussion of global planning to implement zinc for diarrheal treatment, held at the 2004 meeting Planning for Implementation of Zinc for Treatment of Diarrhea.

Lessons learned in a pilot introduction of zinc treatment for childhood diarrhea in Bougouni District, Mali (2005)
Gilroy K, Kuszmerski N, Winch P. USAID
Geared toward program planners and managers who are considering introducing
zinc treatment for diarrhea into existing child health and nutrition interventions, this report discusses key lessons learned through a pilot project and offers conclusions and recommendations for future zinc programs.

Low risk of adverse effects from zinc supplementation (2005)
Fischer C, Harvey P. USAID Micronutrient Program
This brief reviews evidence on the safety of zinc supplementation in children, including reports of adverse effects from both long-term and short-term studies, and concludes that zinc is a safe and effective treatment for diarrhea.

A meta-analysis of the effects of oral zinc in the treatment of acute and persistent diarrhea (2008; abstract only)
Lukacik M, Thomas R, Aranda J. Pediatrics. 121(2):326-336.
The authors reviewed 22 studies of zinc's effect on persistent or acute diarrhea and found that zinc reduced the severity and duration of diarrheal episodes.

Qualitative research for a zinc treatment program in Nepal: findings and recommendations (2006)
Point-of-Use Water Disinfection and Zinc Treatment (POUZN) project
This report summarizes surveys to evaluate knowledge among caregivers and health workers on awareness of zinc as a treatment for diarrhea and provides recommendations for behavioral change messages to convey the concept of zinc as a diarrhea treatment.

Randomized control trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhea (1997)
Roy SK, Tomkins AK, Akramuzzaman SM, Haider R, Mahalanabis D, Fuchs G. Archives of Disease in Childhood. 77:196–200.
This study determined that zinc supplementation is a safe and effective method for management of acute diarrhea in children who are malnourished.

Social marketing zinc to improve diarrhea treatment practices: findings and lessons learned from Cambodia (2007)
POUZN project
This document provides results and lessons learned from a pilot project to market zinc and low-osmolarity ORS in the private sector of two districts in Cambodia. Findings suggest that the program is effective at increasing the use of ORS and zinc, particularly among low-income, rural, and semi-urban populations.

Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young North Indian children (2002)
Bhandari N, et al. Pediatrics. 109(6):e86.
This study concluded that episodes of severe diarrhea were significantly reduced when daily zinc supplements were provided to children. The authors also call for reliable estimates of zinc deficiency levels among children in developing countries, in order to facilitate intervention with zinc supplementation.

Therapeutic and preventive effects of zinc on serious childhood infectious diseases in developing countries (1998)
Black R. American Journal of Clinical Nutrition. 68(suppl):476S–479S.
This review provides details on the therapeutic and preventive effects of zinc supplementation on diarrheal disease episodes, as evidenced by published studies. The author also briefly discusses the effects of zinc on malaria and acute lower respiratory infections.

Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis of randomized controlled trials (2000)
Zinc Investigators’ Collaborative Group, American Journal of Clinical Nutrition. 72:1516-1522.
The authors of this review performed a comprehensive analysis of published studies to determine the efficacy of zinc supplementation given during episodes 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 (abstract only; 2006)
INCLEN Childnet Zinc Effectiveness for Diarrhea (IC-ZED) Group. Journal of Pediatric Gastroenterology & Nutrition. 42(3):300-305.
This study determined that adding zinc to management of acute watery diarrhea does not affect overall ORS use and decreases use of antibiotics and other antidiarrheal medicines.

Zinc therapy for diarrhoea increased the use of oral rehydration therapy and reduced the use of antibiotics in Bangladeshi children (2004)
Baqui A, Black R, El Arifeen S, et al. Journal of Health, Population and Nutrition; 22(4):440-442.
This study conducted by partners from the Johns Hopkins School of Public Health and the International Centre for Diarrhoeal Disease Research concluded that use of zinc supplementation during diarrheal episodes led to a reduction in the use of antibiotics, overuse of which has been shown to increase antimicrobial resistance in developing countries.