Role of Oral Zinc Supplementation in treatment of Acute Dehydrating Diarrhea in age 6 months to 5 years

Background: Oral Rehydration Salt (ORS) is the standard recommended treatment for acute dehydrating diarrhea but it has very little role in decreasing stool frequency and volume. Current studies recommend oral supplementation of zinc as an adjunct to ORS in treating acute dehydrating diarrhea of children especially those who are at risk of zinc deficiency and malnutrition. Aim: To determine the effect of oral zinc supplementation on duration of acute diarrhea and intake of ORS in children between 6 months and 5 years of age. Settings: Tehsil Head Quarters Hospital, Besham District Shangla, Khyber Pakhtunkhwa from October 2019 to September 2020. Methodology: The study was double blinded Randomized Control Clinical Trial in children aged between 6 months to 5 years of age. A total of 90 children were included in the study. In addition to rehydration, 45 children were given oral zinc (20mg daily) while 45 children were given placebo. Results: All 45(100%) patients in zinc group and 39(86.6%) patients in placebo group recovered after 5 days of treatment. Zinc group had significantly reduced duration of diarrhea (68.3±9.4 vs. 99.8±15.2 hours) and consumed less ORS solution (2.3±0.8 vs. 3.4±1.1 liters) as compared to placebo group. Conclusion: It is concluded from this study that oral zinc supplementation in addition to ORS in treating acute dehydrating diarrhea of children has better effect on the clinical course of disease. Key words: Diarrhea, ORS, Zinc, Dehydration.

Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria

Background Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period. Methods Baseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities. Results At baseline, 28% (95% CI: 22–35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52–58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P < 0.001) for the poorest and 17%-points (P < 0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35–41%) compared to 29% (95%CI, 25–33%) in the urban. Conclusion The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

Awareness of quantity of ORS and Zinc among mothers of under five children with diarrhoea at a tertiary care Centre Lahore

Objectives: To assess mothers’ knowledge about quantity of ORS and zinc in management of diarrhoea. Methods: Cross sectional study conducted over a period of 4 months from May 2019 to August 2019 among mothers accompanying under five children admitted in the diarrhoea ward of The Children’s hospital Lahore for rehydration and included 334 children age 2 months to 59 months. Data was collected regarding age, sex, residence, number of children in house hold, socioeconomic status, maternal literacy status, mother’s awareness of signs of dehydration in diarrhoea, familiarity with the term oral rehydration salt (ORS) as regards its correct preparation and administration and Zinc supplementation in diarrhoea. Conclusion: Majority mothers were aware of ORS and doctors were the main source of information. Many knew the correct role of ORS in diarrhoea and its method of preparation as sachet pack was the most commonly used type. Although ORS use rate was high, but most mothers were unaware of quantity of ORS to be given. Zinc use in diarrhoea was very low in our study. Keywords: Awareness, ORS, Zinc, Diarrhoea.

NAD+, Senolytics, or Pyruvate for Healthy Aging?

In last decades, healthy aging has become one of research hotspots in life science. It is well known that the nicotinamide adenine dinucleotide oxidized form (NAD+) level in cells decreases with aging and aging-related diseases. Several years ago, one of NAD+ precursors was first demonstrated with its new role in DNA damage repairing in mice, restoring old mice to their physical state at young ones. The finding encourages extensive studies in animal models and patients. NAD+ and its precursors have been popular products in nutrition markets. Alternatively, it was also evidenced that clearance of cellular senescence by senolytics preserved multiorgan (kidney and heart) function and extended healthy lifespan in mice. Subsequent studies confirmed findings in elderly patients subjected with idiopathic pulmonary fibrosis. The senolytic therapy is now focused on various diseases in animal and clinical studies. However, pyruvate, as both a NAD+ substitute and a new senolytic, may be advantageous, on the equimolar basis, over current products above in preventing and treating diseases and aging. Pyruvate-enriched fluids, particularly pyruvate oral rehydration salt, may be a novel intervention for diseases and aging besides critical care. Albeit the direct evidence that benefits healthy aging is still limited to date, pyruvate, as both NAD+ provider and senolytic agent, warrants intensive research to compare NAD+ or senolytics for healthy aging, specifically on the equimolar basis, in effective blood levels. This review briefly discussed the recognition of healthy aging by comparing NAD+ and Senolytics with sodium pyruvate from the clinical point of view.

Mothers’ perception and management preference of acute diarrheal disease

Globally, diarrheal disease is one of the leading causes of morbidity and mortality among under-five years of children. Every day, approximately 2195 children die due to diarrheal diseases, which accounts for 1 in 9 child deaths worldwide. Many interventions that attempt to reduce childhood diarrhea are often fail because they are programed without understanding the problem in the target community and are culturally unsuitable. Therefore, this study aimed to assess perception and management preference of acute diarrheal disease among mothers who attend under five clinics. An institution based descriptive cross sectional study was conducted from May 1-May 30/2019. A total of 276 respondents were included in the study and consecutive sampling technique was used to identify the study participants. The results show that 47% of respondents perceive childhood diarrhea is caused by teething, 47.8% of the respondents perceive that diarrhea cannot be transmitted from one child to other. Majority of care givers prefer to give home remedies to their child, and also a substantial proportion of mothers and caregivers were not adequately knowledgeable on the use of oral rehydration salt which resulted in many of them using traditional medicine. There is need for increased health education focused on increasing caregivers‟ knowledge about the cause of diarrhea and enhancing adoption of appropriate prevention practices of diarrhea among children under five years.

Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS and Zinc Scale-up Program in Eight States Across Nigeria

Background: Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. However, it has been argued that initiatives that engage the private sector may worsen inequities due to their profit motive.Methods: Changes in disparities in the coverage of ORS and zinc treatments by socioeconomic strata and geographical location were assessed using data from cross-sectional baseline and endline surveys.Results: At baseline, 28% (95% CI: 22 - 35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52 - 58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P = 0.000) for the poorest and 17%-points (P = 0.000) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration index declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35 - 41%) compared to 29% (95%CI: 25 - 33%) in the urban.Conclusion: The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

Gambaran Balance Cairan Pada Anak Diare Setelah Diberikan Pemenuhan Kebutuhan Cairan di Rumah Sakit Kaliwates Jember

Diarrhea is a global event in various countries, including in many developing countries. Management of diarrhea is to use fluid rehydration. Other diarrhea management can be used with supplements, using Oral Rehydration Salt (ORS), using medication from the doctor, and drinking lots of water to replace lost fluids. This study aims to determine how to describe the fluid balance in children with diarrhea after being given the fulfillment of fluid needs in the hospital. The research was conducted at Kaliwates Hospital in Jember, with the research time used by researchers was one month. The sample of this study was thirty-two children of diarrhea patients with mild, moderate, severe dehydration. Data collection was carried out for three days while the child is hospitalized. The result of this study was obtained from total sampling. It was obtained that the fluid balance in diarrhea children did not all turn into balance. There was excess fluid, and they still experienced dehydration. From the research data, it was found that most of the experience of extra fluid status. The study concludes that after rehydration, children have an increasing fluid status. Fulfillment of fluids in children with diarrhea aims to reduce the risk of decreased fluid and maintain body fluids when they lose fluid through liquid feces. Fluid balance makes people's body became immune to the disease.

Zinc Supplementation and Recurrent Diarrhea in Children in Primary Health Care

<div class="WordSection1"><p align="center"><strong>ABSTRACT</strong></p><p><strong> </strong></p><p>The high rate of infant morbidity and mortality due to diarrhea is still a focus on children's health. In addition to Oral Rehydration Salt (ORS), zinc is a supplement needed to treat diarrhea. As long as the child has diarrhea, the body will lose zinc, so that additional zinc is needed to accelerate the healing process of diarrhea. Zinc is an important micronutrient in the growth of children and is able to prevent diarrhea 2-3 months after diarrhea. The previous study showed that most mothers do not give zinc to diarrhea children (59.3 %), thus there are still many recurrent diarrhea in children. Objective of study to determine the relationship between zinc supplementation in children with diarrhea and the incidence of recurrent diarrhea at Kasihan Primary Health Care, Bantul. We used descriptive correlational with a retrospective approach. The number of respondents was 47 children under five years (0-59 months) with diarrhea who were taken to primary health care and received zinc therapy. The sampling technique was carried out by purposive sampling. Data collection was performed by filling out the questionnaire by visiting the respondent's house (home visit). The result of the contingency coefficient showed p= 0.013 (p &lt; 0.05) which means that there was a statistically significant relationship between zinc supplementation and the incidence of recurrent diarrhea. The closeness of the relationship between the two variables was indicated by the correlation coefficient value of 0.342 which was in a moderate relationship. There is a correlation between giving zinc supplementation to children with recurrent diarrhea in Primary Health Care</p><p> </p><p><strong><br /></strong></p></div>