ORS prevents dehydration, corrects electrolyte imbalance and reduces the morbidity and mortality in diarrhoea.

Zinc is an important micro-nutrient. The effect of zinc therapy in diarrhoea is as follows:

1. Bhandari N et al assessed the impact of daily zinc supple-mentation on the incidence of severe and recurrent diarrhoea in a double blind randomised controlled trial. They found that the incidence of diarrhoea during follow-up was lower in the zinc supplemented group as compared with the placebo group as well as the there was decreased incidence of prolonged diarrhoea in the zinc supplemented group.

2. Roy SK et al demonstrated in a double blind randomised controlled trial that children with diarrhoea receiving zinc in addition to multivitamins had lesser stool output and shorter duration of diarrhoea

3. A study from India by Sazawal et al has shown a 7% reduction in the proportion of episodes lasting more than seven days if zinc supplementation was given within 3 days of the onset of diarrhoea

4. Another study from India has reported that children receiving 40 mg of elemental zinc daily during acute diarrhoea responded with a shorter duration of diarrhoea than a control group

5. In Mexican preschool children, zinc supplementation reduced diarrhoeal morbidity

6. In a study in Bangladesh, weekly zinc supplementation over a period of 1 year reported fewer incidents of pneumonia and diarrhoea in the zinc group than the control group

7. Bhatnagar et al demonstrated that zinc with ORS reduces stool output and duration of diarrhoea in hospitalised children in a randomised controlled trial in 287 children

8. In a study in Kolkata, India, zinc supplementation to low birth weight infants reported lesser diarrhoeal episodes in the zinc supplemented group versus the placebo group suggesting a beneficial impact on the incidence of diarrhoea among low birth weight infants

9. In a study in Turkey, mean duration of diarrhoea was shorter in the zinc supplemented group as compared to the placebo group

10. Another study from India demonstrated that there was reduction in diarrhoeal morbidity in zinc supplemented group whether given daily or in a weekly schedule

11.Studies conducted at the ICDDR,B from basic to applied research, have helped to build an evidence base for integrating zinc treatment into current child health practice and policies. This is supported by the revised, joint WHO/Unicef recommendations to include zinc in the management of all acute or persistent cases of diarrhoea in children under five years of age.

Clinical Management of Acute Diarrhea 2004 (WHO and Unicef joint statement) state that in addition to ORS, zinc supple-mentation should be given for 10-14 days in dose of 20 mg/day (10 mg/day for infants under six months) to curtail the severity of the acute diarrhoea and prevent further occurrences in the ensuing 2-3 months.

There is sufficient evidence to recommend zinc in the treatment of acute diarrhoea as adjunct to oral rehydration saline. However ORS remains the mainstay of therapy during acute diarrhoea and zinc has an additional modest benefit in the reduction of stool volume and duration of diarrhoea as an adjunct to ORS.

ICDDR,B has a research based project on Zinc, SUZY, Scaling Up Zinc Treatment For Young Children on diarrhoea.

The ultimate objective of the SUZY project is to implement a zinc treatment scheme that will reach all children, but most importantly those in greatest need - the poor and undernourished.

After many years of research, ICDDR,B decided that the effectiveness and benefits of zinc as a treatment for childhood diarrhea have been sufficiently proven.

The SUZY project will provide zinc treatment for diarrhoea on a large scale, targeting the entire under-five-year-old population of Bangladesh. It has been estimated that zinc treatment could save the lives of 30,000 to 75,000 children per year in Bangladesh alone.

On a global scale, the addition of zinc treatment to the management of childhood diarrhoea could save the lives of almost 400,000 children each year.

But in recent days, by the virtue of media campaign of zinc supplement, more emphasis has been given on zinc therapy than ORS.

Recently I received few patients of acute watery diarrhoea with severe dehydration. While taking history, I found that mother of the children gave zinc tablet to their kids everyday and they forgot about giving ORS. These less educated or illiterate mother by watching TV think that zinc supplement is a new regimen to treat diarrhoea and simply forget to give ORS.

So my humble suggestion to the advertising companies is to put emphasis on ORS in the advertisements mentioning that ORS is the mainstay of diarrhoeal treatment and zinc is the supplementary therapy.

Hope concerned authority will take the matter in to cognizance.

Dr M Karim Khan is an Associate Professor of Paediatrics in Community Based Medical College (CBMC) Mymensingh. [E mail- [email protected]]