The effect of zinc supplementation in children under three years of age with acute diarrhea in Indonesia

Diarrheal diseases continue to be an important cause of childhood mortality in Indonesia. Diarrhea leads to excess zinc losses and could contribute to zinc deficiency. Zinc deficiency in particular is known to limit regeneration of gut epithelium and consequently to delay recovery from diarrhea. To evaluate the effect of zinc supplementation in children on the duration of diarrhea we conducted a randomized, double blind, controlled trial. The treatment group received syrup incorporating zinc acetate providing 4-5 mg elemental zinc/kg body weight/day in two divided doses for the consecutive days during diarrhea. The control group received syrup without elemental zinc. One thousand one hundred and eighty five children under three years of age were visited at home every week for 12 months. During observations there were 2410 diarrheal episodes, 131 (5.4%) were excluded due to lack of information. Among children of zinc supplementation group there was an 11% reduction (95% confidence intervals 3 to 18%) in the risk of continued diarrhea. In children with watery diarrhea there was a decrease of 12% (95% confidence intervals 3 to 21%) in the number of days in the zinc supplementation group. Children who had ≥ 3 episodes during 12 months observations had a greater reduction in diarrheal duration (hazard ratio in the zinc supplementation group = 0.79; 95% confidence intervals 0.64 to 0.97). Zinc supplementation in children with acute diarrhea significantly reduced the duration of diarrhea. Reduction in the number of days may decrease the risk of dehydration and mortality due to diarrhea.