How will the scaling up of zinc for treatment of childhood diarrhoea affect caretakers' practices?

Correspondence and reprint requests should be addressed to: Dr. Charles P. Larson Director, Health Systems and Infectious Diseases Division ICDDR,B: Centre for Health and Population Research GPO Box 128, Dhaka 1000 Bangladesh Email: [email protected] It is now one decade since the publication of the landmark randomized clinical trial results by Sazawal et al. demonstrating the efficacy of zinc in the treatment of acute childhood diarrhoea (1). Since that time, several hospital and community-based randomized trials have consistently shown that zinc is an effective treatment for either acute or persistent diarrhoea in children aged less than five years. Benefits include shortened duration of illness episodes, reduced likelihood of an episode of prolonged (<7 days) or persistent (<14 days) diarrhoeal illness and, following recovery, a decreased likelihood of a repeat episode over the next three months (2,3). Over this same period of time, risk for non-injury death has been estimated to be reduced by 50% (3). On the basis of these findings, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) jointly issued a statement in May 2004 recommending that all children with a diarrhoeal illness be treated by zinc (4). It is estimated that the successful implementation of this recommendation has the potential to save nearly 400,000 lives annually (5).