1013 Zinc and low osmolarity oral rehydration salts(ORS) for diarrhoea

Having recently alluded to South Africa’s foresight and proactive approach in introducing rotavirus vaccine into the national immunization strategy in 2008 (see summary 1004) it is disappointing to note the absence of South Africa on the list of UNICEF priority countries that have plans, pilots or programmes to make low osmolarity ORS and zinc available for the treatment of diarrhoea in infants and children. Globally, diarrhoea remains the second leading cause of under-5 mortality, responsible for around 1.5 million deaths per annum. In the 1970’s and 80’s, scaling up of ORS therapy combined with caregiver education had a major impact on mortality rates, but the initiatives have lost momentum. UNICEF and WHO released a report in October 2009 in an attempt to re-energise prevention and treatment of diarrhoea, and presented a 7-point plan. This plan includes 1) rotavirus and measles vaccination; 2) breastfeeding and vitamin A supplementation; 3) promotion of handwashing with soap; 4) improving water quantity and quality; 5) community-wide sanitation; 6) fluid replacement to prevent dehydration; 7) zinc supplements. Today only 39% of children in developing countries receive the recommended treatment, low osmolarity ORS roll-out has been slow, and zinc supplements are largely unavailable. Given that academic paediatric departments are aware of the recommendations it is difficult to understand why South Africa is not on the list of countries that are introducing the latter two interventions when regional others such as Angola, Cameroon, DRC, Egypt, Mozambique, Nigeria, Rwanda, Tanzania and Zambia are represented. Certainly we have pharmaceutical manufacturers that are more than capable of producing the necessary products and volumes. It appears that political will was lagging in this case and is reassuring to note that there are plans to have zinc available at state primary healthcare facilities during 2010 . As a sequel to questions raised in a previous summary on the role of zinc (see 0738), there now appears to be sufficient evidence to support the intervention, with data showing the ability of zinc supplementation to limit the duration and severity of a diarrhoeal episode, lower mortality, and reduce the likelihood of subsequent infections in the 2-3 months following treatment.

Read more:
Lancet 2010,; 375: 870-2
Bull World Health Org 2009; 87: 780-6
Am J Clin Nutr 2000; 72: 1516-22