Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Am J Trop Med Hyg. 2023 Feb 27;108(4):837-843. doi: 10.4269/ajtmh.22-0532. Print 2023 Apr 5.
Zinc supplementation is an added intervention with oral rehydration solution (ORS) for treating childhood diarrhea as per World Health Organization recommendations. Our study aimed to determine the prevalence of zinc administration in addition to ORS for childhood diarrhea before hospitalization and the nutritional profile of those children admitted to the outpatient department of the largest diarrheal facility in Bangladesh. This study used a screening dataset of a clinical trial (www.clinicaltrials.gov; NCT04039828) on zinc supplementation at a Dhaka hospital (International Centre for Diarrhoeal Disease Research, Bangladesh) between September 2019 and March 2020. A total of 1,399 children aged 3-59 months were included in our study. Children were divided into two groups (one group received zinc and another did not) and were analyzed accordingly; 39.24% (n = 549) children received zinc along with ORS for the current diarrheal episode prior to hospitalization. Percentages of underweight (weight-for-age z-score < -2 SD), stunting (length/height-for-age z-score < -2 SD), wasting (weight-for-length/height z-score < -2 SD), and overweight (weight-for-age z-score > +2 SD) among these children were 13.87% (n = 194), 14.22% (n = 199), 12.08% (n = 169), and 3.43% (n = 48), respectively. In logistic regression after adjusting age, sex, and nutritional status (underweight, stunting, wasting, and overweight), association of dehydration (adjusted odds ratio [aOR]: 0.06; 95% CI: 0.03-0.11; P < 0.01), bloody diarrhea (aOR: 0.18; 95% CI: 0.11-0.92; P < 0.01), and fever (aOR: 0.27; 95% CI: 0.18-0.41; P < 0.01) were less with children who received zinc at home. Bangladesh is one of the leading zinc coverage areas globally but lags behind the target for zinc coverage in diarrheal illness among under-five children. Policymakers should scale up and formulate guidelines with sustainable strategies to encourage zinc supplementation in diarrheal episodes in Bangladesh and elsewhere.
锌补充剂是世界卫生组织推荐的口服补液盐（ORS）治疗儿童腹泻的附加干预措施。我们的研究旨在确定在孟加拉国最大腹泻治疗机构的门诊部住院前，除了 ORS 之外，儿童腹泻时额外给予锌的流行情况，以及这些儿童的营养状况。本研究使用了达卡医院（孟加拉国国际腹泻病研究中心）一项锌补充剂临床试验（www.clinicaltrials.gov；NCT04039828）的筛查数据集，该试验于 2019 年 9 月至 2020 年 3 月进行。共有 1399 名 3-59 个月大的儿童纳入我们的研究。儿童分为两组（一组接受锌治疗，另一组不接受），并进行相应分析；39.24%（n=549）的儿童在住院前的当前腹泻发作时同时接受了锌和 ORS。这些儿童中体重不足（体重年龄 z 评分< -2 SD）、发育迟缓（身长/身高年龄 z 评分< -2 SD）、消瘦（体重/身长/身高 z 评分< -2 SD）和超重（体重年龄 z 评分> +2 SD）的比例分别为 13.87%（n=194）、14.22%（n=199）、12.08%（n=169）和 3.43%（n=48）。在调整年龄、性别和营养状况（体重不足、发育迟缓、消瘦和超重）后进行逻辑回归分析，与在家中接受锌治疗的儿童相比，脱水（调整后的优势比[aOR]：0.06；95%CI：0.03-0.11；P < 0.01）、血性腹泻（aOR：0.18；95%CI：0.11-0.92；P < 0.01）和发热（aOR：0.27；95%CI：0.18-0.41；P < 0.01）的相关性降低。孟加拉国是全球领先的锌覆盖地区之一，但在五岁以下儿童腹泻病锌覆盖目标方面落后。政策制定者应扩大规模并制定可持续战略的指南，以鼓励在孟加拉国和其他地方的腹泻发作时补充锌。
