effect of zinc supplementation on acute diarrhea among children in khartoum children emergency ...

150 Pages·2005·0.72 MB·English

University of Khartoum
Graduate College
Medical and Health Studies Board

EFFECT OF ZINC SUPPLEMENTATION ON
ACUTE DIARRHEA AMONG CHILDREN IN
KHARTOUM CHILDREN EMERGENCY
HOSPITAL

By
Dr. Rihab Salah Eldin Elnour Mattar
MBBCH University of Zagazig Egypt

A thesis submitted in partial fulfillment for the requirements of the Degree of
Clinical MD in Paediatrics and Child Health,
August 2004

Supervisor
Dr. Eltahir M. Elshibly
M.P.H (Harvard)
M.D (U of K)
FRCPCH (London)
MPCH & MBBS (U of K)
Associate prof.-Consultant pediatrician
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To
My dear parents …,
My sister, brothers …
&
To all who love & take care of children …

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CONTENTS
Page
Acknowledgement i
Abstract ii
Arabic abstract iv
List of abbreviation v
List of tables vi
List of figures viii
CHAPTER ONE
Introduction and Literature Review
1.1. Definition of diarrhoea 1
1.1.2. Epidemiology of acute watery diarrhoea 1
1.1.3. Aetiology 4
1.1.4. Pathophysiology of acute diarrhoea disease 4
1.1.5. Assessment and classification of dehydration 8
1.2.1 . Historical background of zinc deficiency 9
1.2.2. Role of zinc ion 13
1.2.3. Zinc metabolism and function 14
1.2.4. General zinc biochemistry 16
1.2.5. Dietary sources 17
1.2.6. Daily requirement 18
1.2.7. Zinc deficiency 18
1.2.8. Zinc toxicity 21
1.2.9. Laboratory assessment 22
1.2.10. Zinc supplementation 22
1.2.10.1. Effect of zinc supplementation in diarrhoea 22
1.2.10.2. Zinc supplementation and malnutrition 29
1.2.10.3. Zinc supplementation and pneumonia 30
1.2.10.4. Zinc supplementation and common cold 31
1.2.10.5. Zinc supplementation and HIV 31
1.2.10.6. Zinc supplementation and pregnancy and prenatal develop 32
1.2.10.7. Zinc supplementation and growth 32
1.2.10.8. Zinc supplementation and sickle cell disease 33
1.2.10.9. Zinc supplementation and Grohn’s disease 33
1.2.10.10. Zinc supplementation and liver disease 34
1.2.10.11. Zinc supplementation and renal disease 34
Justification 35
Objectives 36
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CHAPTER TWO
Material & Methods 37
2.1. Study design 37
2.2. Study area 37
2.3. Study period 37
2.4. Study population 37
2.4.1. Patients 37
2.4.2. Control group 38
2.4.3. Case definition 38
2.4.4. Inclusion criteria 38
2.4.5. Exclusion criteria 39
2.5. Sample size and sampling technique 39
2.5.1. Sample size 39
2.5.2. Sampling technique 39
2.6. Ethical consideration 41
2.7. Research team 41
2.8. Input of the author 41
2.9. Research tools 42
2.9.1. Questionnaire 42
2.9.2. Clinical examination 42
2.9.2.1. Weight 42
2.9.2.2. Height 43
2.9.2.3. Temperature measurement 43
2.9.2.4. Assessment of the degree of dehydration 43
2.10. Laboratory investigation 43
2.10.1. Stool analysis 44
2.10.2. Serum zinc level 44
2.11. Treatment 48
2.11.1. Intervention 50
2.12. Statistical analysis 51
CHAPTER THREE
Results
3.1. Demographic characteristics of children in the studied 52
population
3.1.1. Age and sex characteristics of study group 53
3.1.2. Description of children in the study according to their 53
residence
3.2. Clinical presentation of patients studied population 53
3.2.1. Duration of diarrhoea in studied population at presentation 53
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3.2.3. Frequency of diarrhea in studied population 54
3.2.1. Description of stool by mothers of children included in the 54
study
3.2.4. The associated symptoms in studied population 54
3.4. Past history of diarrhea in studied population 55
3.5. Past history of admission for nutritional support in studied 55
population
3.6. Pattern of breast feeding 56
3.7 . Pattern of supplementary feeding 56
3.8. Pattern of feeding during diarrhoea 56
3.9. Immunization status of children in the study 57
3.11. Socio demographic character of study group 57
3.11.1. Family size of study groups 57
3.11.3. Source of water among studied population 58
3.11.4. Level of education of parents in studied population 58
3.12. ORS practice in studied population 58
3.13. Degree of dehydration on admission 59
3.14. Nutritional status of studied population 59
3.15. Associated clinical signs in study group 59
3.16. Management received before the enrollment in the study 60
3.17. Investigations 60
3.18.1.2. Giardiasis 60
3.16.2. Serum zinc level 60
CHAPTER FOUR
Discussion 97
Conclusion 106
Recommendations 107
References 108

Appendix (Questionnaire)

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Acknowledgement
This study could not have been completed without the help and
support of many individuals for whom words are inadequate to convey my
gratitude.
I would like to express my endless thanks to Dr. Eltahir Medani
Elshibly for his supervision, guidance, unlimited valuable advice and
patience.
Great thanks to mothers and babies who offered their help.
A special word of appreciation goes to Dr. Gaffar Ibn Auf (Director of
KCEH) for his acceptance to conduct the study in the KCEH.
May I seize this opportunity to thank Dr. Peter, Dr. Rose and Dr.
Abu Obeida. They helped me so much in making this work successful.
Gratitude and appreciation are extended to Miss Shereen for typing
this manuscript and to Mr. Hassan Ali for helping in data analysis.
Finally my gratitude is forwarded to my patrents, brothers and sister
for their patience, support and encouragement.
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ABSTRACT
Diarrhoeal diseases are a major cause of morbidity and
mortality worldwide. Diarrhoea leads to excess zinc losses in stool
beside low energy intake, zinc deficiency contributed to continued
diarrhoea.
This study was conducted in Khartoum Children Emergency
Hospital during the period from 1st of March to 30th of June 2004. It
was an interventional double-blinded controlled hospital based
study.
The main objectives of this study were to determine the serum
zinc level in children with acute diarrhoea and signs of dehydration
and to study the effect of zinc supplementation on outcome of acute
diarrhoea. A total 156 children (68% males and 32% females) aged 6
month to 60 months were enrolled. All relevant informations on
medical history, nutritional history, past medical history, and
physical examination including general examination, assessment of
the degree of dehydration according to WHO criteria and
determination of nutritional status were noted on a pre coded
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questionnaire. Serum zinc level was done to all enrolled children;
also it was taken from a healthy 53 Sudanese children age and sex
matched coming to hospital for routine vaccination as control group.
The children were subdivided into 2 equal groups, 1st group received
zinc sulphate syrup 10mg for those less than 12-month and 20mg for
those more than 12 months daily b.d. for 4 days.
The study showed that the predominant age group was 6-24
months, which represent 90% of the study population.
63% had a past history of diarrhoea, 78% of them necessitated
hospital admission for rehydration (P= 0.000035).
It was found that there is a significant association between low
zinc level and the duration of diarrhoea. Children received zinc
supplementation in this study showed a marked reduction in the
mean duration, and frequency of the stool passage compared with
the placebo group.
The study concluded that most children with acute diarrhoea
had low serum zinc level, and supplementation with zinc may
reduces admission to hospital for diarrhoea and reduce mortality.
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ﺔــــﺣوﺮﻃﻷا ﺺـــﺨﻠﻣ
ةدﺎﻳز ﻰﻟإ يدﺆﻳ لﺎﻬﺳﻹا .ﻢﻟﺎﻌﻟﺎﺑ تﺎﻴﻓﻮﻟا ﻲﻓ ﻲﺴﻴﺋر ﺐﺒﺳ تﻻﺎﻬﺳﻹا ضاﺮﻣأ
.لﺎﻬﺳﻹا راﺮﻤﺘﺳﻻ يدﺆﻳ ﺎﻤﻣ ﻢﺴﺠﻟا ﻦﻣ ﻚﻧﺰﻟا ﺮﺼﻨﻋ ناﺪﻘﻓ
ﻰﻔﺸﺘﺴﻤﺑ ﺖﻤﺗ ﺔﺟودﺰﻣ ﺔﻴﺋاﻮﺸﻋ ﺔﻴﻠﺧﺪﺗ ﺔﻴﺒﻳﺮﺠﺗ ﺔﻨﻴﻋ ﻦﻋ ةرﺎﺒﻋ ﺔﺳارﺪﻟا ﻩﺬه
.م2004 ﻮﻴﻧﻮﻳ ﺮﻬﺷ ﺔﻳﺎﻬﻧ ﻰﺘﺣو سرﺎﻣ ﺮﻬﺷ ﻦﻴﺑﺎﻣ ةﺮﺘﻔﻟا ﻲﻓ مﻮﻃﺮﺨﻟا ثداﻮﺣ
نﻮﻧﺎﻌﻳو لﺎﻬﺳﻹﺎﺑ ﻦﻴﺑﺎﺼﻤﻟا لﺎﻔﻃﻷا مﺪﺑ ﻚﻧﺰﻟا ﺔﺒﺴﻧ ﺔﻓﺮﻌﻣ ﺔﺳارﺪﻟا ﻦﻣ فﺪﻬﻟا
.لﺎﻬﺳﻺﻟ ﺖﻴﻔﻠﺳ ﻚﻧﺰﻟا باﺮﺷ لﻮﻌﻔﻣ ﺔﺳاردو ﻞﺋاﻮﺴﻟا ناﺪﻘﻓ ﻦﻣ
،ﺔﻋﻮﻤﺠﻣ ﻞآ ﻲﻓ ﻞﻔﻃ 68 ، ﺮﻬﺷ 60-6 ﺮﻤﻋ ﻦﻣ ﻞﻔﻃ 156 ﺔﺳارﺪﻟا ﺖﻠﻤﺷ
ﻞﺛﺎﻤﻣ باﺮﺷ ﺖﻴﻄﻋأ ﺔﻴﻧﺎﺜﻟا ﺔﻋﻮﻤﺠﻤﻟاو ﺖﻴﻔﻠﺳ ﻚﻧﺰﻟا باﺮﺷ تﺬﺧأ ﻰﻟوﻷا ﺔﻋﻮﻤﺠﻤﻟا
لﺎﻔﻃﻸﻟ س س 20و ﺔﻨﺳ ﻦﻣ ﻞﻗﻻا لﺎﻔﻃﻸﻟ ﺎًﻴﻣﻮﻳ س س10 ﻢﻌﻄﻟاو نﻮﻠﻟاو ﻞﻜﺸﻟا ﻲﻓ
.ﺔﻨﺳ ﻦﻣ ﺮﺜآﻷا
ﺦﻳرﺎﺗ ﺎﻬﻟ تﻻﺎﺤﻟا ﻦﻣ %63 رﻮآﺬﻟا ﻦﻣ اًدﺪﻋ ﺮﺜآأ ثﺎﻧﻹا نأ ﺔﺳارﺪﻟا تﺮﻬﻇا
.ءاورﻻﺎﺑ فﺎﻔﺠﻟا جﻼﻌﻟ ﻰﻔﺸﺘﺴﻤﻟا لﻮﺧد ﻢﻬﻟ ﻖﺒﺳ ﺪﻗ ﻢﻬﻨﻣ %78 و ﻖﺑﺎﺳ ﻲﺿﺮﻣ
، ﻲﻠﻜﻟا عﻮﻤﺠﻤﻟا ﻦﻣ %52 ﻲﻓ ﻲﻌﻴﺒﻄﻟا لﺪﻌﻤﻟا ﻦﻣ ﻞﻗأ ﺪﺟو مﺪﻟﺎﺑ ﻚﻧﺰﻟا ﺮﺼﻨﻋ
.ﻞﻣﺎﻜﺘﻣ ﺮﻴﻏ ءاﺬﻏ نﻮﻘﻠﺘﻳ ﺔﺳارﺪﻟﺎﺑ لﺎﻔﻃﻷا ﻒﺼﻧ
ﻦﻳﺬﻟا لﺎﻔﻃﻷا .ﻲﻌﻴﺒﻄﻟا لﺪﻌﻤﻟا ﻦﻣ ﻞﻗأ ﻢﻬﻧزو نا ﺪﺟو ﺔﺳارﺪﻟﺎﺑ لﺎﻔﻃﻻا ﺐﻠﻏأ
باﺮﺷ اﻮﻃﺎﻌﺘﻳ ﻢﻟ ﻦﻳﺬﻟا ﻦﻣ ﻞﻗأ ﻩددﺮﺗو لﺎﻬﺳﻹا راﺮﻤﺘﺳا نأ ﺪﺟو ﻚﻧﺰﻟا باﺮﺷ اﻮﻃﺎﻌﺗ
.ﻰﻔﺸﺘﺴﻤﻟﺎﺑ ثﻮﻜﻤﻟا ءﺎﻨﺛأ ﻚﻧﺰﻟا
،مﺪﻟﺎﺑ ﻚﻧﺰﻟا ﺺﻘﻧ ﻊﻣ ةﺮﺷﺎﺒﻣ ﺔﻗﻼﻋ ﻪﻟ لﺎﻬﺳﻻا راﺮﻤﺘﺳا نﺄﺑ ﺔﺳارﺪﻟا ﺖﺼﻠﺧ
.ىﺮﺧﻷا ﺔﻋﻮﻤﺠﻤﻟﺎﺑ ﺔﻧرﺎﻘﻣ ﺔﺑﺮﺸﺑ اﻮﻨﺴﺤﺗ ﻚﻧﺰﻟا باﺮﺷ اﻮﻘﻠﺗ ﻦﻳﺬﻟا لﺎﻔﻃﻷا
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ﺔﺳارد ﻊﻣ ﺔﺳارﺪﻟا ﺖﻘﻔﺗا .ﺔﻴﻌﻴﺒﻄﻟا ﺔﻋﺎﺿﺮﻟا ﻊﻴﺠﺸﺗو ﻦﺴﺤﺘﺑ ﺔﺳارﺪﻟا ﺖﺻوأ
لﺎﻬﺳﻹا ءﺎﻨﺛأ ﺖﻴﻔﻠﺳ ﻚﻧﺰﻟا باﺮﺸﺑ لﺎﻔﻃﻷا ﺪﻳوﺰﺗ نﺄﺑ ﺔﻴﻤﻟﺎﻌﻟا ﺔﺤﺼﻟا ﺔﻤﻈﻨﻤﺑ ﺔﻠﺛﺎﻤﻣ
.تﺎﻴﻔﺸﺘﺴﻤﻟﺎﺑ لﺎﻔﻃﻷا ددﺮﺗ ﻞﻠﻘﻳو ﻢﻬﺘﻟﺎﺣ ﻦﺴﺤﻳ
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