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Zinc supplementation in the management of diarrhoea

Intervention | Last updated: 26 April 2023


Diarrhoea remains a leading cause of death globally among children under five years of age. Diarrhoea contributes to nutritional deficiencies, reduced resistance to infections and impaired growth and development. Severe diarrhoea leads to fluid loss, and may be life-threatening, particularly in young children and people who are already malnourished or have impaired immunity.

Zinc is important for cellular growth, cellular differentiation and metabolism and deficiency limits childhood growth and decreases resistance to infections. Although severe zinc deficiency is rare in humans, mild to moderate deficiency may be common worldwide.

Zinc supplementation has been shown to reduce the duration and severity of diarrhoea, and to prevent subsequent episodes, although the mechanisms by which zinc exerts its anti-diarrhoeal effect are not fully understood.

WHO Recommendations


Mothers, other caregivers and health workers should provide children with 20 mg per day of zinc supplementation for 10-14 days (10 mg per day for infants under the age of six months).

Evidence


Related Cochrane reviews


Oral zinc for treating diarrhoea in children

Lazzerini M, Wanzira H. Cochrane Database of Systematic Reviews. 2016; Issue 12. Art. No.: CD005436.


Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years of age

Mayo-Wilson E, Junior JA, Imdad A, Dean S, Chan XHS, Chan ES, et al. Cochrane Database of Systematic Reviews. 2014; Issue 5. Art. No.: CD009384.

Summary of this review Alternate Text

Other related systematic reviews


Therapeutic value of zinc supplementation in acute and persistent diarrhea: a systematic review

Patel A, Mamtani M, Dibley MJ, Badhoniya N, Kulkarni H. PloS One. 2010;5(4):e10386.


Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials

Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM, Hidayat A, et al. American Journal of Clinical Nutrition. 2000; 72(6):1516–1522.


Role of zinc administration in prevention of childhood diarrhea and respiratory illnesses: a meta-analysis.

Aggarwal R, Sentz J, Miller MA. Pediatrics. 2007; 119(6):1120–1130.


Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria

Yakoob MY, Theodoratou E, Jabeen A, Imdad A, Eisele TP, Ferguson J, et al. BMC Public Health. 2011;11 Suppl 3:S23.


A meta-analysis of the effects of oral zinc in the treatment of acute and persistent diarrhea.

Lukacik M, Thomas RL, Aranda JV. Pediatrics. 2008; 121(2):326–336.


Zinc for the treatment of diarrhoea: effect on diarrhoea morbidity, mortality and incidence of future episodes.

Fischer Walker CL, Black RE. International Journal of Epidemiology. 2010; 39(Suppl. 1):i63–i69.


Oral zinc supplementation for the treatment of acute diarrhea in children: A systematic review and meta-analysis

Lamberti, L.M, Walker CLF, Chan KY, Jian WY, Black RE. Nutrients. 2013;5(11):4715-40.


Cost-effectiveness Learn More Alternate Text


Cost-effectiveness analyses


Comparison of the estimated cost-effectiveness of preventive and therapeutic zinc supplementation strategies for reducing child morbidity and mortality in sub-Saharan Africa

Brown KH, Hess SY, Vosti SA, Baker SK. Food Nutr Bull. 2013; 34(2):199-214.


Zinc supplementation reduced cost and duration of acute diarrhea in children

Gregorio GV, Dans LF, Cordero CP, Panelo CA. J Clin Epidemiol. 2007; 60(6):560-6.


Cost-effectiveness analysis of zinc supplementation for treatment of acute diarrhea in children younger than 5 years in Colombia

Mejía A, Atehortúa S, Flórez ID, Sierra JM, Mejia ME, Ramírez C. J Pediatr Gastroenterol Nutr. 2015; 60(4):515-20.


Cost effectiveness analysis of strategies for child health in developing countries

Edejer TT, Aikins M, Black R, Wolfson L, Hutubessy R, Evans DB. BMJ. 2005; 331(7526):1177.