title: Effectiveness of zinc supplementation plus oral rehydration salts compared with oral rehydration salts alone as a treatment for acute diarrhea in a primary care setting: a cluster randomized trial.
abstract: OBJECTIVE
  The purpose of this work was to evaluate whether education about zinc supplements and provision of zinc supplements to caregivers is effective in the treatment of acute diarrhea and whether this strategy adversely affects the use of oral rehydration salts.
  
  
  METHODS
  Six clusters of 30,000 people each in Haryana, India, were randomly assigned to intervention and control sites. Government and private providers and village health workers were trained to prescribe zinc and oral rehydration salts for use in diarrheal episodes in 1-month-old to 5-year-old children in intervention communities; in the control sites, oral rehydration salts alone was promoted. In 2 cross-sectional surveys commencing 3 months (survey 2) and 6 months (survey 3) after the start of the intervention, care-seeking behavior, drug therapy, and oral rehydration salts use during diarrhea, diarrheal and respiratory morbidity, and hospitalization rates were measured.
  
  
  RESULTS
  In the 2 surveys, zinc was used in 36.5% (n = 1571) and 59.8% (n = 1649) and oral rehydration salts in 34.8% (n = 1571) and 59.2% (n = 1649) of diarrheal episodes occurring in the 4 weeks preceding interviews in the intervention areas. In control areas, oral rehydration salts were used in 7.8% (n = 2209) and 9.8% (n = 2609) of episodes. In the intervention communities, care seeking for diarrhea reduced by 34% (survey 3), as did the prescription of drugs of unknown identity (survey 3) and antibiotics (survey 3) for diarrhea. The 24-hour prevalences of diarrhea and acute lower respiratory infections were lower in the intervention communities (survey 3). All-cause, diarrhea, and pneumonia hospitalizations in the preceding 3 months were reduced in the intervention compared with control areas (survey 3).
  
  
  CONCLUSIONS
  Diarrhea is more effectively treated when caregivers receive education on zinc supplementation and have ready access to supplies of oral rehydration salts and zinc, and this approach does not adversely affect the use of oral rehydration salts; in fact, it greatly increases use of the same.
authors.affiliation: Society for Applied Studies, 384 Chirag Delhi, New Delhi 110017, India. community.research@cih.uib.no
authors.forename: Nita
authors.initials: N
authors.lastname: Bhandari
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.forename: Brinda
authors.initials: B
authors.lastname: Dube
authors.forename: R C
authors.initials: RC
authors.lastname: Agarwal
authors.forename: Dilip
authors.initials: D
authors.lastname: Mahalanabis
authors.forename: Olivier
authors.initials: O
authors.lastname: Fontaine
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Maharaj K
authors.initials: MK
authors.lastname: Bhan
mesh_terms: D000284:Administration, Oral; D017028:Caregivers / Q000193:education; D002675:Child, Preschool; D003906:Developing Countries; D003967:Diarrhea / Q000628:therapy*; D003968:Diarrhea, Infantile / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007194:India; D007223:Infant; D015532:Rehydration Solutions / Q000008:administration & dosage*; D012423:Rural Health; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D015532:Rehydration Solutions; D015032:Zinc