 The
USAID Micronutrient Program
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The
USAID Micronutrient Program
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ZINC Publications and Reference Materials In
May 2004, a WHO/UNICEF Joint Statement on the Clinical Management of Acute
Diarrhea was issued. This statement called for the adoption of new recommendations
for zinc supplementation together with a new ORS formula for the clinical
management of diarrhea. On behalf of USAID, MOST is supporting the rapid
scale-up of this high impact, child survival intervention. A component
of this support is to increase the accessibility of information about
the use of zinc supplementation as an adjuvant treatment for diarrhea.
Key DocumentsThe first eight documents
provide key evidence in support of USAID's decision to encourage the rapid
global rollout of this new, high-impact child survival intervention. Bhutta et al. Am J Clin Nutr 2000. Presents the meta-analyses of efficacy studies demonstrating that 10-14 days of zinc supplementation reduce the duration and severity of diarrhea episodes. PDF Zinc Investigators' Collaborative Group. The Journal of Pediatrics 1999 (abstract only). Presents the evidence of reduction in incidence in diarrhea and pneumonia for 2-3 months following treatment of diarrhea with 10-14 days of zinc supplementation. Baqui et al. BMJ 2002. Presents evidence from a community-based trial confirming the shorter duration of diarrhea with zinc supplementation, and other benefits of zinc including reduced incidence of both diarrhea and acute lower respiratory tract infections, and fewer admissions to hospital in children with diarrhea. PDF Robberstad et al. Bull WHO 2004. Presents a cost-effectiveness analysis in terms of DALYs and child deaths averted using a simulation technique with cost data from health facilities in Tanzania. The authors concluded that zinc for diarrhea treatment is highly cost-effective. PDF Application for the inclusion of zinc sulphate in the WHO Model List of Essential Medicines. Approved March 2005. It presents an update to March 2003 of further efficacy studies published and presents more detail on safety. PDF Low Risk of Adverse Effects from Zinc Supplementation. This article reviews the available evidence on the safety of zinc supplementation in children, summarizes reports of adverse effects from both long-term and short-term studies, and concludes that zinc supplementation is a safe and effective treatment for diarrhea. PDF US Pharmacopeia. The definition of the zinc tablet is developed to enable quality assurance. PDF
Guidelines for Clinic-Based Health Workers - Not yet field tested. Guidance on how to implement the new WHO/UNICEF recommendations for the use of ORS and zinc supplementation in the clinical management of diarrhea. The guidelines presented in this document are generic; that is, they will be most effective when modified to support the particular strategy being used to introduce the new recommendations in each country. (no. 135) (PDF in English), (PDF in Spanish) Guidelines for New Diarrhea Treatment Protocols for Community-Based Workers - Not yet field tested. With the new tools described in this guide, community healthcare workers will be well prepared to help mothers treat a child with diarrhea. PDF Introducing Zinc in a Diarrheal Control Program: A Manual for Conducting Formative Research. Describes the methods used for formative assessment in a multi-country clinical trial coordinated by INCLEN. The purpose of the trial was to assess acceptance by the global community of zinc supplementation as an adjuvant treatment to ORS prior to its introduction as a policy. The manual was developed to provide a standardized approach to developing appropriate and effective messages to use both ORS and zinc together. This clinical trial was conducted in seven sites: 1) Lucknow and 2) Nagpur in India, 3) Manila, Philippines, 4) Pretoria, South Africa, 5) Cairo, Egypt, 6) Addis Ababa, Ethiopia, and 7) Fortazena, Brazil. (Available at http://www.inclentrust.org. Look under What's New.) The Treatment of Diarrhoea – A manual for physicians and other senior health workers has been updated to include these changes and should serve as the reference for the management of diarrhoea. This guide is distributed by WHO UNICEF/WHO Joint statement on ORS, March 2002. This document was prepared to inform national authorities on the position of the United Nations Children’s Fund (UNICEF) and of the World Health Organization (WHO) with respect to issues such as flavoring, coloring, and rice-based ORS. It is based on a document first published in July 1996 that was revised to take into account results of studies on ORS formulation and zinc supplementation. PDF Brochure/Poster. This on-the-job aid is designed to assist clinic-based healthcare workers in the proper assessment and treatment of diarrhea in children under 5 according to the new WHO recommendation. The brochure/poster is formatted for A3 paper. PDF Bookmark for Community Healthcare Workers. A job aid with one side containing information about how to classify diarrhea, how to decide whether a child should go to the clinic, and how to help the mother with ORS/Zinc, and the other side containing a recipe for ORS and instructions on working with zinc. The bookmark is formatted for four-to-a-page on A4 size paper. PDF Other Zinc Links and Documents Lessons learned in a pilot introduction of zinc treatment for childhood diarrhea in Bougouni District in Mali. This April 2005 report is written for program managers and planners interested in the lessons learned about operational issues in the pilot introduction of zinc supplementation as an adjunct treatment for childhood diarrhea in Mali. PDF Zinc Supplementation for the Treatment of Diarrhea: Moving from Research to Practice. A five-page document describing the history of ORS and the inclusion of zinc supplementation, case studies proving the benefits of zinc, using zinc for diarrhea treatment, and programmatic challenge points. PDF MOST summary article 2005. Cost-effectiveness of zinc supplementation as an adjunct treatment for childhood diarrhea PDF New diarrhea treatment guidelines could save more lives, article on pages 3-4 of the 2004/4 Nutriview Newsletter SUZY
- Scaling Up Zinc Treatment for Young Children with Diarrhoea in Bangladesh.
A large national program to introduce new guidelines for the management
of diarrhea in Bangladesh. Effectiveness
and cost of facility-based Integrated Management of Childhood Illness
(IMCI) in Tanzania. Lancet. 2004 Oct 30;364(9445):1583-94. Integrated
Management of Childhood Illness (IMCI) in Bangladesh:
Early findings from a cluster-randomized study. Lancet. 2004 Oct 30;364(9445):1595-602. Summary Document from June 2004 Zinc Implementation Meeting in Baltimore, the purpose of which was to bring together experts in zinc research and program design/implementation to review recent research on zinc in treatment of diarrhea; learn about WHO/UNICEF/USAID plans for rolling-out zinc for treatment of diarrhea; and strategize next steps for the scaling up of zinc supplementation through NGOs, public and private sectors PDF In preparation for promotion of zinc treatment for childhood diarrhea: Cross-country comparison of diarrhea treatment practices and implications for programs. Summary document developed for the June 2004 Zinc Implementation Meeting in Baltimore. PDF PowerPoint presentation given at USAID in September 2004 regarding zinc and ORS. Document is in the form of a handout, six slides to a page. PDF Zinc FAQsA series of questions, to date, that has arisen in the field regarding the promotion of ORS/zinc treatment. PDF Frequently asked questions concerning the "NEW ORS" - i.e. low osmolarity ORS. Developed by WHO, May 2004. PDF (in English), PDF (in French) |
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