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Comparative study on treatment efficiency with zinc sulfate and ORS solution for intensity or duration of acute diarrhea in 1-4 years old infants at Malard City, Fars Province- Iran.

Introduction

Diarrhea is a very common disorder among newly born and 1-4 years old kids, world widely [1]. It is a main agent of grow delay and early mortality in developing countries [2]. In United States of America 2.1 to 3.7 million diarrhea cases were diagnosed annually and 300-400 cases of annual mortality were recorded because of acute diarrhea[3]. Patient with diarrhea causes high economic costs for developing countries, for example about 30 present of hospital beds in these countries were occupied by diarrhea suffered infants [4]. In Iran, diarrhea is a main reason of mortality for 1-4 years old group [5]. In other word, about 12% 1-4 years old of infants in cities and 14% in villages were suffering from diarrhea [6]. Main reason of diarrhea related mortality is incidence of dehydration that commonly liquid intravenous injection was used for treatment [7]. In a research it is cleared that treatment with only solution injection may cause lowering mortality incidence but can't decline duration of diarrhea period [8]. Because of negative effect of acute diarrhea on body weight and immune system [9], suggested treatment is including zinc sulfate syrup and ORS solution [10]. Efficiency of this kind of treatment was documented in researches [11,12]. Also, some studies decelerated that zinc supplementation can prevent respiratory disorders and can help for diarrhea period declining in acute or chronic diarrhea [3,13,14].

With attention to effectiveness of ORS and zinc sulfate treatment, in present study, effect of both of treatments in 1-4 year old infants were compared.

Material and methods

Grouping and Treatment Procedure:

This study conducted with clinical based diagnosis on patients (1-4 year old infants) at healthcare center of Malard city. The investigable patients have these parameters; 1-4 years old, suffering from diarrhea without hemorrhage and without antibiotic usage from began to end of treatment.

Patients with lower and higher ages (lower than one or higher than four), diarrhea with hemorrhage or without parents allowance were removed from my experimental groups.

Totally, 112 infant were divided in to two experimental groups; 52 of them as control group and 60 of them as experimental or treatment group. In control group we had used only ORS and in experimental group, we had used ORS with zinc sulfate syrup according to hospital treatment protocol. Data were collected via communications with patient's parents, documents or disease history review and co-workerdoctor's reports in same research project.

Statistical Analysis:

Data were analyzed by SPSS Ver. 16 software and t-test was done for comparison of two groups and detection of significant differences.

Results:

Findings show 66.1 percent of diarrhea suffered infants were boy and 33.9 percent were girl.

Age mean of infants was 2.41 years old and around 52.7 percent had lower than two years old. Demographic information of samples is presented as table. 1.

Diarrhea frequency and duration in control and experimental group are presented in tables 2 and 3. In both of parameters, superiority of experimental group was observed.

Statistical analysis for diarrhea intensity show t-value: 11.07 with df: 110 and p<0.001.

Also, Statistical analysis for diarrhea duration showst-value: 8.21 with df: 110 and p<0.001. Comparative statistical description for treatments is presented in table 4.

According to tables 1-4, mean diarrhea frequency after zinc sulfate syrup and ORS was 2.35 time/ day that in comparison with control group (4.17 time/ day) had considerable declines.

For treatment period duration, efficiency of treatment with both of zinc sulfate and ORS in comparison with only ORS, it was observed that mean healing period in experimental group was 1.9 day that was 3.21 day for control group.

Discussion:

Findings of present study showed that synchronic application of ORS and zinc sulfate syrup in comparison with only ORS application is more efficient for both treatment parameters (declining of diarrhea frequency and shorting of healing period), qua in control group only 5.8% of infants in first 24 hours and 15.4% in 48 hours of treatment have healing signs, but in experimental group 30% of infants in first 24 hours and 55% of them in 48 hours had healing signs.

About diarrhea intensity similar trend was observed; diarrhea frequency was 2 time/day. In control group it was 3.8% and in experimental group it was 60%.

Obtained findings were according to past related studies [15,16]. In Sazawal et al., [15] and Dutta et al., [16], treatment with zinc sulfate and ORS solution could lower diarrhea intensity and duration and in overall it had healing effect on acute diarrhea in infants. It is concluded, zinc sulfate is a suitable completive treatment for ORS in term of infant's diarrhea treatment.

References

[1.] King, C.K., R. Glass., J.S.Breseeand, C. Duggan., 2003. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm. Rep., 52(RR-16): 1-16.

[2.] Bettger, W.J. and B.L. Odell., 1981. Acritical physiological role of zinc in the structure and function of biomembranes. Life Science, 28(13): 1425-38.

[3.] Behrman, R.E., R.M. Kliegman., H.B. Jenson and O.S. Nelson.,. 2004. Textbook of pediatrics. 17thed. Philadelphia: W.B. Saunders Company; pp: 169-72.

[4.] Prasad, A.S., 1998. Zinc deficiency in humans: A neglected problem. Journal of American Collage of Nutrition, 17(6): 542-543.

[5.] Shams, H., 2001. Educational demands of parents about acute diarrhea and application of ORS for fewer than five years old infants at gonabad city. OfogeDanesh Magazine, 2: 55. [In Persian]

[6.] Iranian health ministry., 2002. Health feature. Tabalvor publication, first edition, Tehran, pp: 32.

[7.] Arcasoy, A., N. Akar., U. Ors., L. Delibasi and S. Karayalcin., 1990. Ultra structual changes in the mucosa of the small intestine in patient with geophagic. Journal of pediatrics Gastroenterology and Nutrition, 11: 279-282.

[8.] Richard, Z.L., M. Claesonand, N.F. Pierce., 1993. Manage met of acute diarrhea in children: lessons learned. Pediatric Infective Disease Journal, 12(1): 5-9.

[9.] Baqui, A.H., R.B. Sack., R.E. Black., H.R. Chowdhury., M. Yunus and A.K. Siddique., 1993. Cell- mediated immune deficiency and malnutrition are independent risk factors for persistent diarrhea in Bangladeshi children. American Journal of Clinical Nutrition, 58(4): 543-548.

[10.] Black, R.E., K.H. Brown and S. Becker., 1984. Malnutrition is a determining factor in diarrheal duration/not incidence among young children in a longitudinal study in rural Bangladesh. American Journal of Clinical Nutrition, 39(1): 87-94.

[11.] Reinhold, J.G. and P. Charami, 1981. An Attended Study of the Effect of Iranian Village and Urban Flat Breads of the Mineral Balances of two Men Before and After Supplementation with Vitamin D. Ecology,

Food and Nutrition, 10: 169-77.

[12.] Al-Sonboli, N., R.Q. Gurgel., A. Shenkin., C.A. Hart and L.E. Cuevas., 2003. Zinc supplementation in brazilian children with acute diarrhoea. Annals of TropicalPediatrics, 23(1): 3-8.

[13.] Raqib, R., S.K. Roy., M.J. Rahman., T. Azim., S.S. Ameerand, J. Chisti., 2004. Effect of Zinc supplementation on immune and inflammatory responses in pediatric patients with shigellosis. American Journal of Clinical Nutrition, 79(3): 444-450.

[14.] Bhandari, N., R. Bahl, S. Taneja and T.S. Substantial, 2002. Reduction in severe diarrheal morbidity by daily Zinc supplementation in young north indian children. Pediatrics., 109(6): e 86.

[15.] Sazawal, S., R.E. Black., S. Jalla., S. Mazumdar., A. Sinha and M.K. Bhan., 1997. Effect of zinc supplementation on cell mediated immunted and lymphocyte subsets in preschool children. Indian. Pediatrics, 34: 589-597.

[16.] Dutta, P., U. Mitra., A. Datta., S.K. Niyogi., S. Dutta and B. Manna., 2000. Impact of zinc supplementation in malnourished children with acute watery diarrhea. Journal of Tropical Pediatrics, 46(5): 259-263.

(1)Hakimeh Sajjadi and (2) Abdolvahab Samavi

(1)Center of emergency care, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

(2)Hormozgan University, Bandar Abbas, Iran.

Corresponding Author

HakimehSajjadi, Center of emergency care, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

E-mail: hakimeh.sajjadi@yahoo.com
Table 1: Demographic information of studied sample.

Parameters             Gender

              girl     boy      total

Number        74       38       112
Percent       66.1     33.9     100

Parameters                 Age mounts old

              12       13-24    25-36    37-48    total

Number        26       33       34       19       112
Percent       23.2     29.5     30.4     17       100

Table 2: Diarrhea intensity or frequency (time/day) in control and
experimental group.

Group time             2      3      4       6       More      total
                                                     than 6

Control         No.    2      5      32      8       5         52
                %      3.8    9.6    61.5    15.4    9.6       100
Experimental    No.    42     9      9       0       0         69
                %      70     15     15      0       0         100

Table 3: Diarrhea duration (day) in control and experimental group.

Group day              1      2       3       More than 3     total

Control         No.    3      8       16      25              52
                %      5.8    15.4    30.8    48.1            100
experimental    No.    18     33      6       3               60
                %      30     55      10      5               100

Table 4: Comparison of diarrhea duration and intensity in control and
experimental groups via t-test..

trait        group           mean    S.d     t-value    df

Intensity    Control         4.17    0.87    11.07      110
             Experimental    2.35    0.86

Duration     Control         3.21    0.91    8.21       110
             Experimental    1.9     0.77

                             significance
trait        group           level

Intensity    Control         p < 0.001
             Experimental

Duration     Control         p < 0.001
             Experimental
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Article Details
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Title Annotation:Original Article; oral rehydration solutions
Author:Sajjadi, Hakimeh; Samavi, Abdolvahab
Publication:Advances in Environmental Biology
Article Type:Report
Geographic Code:7IRAN
Date:May 1, 2011
Words:1551
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