Operational feasibility of implementing community-based zinc supplementation - Impact on childhood diarrheal morbidity

Objective: To determine the effect of zinc supplementation on diarrheal incidence and to discover any operational constraints of zinc supplementation at the community level. Methods: We included 1712 children aged between 6 and 48 months in a randomized double blind study in rural area comprising of 11 villages. Children were randomly divided into 2 groups. Zinc/placebo syrup supplementation was continued for 6 months in a weekly schedule from May 2003. Children were followed up weekly for detection of diarrhea from May 2003 until April 2004. Around 30% of the study children were evaluated every 2 months during supplementation period. Results: During the period, 80,534 weekly visits were made giving 1548.73-child years of observation. We detected 1438 diarrheal episodes among 846 children. The incidence of diarrhea was significantly less during the supplemented period (P < 0.001; RR 0.74 (0.64-0.87)) in the zinc group. A significant difference was also noted during the follow up period (P < 0.05). In the zinc group, children < 2 years of age had significantly less diarrhea during supplementation and the follow up period. Multiple episodes of diarrhea (>= 2) were significantly less in the zinc group. Approximately 85% of the surveillance workers made weekly visits to the houses and 96% of mothers administered syrup weekly to their children. Around 80% of mother's were aware of the possible benefits of zinc supplementation. Conclusion: Weekly zinc supplementation was effective in reducing diarrheal morbidity at the community level and it was operationally feasible.