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

To determine the effect of zinc supplementation on diarrheal incidence and to discover any operational constraints of zinc supplementation at the community level.

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.

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 (>or=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.

Weekly zinc supplementation was effective in reducing diarrheal morbidity at the community level and it was operationally feasible.