Where are we now who s perspective
Download
1 / 18

- PowerPoint PPT Presentation


  • 130 Views
  • Uploaded on

Where are we now? WHO’s Perspective. Dr Olivier Fontaine World Health Organization Geneva. Demonstration of the increased efficacy of a new formulation for oral rehydration salts (ORS) containing lower concentrations of glucose and salt, and

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '' - rigg


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Where are we now who s perspective

Where are we now?WHO’s Perspective

Dr Olivier Fontaine

World Health Organization

Geneva


Recent developments in the clinical management of acute diarrhoea

Recent developments in the clinical management of acute diarrhoea


Where are we now who s perspective
Meta-analysis of unscheduled intravenous infusion among children randomized to reduced osmolarity and standard WHO rehydration solution

Hahn S et al. BMJ 2001; 323:81-5


Where are we now who s perspective
Meta-analysis of stool output among children randomized to reduced osmolarity and standard WHO rehydration solution

Hahn S et al. BMJ 2001; 323:81-5


Where are we now who s perspective
Meta-analysis of vomiting among children randomized to reduced osmolarity and standard WHO rehydration solution

Hahn S et al. BMJ 2001; 323:81-5


Conclusion 1
CONCLUSION (1) reduced osmolarity and standard WHO rehydration solution

The group of experts recommended that a single ORS solution be used and that this ORS solution contain 75 mEq/l of sodium and 75 mmol/l of glucose, and have a total osmolarity of 245 mOsmol/l.


Trials on the therapeutic effect of zinc on acute diarrhea
Trials on the Therapeutic Effect of Zinc reduced osmolarity and standard WHO rehydration solutionon Acute Diarrhea

  • Countries: Bangladesh (4), Brazil, India (6), Indonesia, Nepal

  • Age groups: 1-60 months

  • Dose of zinc: 5 to 40 mg/day (1 to 4 RDA)

  • Total number of children:

    • zinc 4965

    • control 4351


Effect of zinc supplementation on duration of acute diarrhoea time to recovery
Effect of Zinc Supplementation on Duration of Acute Diarrhoea/Time to Recovery

*India, 1988

*Bangladesh, 1999

*India, 2000

*Brazil, 2000

*India, 2001

Indonesia, 1998

India, 1995

Bangladesh, 1997

India, 2001

India, 2001

Nepal, 2001

Bangladesh, 2001

Meta-analysis

1

*Difference in mean and 95% CI

Relative Hazards and 95% CI


Effect of zinc supplementation on duration of episodes lasting more than 7 days
Effect of Zinc Supplementation on Duration of Episodes Lasting More than 7 Days

Indonesia, 1998

India, 1995

Bangladesh, 1997

India, 2001

Nepal, 2001

Meta-analysis

1

Odds ratio and 95% CI



Therapeutic effects of zinc supplementation on acute diarrheal severity 2

Country Diarrheal Severity (1)

Outcome Measure

Percent Reduction

Bangladesh, 1997

Stool Output

28

India, 2000

Stool Output

38*

India, 2001

Stool Output

28*

Therapeutic Effects of Zinc Supplementation on Acute Diarrheal Severity (2)

* p<0.05


Conclusions 2
CONCLUSIONS (2) Diarrheal Severity (1)

  • Zinc supplementation given at a dose of about 2 RDAs per day (10-20 mg) for 10-14 days, is efficacious in reducing the severity of diarrhoea and the duration of the episode significantly.


Who unicef joint statement

WHO/UNICEF JOINT STATEMENT Diarrheal Severity (1)

Clinical Management of Acute Diarrhoea


Recommendations for mothers and other caregivers
Recommendations for Mothers and Diarrheal Severity (1)Other Caregivers

  • Prevent dehydration through the early administration of increased amounts of appropriate fluids available in the home, and ORS solution, if on hand

  • Continue feeding (or increase breastfeeding) during, and increase all feeding after the episode

  • Recognize the signs of dehydration and take the child to a health-care provider for ORS or intravenous electrolyte solution, as well as familiarize themselves with other symptoms requiring medical treatment (e.g., bloody diarrhoea)

  • Provide infants with 20 mg per day of zinc supplementation for 10–14 days (10 mg per day for infants under six months old)


Recommendations for health care workers
Recommendations for Health-Care Workers Diarrheal Severity (1)

  • Counsel mothers to begin administering suitable available home fluids immediately upon onset of diarrhoea in a child

  • Treat dehydration with ORS solution (or with an intravenous electrolyte solution in cases of severe dehydration)

  • Emphasize continued feeding or increased breastfeeding during, and increased feeding after the diarrhoeal episode

  • Use antibiotics only when appropriate, i.e. in the presence of bloody diarrhoea or shigellosis, and abstain from administering anti-diarrhoeal drugs

  • Provide infants with 20 mg per day of zinc supplementation for 10–14 days (10 mg per day for infants under six months old)

  • Advise mothers of the need to increase fluids and continue feeding during future episodes.


Next steps 1 ongoing research
Next Steps (1) Diarrheal Severity (1)Ongoing Research

  • Acceptability of zinc as an adjunct therapy for the management of acute diarrhoea in health facilities (Brazil, Egypt, Ethiopia, India and Philippines)

  • Intervention Studies to evaluate the effectiveness of adding zinc to the management of diarrhoea (India, Mali and Pakistan)

  • Controlled Clinical Trials to evaluate the safety/efficacy of zinc supplementation in the management of diarrhoea in infants below 6 months of age (Ethiopia, India and Pakistan)


Next steps 2 zinc tablet production
Next Steps (2) Diarrheal Severity (1)Zinc Tablet Production

  • Inclusion of zinc in the WHO model list of Essential Drugs

  • Development of product specification for allowing UNICEF to procure zinc tablets

  • Transfer of Technology for the production of zinc tablets


Next steps 3 planning for implementation of zinc for treatment of diarrhoea
Next Steps (3) Diarrheal Severity (1)Planning for Implementation of Zinc for Treatment of Diarrhoea

  • Development of draft guidelines for introduction of zinc for diarrhoea in a country

  • Development of a guide for formative research

  • Development of educational materials on diarrhoea