Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.

<h4>Background</h4>Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preven...

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Autores principales:	Daniel R Feikin, Godfrey Bigogo, Allan Audi, Sherri L Pals, George Aol, Charles Mbakaya, John Williamson, Robert F Breiman, Charles P Larson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/03f3d39db6e840fe8ae7f24f9d41e5c6
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spelling	oai:doaj.org-article:03f3d39db6e840fe8ae7f24f9d41e5c62021-11-18T08:19:00ZVillage-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.1932-620310.1371/journal.pone.0094436https://doaj.org/article/03f3d39db6e840fe8ae7f24f9d41e5c62014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24835009/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities.<h4>Methods</h4>We randomized 16 Kenyan villages (1,903 eligible children) to receive a 10-day course of zinc and two oral rehydration solution (ORS) sachets every two months at home and 17 villages (2,241 eligible children) to receive ORS at home, but zinc at the health-facility only. Children's caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI) reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children's age.<h4>Results</h4>There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed), 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001). There were no differences in ORS use between zinc (59.6%) and comparison villages (58.8%). Among children with fever or cough without diarrhea, zinc use was low (<0.5%). There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46-0.99), but not presenting at clinic.<h4>Conclusions</h4>In this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low.<h4>Trial registration</h4>ClinicalTrials.gov NCT00530829.Daniel R FeikinGodfrey BigogoAllan AudiSherri L PalsGeorge AolCharles MbakayaJohn WilliamsonRobert F BreimanCharles P LarsonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 5, p e94436 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Daniel R Feikin Godfrey Bigogo Allan Audi Sherri L Pals George Aol Charles Mbakaya John Williamson Robert F Breiman Charles P Larson Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.
description	<h4>Background</h4>Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities.<h4>Methods</h4>We randomized 16 Kenyan villages (1,903 eligible children) to receive a 10-day course of zinc and two oral rehydration solution (ORS) sachets every two months at home and 17 villages (2,241 eligible children) to receive ORS at home, but zinc at the health-facility only. Children's caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI) reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children's age.<h4>Results</h4>There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed), 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001). There were no differences in ORS use between zinc (59.6%) and comparison villages (58.8%). Among children with fever or cough without diarrhea, zinc use was low (<0.5%). There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46-0.99), but not presenting at clinic.<h4>Conclusions</h4>In this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low.<h4>Trial registration</h4>ClinicalTrials.gov NCT00530829.
format	article
author	Daniel R Feikin Godfrey Bigogo Allan Audi Sherri L Pals George Aol Charles Mbakaya John Williamson Robert F Breiman Charles P Larson
author_facet	Daniel R Feikin Godfrey Bigogo Allan Audi Sherri L Pals George Aol Charles Mbakaya John Williamson Robert F Breiman Charles P Larson
author_sort	Daniel R Feikin
title	Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.
title_short	Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.
title_full	Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.
title_fullStr	Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.
title_full_unstemmed	Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.
title_sort	village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural western kenya.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/03f3d39db6e840fe8ae7f24f9d41e5c6
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Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.

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