Showing papers by "Tor A. Strand published in 2011"
TL;DR: The World Health Organization–recommended daily dose of zinc for diarrhea was not achieved in most children beyond the first day of treatment, which is the likely explanation for the lack of improvement in outcomes from zinc-ORS when compared with ORS alone.
Abstract: BACKGROUND AND AIM: The World Health Organization recommends oral zinc (tablets or syrups) as adjunct therapy with oral rehydration solution (ORS) for acute childhood diarrhea. Mixing zinc with ORS can be an attractive approach for simultaneous provision of these 2 effective interventions. This double-masked randomized controlled trial evaluated the efficacy of ORS containing 40 mg/L elemental zinc per liter (zinc-ORS) in reducing stool weight and duration of diarrhea. PATIENTS AND METHODS: Five hundred northern Indian children ages 1 to 35 months with diarrhea <7 days duration were randomized to zinc-ORS or ORS. The primary outcomes were total stool output and time to recovery. RESULTS: The median total stool output was 2.12 g . kg(1) . h(1) (interquartile range [IQR] 0.9-3.76) in the zinc-ORS group compared with 1.78 g . kg(1) . h(1) (IQR 0.83-3.45) in the ORS group. The time to recovery was also similar in the 2 groups (hazard ratio 1.06 [95% confidence interval 0.88-1.27]). In subjects who received zinc-ORS the median (IQR) zinc intakes were 27 (16-46) mg on day 1 15 (6-27) mg on day 2 and negligible thereafter. CONCLUSIONS: The World Health Organization-recommended daily dose of zinc for diarrhea was not achieved in most children beyond the first day of treatment. This is the likely explanation for the lack of improvement in outcomes from zinc-ORS when compared with ORS alone. Our findings do not support a change from using zinc syrup or dispersible tablets for treatment of acute diarrhea in children.
18 citations
TL;DR: Poor folate status was an independent predictor of persistent diarrhea in this population of children in New Delhi, India, and plasma cobalamin concentration was not a predictor of diarrheal morbidity.
Abstract: Poor micronutrient status is associated with diarrheal illness, but it is not known whether low folate and/or cobalamin status are independent risk factors for diarrhea. We measured the association ...
18 citations
TL;DR: RSV was the dominant respiratory viral pathogen detected in young Nepalese children hospitalized with severe pneumonia, the viral infections contributing importantly to these epidemics.
Abstract: BACKGROUND Pneumonia is among the leading causes of illness and death in children <5 years of age worldwide. There is little information on the viral etiology of severe pneumonia in low-income countries, where the disease burden is particularly high. METHODS We analyzed nasopharyngeal aspirates from 629 children 2 to 35 months of age meeting World Health Organization criteria for severe pneumonia and presenting at Kanti Children's Hospital, Kathmandu, Nepal, from January 2006 through June 2008. We examined one specimen from each child for 7 respiratory viruses using reverse transcription polymerase chain reaction. RESULTS We detected one or more respiratory viruses in 188 (30%; confidence interval: 26.4%-33.7%) of the 627 specimens with a valid polymerase chain reaction result, of which 88 (14%) yielded respiratory syncytial virus (RSV), 28 (4.5%) influenza A, 24 (5.8%) parainfluenza virus (PIV) type 3, 23 (3.7%) PIV type 1, 17 (2.7%) influenza B, 9 (1.4%) human metapneumovirus, and 5 (0.8%) PIV type 2. Episodes of severe pneumonia occurred in an epidemic pattern with 2 main annual peaks, the viral infections contributing importantly to these epidemics. The largest peaks of severe pneumonia coincided with peaks of RSV infection, which occurred during the last part of the monsoon season and in winter. CONCLUSIONS RSV was the dominant respiratory viral pathogen detected in young Nepalese children hospitalized with severe pneumonia.
17 citations
TL;DR: The efficacy of zinc on reducing the risk of prolonged diarrhea was higher in children with plasma cobalamin concentrations below the 25th percentile and in those with tHcy and MMA concentrations above the 75th percentile, which indicates a need to identify subgroups most likely to benefit from improved zinc nutriture.
Abstract: The observed effect of zinc supplementation on diarrheal morbidity varies between trials and there is a need to identify subgroups most likely to benefit from improved zinc nutriture. In a randomized, double-blind trial in 2296 children in New Delhi, India, we assessed whether baseline cobalamin or folate status modified the effect of zinc supplementation on the incidence of prolonged (≥ 7 d duration) and acute diarrhea. Children aged 6-30 mo received zinc or placebo daily for 4 mo. We measured plasma concentrations of folate, cobalamin, total homocysteine (tHcy), and methylmalonic acid (MMA) at enrollment and assessed the efficacy of zinc supplementation in subgroups based on these variables. The efficacy of zinc on reducing the risk of prolonged diarrhea was higher in those with plasma cobalamin concentrations below the 25th percentile and in those with tHcy and MMA concentrations above the 75th percentile. The OR (95% CI) for children below and above the 25th percentile for cobalamin were 0.53 (0.35-0.78) and 0.90 (0.73-1.11), respectively (P-interaction = 0.015). There were similar differences for the OR when comparing efficacy in those above and below the 75th percentile for tHcy and MMA (P-interaction = 0.045 and 0.188, respectively). Baseline folate status did not modify the effect of zinc on prolonged diarrhea. Neither cobalamin nor folate status influenced the effect of zinc on acute diarrhea. Children with poor cobalamin status benefited more from zinc supplementation for the prevention of prolonged diarrhea.
7 citations
01 Jan 2011
TL;DR: In a randomized, double-blind trial in 2296 children in New Delhi, India, this article assessed whether baseline cobalamin or folate status modified the effect of zinc supplementation on the incidence of prolonged ($7 d duration) and acute diarrhea.
Abstract: The observed effect of zinc supplementation on diarrheal morbidity varies between trials and there is a need to identify subgroups most likely to benefit from improved zinc nutriture. In a randomized, double-blind trial in 2296 children in New Delhi, India, we assessed whether baseline cobalamin or folate status modified the effect of zinc supplementation on the incidence of prolonged ($7 d duration) and acute diarrhea. Children aged 6‐30 mo received zinc or placebo daily for 4 mo. We measured plasma concentrations of folate, cobalamin, total homocysteine (tHcy), and methylmalonic acid (MMA) at enrollment and assessed the efficacy of zinc supplementation in subgroups based on these variables. The efficacy of zinc on reducing the risk of prolonged diarrhea was higher in those with plasma cobalamin concentrations below the 25th percentile and in those with tHcy and MMA concentrations above the 75th percentile. The OR (95% CI) for children below and above the 25th percentile for cobalamin were 0.53 (0.35‐0.78) and 0.90 (0.73‐1.11), respectively (P-interaction = 0.015). There were similar differences for the OR when comparing efficacy in those above and below the 75th percentile for tHcy and MMA (P-interaction = 0.045 and 0.188, respectively). Baseline folate status did not modify the effect of zinc on prolonged diarrhea. Neither cobalamin nor folate status influenced the effect of zinc on acute diarrhea. Children with poor cobalamin status benefited more from zinc supplementation for the prevention of prolonged diarrhea. J. Nutr. 141: 1108‐1113, 2011.
2 citations