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Current Opinion in Gastroenterology. 2010 Sep 10; 26: p.PURPOSE OF REVIEW: To highlight recent advances in our understanding of prolonged episodes of acute diarrhea and persistent diarrhea in children. The focus is on the contribution of these illnesses to the global burden of diarrhea, their impact on childhood growth and development, novel epidemiologic links between prolonged and persistent diarrheal episodes, and strategies for their prevention and management. RECENT FINDINGS: Although less common than acute diarrhea, prolonged and persistent episodes of diarrhea in childhood constitute a significant portion of the global burden of diarrhea. These episodes also play a key role in the vicious cycle of childhood diarrhea and malnutrition in which undernutrition is both a risk factor and an outcome of diarrhea. Increased efforts to provide WHO-recommended zinc therapy for all children with diarrhea in developing countries will significantly reduce morbidity and mortality. In children who develop persistent diarrhea, yogurt-based or amino acid-based diets may accelerate their recovery. SUMMARY: In addition to increased implementation of strategies already known to effectively prevent and manage acute diarrhea, further research is needed to address the recognition, prevention, and treatment of prolonged episodes of acute diarrhea and persistent diarrhea in resource-limited settings.
BMJ. British Medical Journal. 2005 Feb 12; 330:347-349.Zinc deficiency is one of the ten biggest factors contributing to burden of disease in developing countries with high mortality. Since the problem was highlighted in the World Health Report 2002, calls have increased for supplementation and food fortification programmes. Zinc interventions are among those proposed to help reduce child deaths globally by 63%. Populations in South East Asia and sub-Saharan Africa are at greatest risk of zinc deficiency; zinc intakes are inadequate for about a third of the population and stunting affects 40% of preschool children. Zinc is commonly the most deficient nutrient in complementary food mixtures fed to infants during weaning. Improving zinc intakes through dietary improvements is a complex task that requires considerable time and effort. The case for promoting the use of zinc supplements and for fortifying foods with zinc, especially those foods commonly eaten by young children, therefore seems strong. However, global policies or recommendations for zinc interventions are few. The World Health Organization recommends zinc only as a curative intervention, either as part of the mineral mix used in the preparation of foods for the treatment of severe malnutrition, or more recently in the treatment of diarrhoea. We review current evidence that improving zinc intake has important preventive or curative benefits for mothers and young children and examine the programme implications for achieving this in developing countries. (excerpt)