A COMPARATIVE EVALUATION ON THE EFFECT OF ZINC-PROBIOTIC AND PROBIOTIC THERAPY IN PAEDIATRIC ACUTE DIARRHOEA AND THE IMPACT OF COUNSELLING OF MOTHERS Original Article ALEENA ANN ABRAHAM 1 , S. R. AMRITHA 2 , C. D. SHAJI SELVIN 3 Sreekrishna College of Pharmacy and Research Centre, Parassala, Thiruvananthapuram, Kerala, India Email: shajimpharm@gmail.com * Received: 18 Mar 2016 Revised and Accepted: 17 May 2016 ABSTRACT Objective: To compare the efficacy of zinc-probiotic combination therapy and probiotic therapy alone in the treatment of acute paediatric diarrhoea and to assess the knowledge, attitude and practice (KAP) of the mothers of affected children and the impact of counselling on diarrhoea management. Methods: A prospective observational comparative study was conducted from October 2014 to March 2015 in the paediatric department of Cosmopolitan Hospitals Pvt. Ltd., Thiruvananthapuram, Kerala, South India. The study was carried out on 150 patients between the ages of 3 mo to 12 y. The selected patients were divided into 2 groups of 75 members each. Initially, demographic data, details of socioeconomic status, severity, duration and frequency of diarrhoea and the presence of other associated symptoms and KAP of mothers before and after counselling was collected by using specially designed proforma. Group 1 patients received zinc and probiotic and Group 2 received probiotic only by oral administration. All children in both groups received sufficient quantity of oral rehydration solution (ORS). The requirement of other medications and adverse effects were also monitored. Results: The study revealed that, in group 1, 54.6% of patients were males and in group 2, 58.6% were females. The mean age of affected children was 5.14±3.53. In both groups, the majority of patients were from outpatient (OP) departments. In group 1, majority of patients, 49.3% were resting in upper lower economic class followed by 30.7% were lower middle class. In the case of group 2, 34.6% patients were from lower middle and 28% were from upper middle class. Other medications such as antiemetic and antipyretic were administered to 127and 110 patients respectively. Antisecretory and antibiotic were administered to 31 and 26 patients respectively. Totally 8 patients were affected with adverse drug reactions such as rashes and swelling of lips. In both groups severity of diarrhoea was high before treatment and it was changed after effective treatment with drugs. Comparing with group 2, the duration and severity of diarrhoea and other associated symptoms in group 1 patients were significantly reduced after treatment. Before counseling, the majority of mothers had very poor knowledge about the diarrhoeal disease and its management. Evaluation after counselling showed a significant improvement. Conclusion: Low socioeconomic life is a risk factor for diarrhoea. A combination of zinc and probiotic therapy is more effective than probiotic therapy alone in the treatment of acute diarrhoea and vomiting in children. The emergence and severity of the diarrhoeal disease can be reduced by effective clinical pharmacist interventions, and a great emphasis is needed in the counselling and education of mothers about this disease and its management. Keywords: Paediatric diarrhoea, Zinc, Probiotic, KAP, Counselling and education © 2016 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) INTRODUCTION Diarrhoea is a common problem, affects all age groups. It is defined as the passage of loose and watery stools for 3 or more times in a day [1, 2]. A bacterial infection such as Campylobacter, E. coli, Salmonella and Shigella infections, viral infections such as Rotavirus, Cytomegalovirus, Norwalk, Hepatitis and Herpes simplex infections, intestinal parasites infections and food intolerances are some of the important causes of diarrhoea in both children and adults. Administration of antibiotics and antacids containing magnesium may also lead to diarrhoea. Overcrowding, poor sanitation and lack of safe drinking water are some of the important issues closely associated with diarrhoeal disease [1]. Diarrhoea is one of the common causes of childhood morbidity and mortality in developing countries [3, 4]. Diarrhoea kills more children worldwide, comparing with tuberculosis, malaria, and AIDS combined. Dehydration, acidosis, impairment of renal function, secondary infections are some of the important factors closely associated with deaths due to diarrhoea [1]. According to the guidelines of World Health Organization, antibacterial, antiamoebic and antidiarrhoeal agents have a little role in the management of diarrhoea [3]. In developing countries, duration and severity of diarrhoea is more among younger age groups with malnutrition and impaired immune status which may be associated with zinc deficiency. Diarrhoea is more common in children with zinc deficiency and responds quickly to zinc supplementation [5, 6]. In recent years, probiotics have been widely studied in the prevention and treatment of diarrhoea particularly in paediatric population [7, 8]. Probiotics are live microbes administered in sufficient quantity to develop a health benefit on the host. Either single or mixed culture of bacteria of genera Bacillus, Lactobacillus, Bifidobacterium and non-pathogenic yeast such as Saccharomyces boulardii are some examples for commonly used probiotics. It is used in the prevention and treatment of diarrhoea based on the assumption that they modify the microflora composition of the colon and act against enteric pathogens [7]. Diarrhoeal episodes are mostly treated in homes and mothers are the main caregivers for children below five years old. Hence their knowledge about this disorder gains importance [2, 3]. Though lot of studies has been conducted on diarrhoea and KAP of mothers of young children worldwide, it was identified that in the present study area, none of the studies were carried out in this regard in recent years. With this view, the present study was designed to evaluate the efficacy of zinc- probiotic combination therapy and probiotic therapy alone in the treatment of acute paediatric diarrhoea and to assess the KAP of the mothers of affected children and the impact of counselling provided to them regarding diarrhoea management. The outcome of this study would provide a good platform for further study. International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 8, Issue 7, 2016