Among children under five, acute diarrhoea continues to be one of the leading causes of illness and mortality globally, especially in low- and middle-income nations. Diarrhoeal illnesses still represent a serious threat to children's health despite great advancements in diet, immunisation, sanitation, and healthcare facilities. The World Health Organization (WHO) reports that diarrhoea causes millions of outpatient visits and hospital admissions each year and is one of the main causes of death for children under five [1, 2]. The passage of three or more loose or watery stools each day for fewer than 14 days is commonly referred to as acute diarrhoea. If left untreated, the illness, which is frequently brought on by bacterial, viral, or parasite infections, can result in malnourishment, electrolyte imbalance, dehydration, and growth retardation. Among the microorganisms most commonly linked to paediatric diarrhoeal diseases include rotavirus, norovirus, enterotoxigenic Escherichia coli, Shigella, and Salmonella species [3, 4]. Oral Rehydration Therapy (ORT), which has dramatically decreased the mortality linked to dehydration, is the cornerstone of treatment for acute diarrhoea. One of the most significant public health initiatives in paediatric medicine, ORT efficiently replenishes lost fluids and electrolytes. Nevertheless, ORT does not significantly lower the frequency of stools, the length of the illness, or the recurrence of diarrhoeal episodes, even if it prevents and relieves dehydration [5, 6]. Enzyme activity, immunological response, intestinal epithelial integrity, and cellular proliferation all depend on zinc, an important trace element. Children in poorer nations frequently suffer from zinc deficiency as a result of poor food intake, recurring illnesses, and malnutrition. Zinc losses rise dramatically during severe diarrhoeal episodes, further impairing immunological responses and intestinal function. Zinc supplements have been demonstrated to strengthen immune systems, improve water and electrolyte absorption, improve intestinal mucosal healing, and lessen the intensity and duration of diarrhoeal episodes [7, 8]. Numerous clinical trials have shown how zinc can help children with acute diarrhoea. However, different groups may respond differently to treatment due to differences in nutritional status, socioeconomic circumstances, disease severity, and healthcare practices. Therefore, it is still crucial to assess zinc supplementation in certain clinical contexts in order to improve evidence-based treatment approaches [9, 10]. In children with acute diarrhoea, the current study was conducted to examine the effectiveness of zinc supplementation in conjunction with oral rehydration therapy with oral rehydration therapy alone. The purpose of the study was to evaluate how the two treatment modalities differed in terms of recovery rate, length of hospital stay, frequency of stools, duration of diarrhoea, and overall clinical results. The results may contribute to better paediatric healthcare outcomes and promote the best management practices for acute diarrhoeal illnesses in children [11].

This prospective comparative study was conducted in the Department of Paediatrics, Kanya Kumari Medical Missions Medical College, Kanyakumari, Tamil Nadu, between September 2024 and August 2025. A total of 40 children aged 6 months to 5 years presenting with acute diarrhea were included in the study after obtaining informed consent from their parents or legal guardians. Ethical approval for the study was obtained from the Institutional Ethics Committee prior to commencement. All enrolled children underwent detailed clinical evaluation including history taking, physical examination, and assessment of dehydration status, nutritional evaluation, and relevant laboratory investigations whenever indicated. Methods: Patient demographics, age, gender, duration of diarrhea, stool frequency, dehydration status, nutritional status, feeding practices, and clinical presentation were recorded. The participants were randomly allocated into two groups of 20 children each. • Group A: Received Oral Rehydration Therapy (ORT) along with age-appropriate zinc supplementation for 14 days. • Group B: Received Oral Rehydration Therapy (ORT) alone. Children aged 6 months to 5 years received zinc supplementation according to WHO recommendations. Clinical parameters including duration of diarrhea, daily stool frequency, duration of hospitalization, recovery time, adverse effects, and treatment outcomes were monitored and recorded. Standard treatment protocols for acute diarrhea, including continued feeding and supportive care, were followed in both groups. Follow-up assessments were performed until complete recovery. Inclusion Criteria: • Children aged 6 months to 5 years. • Children presenting with acute diarrhea of less than 14 days duration. • Children with mild to moderate dehydration or no dehydration. • Parents or guardians willing to provide written informed consent. • Children available for follow-up during the study period. Exclusion Criteria: • Children younger than 6 months or older than 5 years. • Chronic diarrhea lasting more than 14 days. • Severe dehydration requiring immediate intensive management. • Children with congenital gastrointestinal disorders. • Children already receiving zinc supplementation before enrollment. • Parents or guardians unwilling to participate in the study. Statistical Analysis: We used SPSS version 26.0 to analyse the data that had been entered into Microsoft Excel. Mean ± standard deviation (SD) was used to represent continuous variables, whilst frequencies and percentages were used for categorical variables. We used the Chi-square test or Fisher's exact test to compare categorical variables between the two treatment groups. The Student's t-test was used to compare continuous variables such as duration of diarrhea, stool frequency, and duration of hospitalization. Treatment efficacy was assessed by comparing recovery rates, reduction in stool frequency, and duration of illness between the zinc plus ORT group and the ORT-alone group. Statistical significance was determined by a p-value less than 0.05.

A total of 40 children with acute diarrhea were enrolled in the study and randomly allocated into two groups. Group A (n=20) received Oral Rehydration Therapy (ORT) along with zinc supplementation, while Group B (n=20) received ORT alone. The demographic characteristics, clinical outcomes, and treatment responses were analyzed and compared between the two groups. Table 1: Baseline Demographic Characteristics of Study Participants Variable Group A (ORT + Zinc) (n=20) Group B (ORT Alone) (n=20) p-value Mean Age (Years) 2.2 ± 1.1 2.4 ± 1.3 0.62 Male 12 (60.0%) 12 (60.0%) 1.00 Female 8 (40.0%) 8 (40.0%) 1.00 Mild Dehydration 11 (55.0%) 10 (50.0%) 0.75 Moderate Dehydration 9 (45.0%) 10 (50.0%) 0.75 Table 1 shows that both groups were comparable with respect to age, gender distribution, and dehydration status at baseline, with no statistically significant differences. Table 2: Clinical Characteristics at Presentation Parameter Group A (n=20) Group B (n=20) Mean Duration of Diarrhea Before Admission (Days) 2.1 ± 0.8 2.3 ± 0.9 Mean Stool Frequency/Day 7.8 ± 1.5 8.0 ± 1.6 Vomiting 8 (40.0%) 9 (45.0%) Fever 7 (35.0%) 8 (40.0%) Poor Feeding 6 (30.0%) 5 (25.0%) Table 2 demonstrates that the clinical characteristics at presentation were similar in both treatment groups. Table 3: Comparison of Treatment Outcomes Outcome Parameter Group A (ORT + Zinc) Group B (ORT Alone) p-value Duration of Diarrhea (Days) 3.2 ± 1.1 4.8 ± 1.4 0.001 Stool Frequency on Day 3 3.1 ± 1.0 5.0 ± 1.3 0.002 Duration of Hospital Stay (Days) 2.1 ± 0.8 3.4 ± 1.1 0.003 Time to Clinical Recovery (Days) 3.4 ± 1.0 5.0 ± 1.5 0.001 Table 3 shows that children receiving zinc supplementation along with ORT experienced significantly shorter duration of diarrhea, lower stool frequency, reduced hospital stay, and faster clinical recovery compared to those receiving ORT alone. Table 4: Recovery Status Recovery Outcome Group A (n=20) Group B (n=20) Recovered Within 5 Days 18 (90.0%) 13 (65.0%) Recovered After 5 Days 2 (10.0%) 7 (35.0%) Total Recovery 20 (100.0%) 20 (100.0%) Table 4 demonstrates that a significantly higher proportion of children in the zinc supplementation group recovered within five days compared to the ORT-alone group. Table 5: Adverse Effects Observed During Treatment Adverse Effect Group A (n=20) Group B (n=20) Mild Vomiting 2 (10.0%) 0 (0.0%) Abdominal Discomfort 1 (5.0%) 1 (5.0%) Serious Adverse Events 0 (0.0%) 0 (0.0%) Table 5 shows that zinc supplementation was generally well tolerated. Mild vomiting was observed in two children receiving zinc but did not necessitate discontinuation of therapy.

In the present study, both treatment groups were comparable with respect to age, gender distribution, dehydration status, and clinical presentation at baseline, allowing a reliable comparison of treatment outcomes. The majority of children were between 1 and 3 years of age, which is consistent with the age group most vulnerable to diarrheal illnesses due to immature immunity, increased environmental exposure, and nutritional deficiencies [12, 13]. The present study also demonstrated a significant reduction in stool frequency among children receiving zinc supplementation. By the third day of treatment, children in the zinc group experienced fewer diarrheal episodes compared to those receiving ORT alone. Reduced stool frequency not only improves patient comfort but also decreases the risk of dehydration and the need for prolonged medical care. Similar observations have been reported in previous studies evaluating zinc as an adjunct therapy for acute childhood diarrhea [14, 15]. Another important finding was the shorter duration of hospitalization among children receiving zinc supplementation. Reduced hospital stay has important clinical and economic implications, including decreased healthcare costs, reduced burden on healthcare facilities, and lower risk of hospital-acquired infections. Faster recovery observed in the zinc-treated group further supports the therapeutic benefits of zinc supplementation in pediatric diarrheal diseases [16, 17]. Zinc supplementation was found to be safe and well tolerated. Only a small number of children experienced mild vomiting, which did not require discontinuation of therapy. No serious adverse effects were observed during the study. These findings are consistent with the established safety profile of zinc supplementation reported in previous pediatric studies and WHO recommendations [18, 19]. The present study has certain limitations. The sample size was relatively small, and the study was conducted at a single tertiary care center, which may limit the generalizability of the findings. Furthermore, microbiological identification of causative pathogens was not performed routinely, preventing assessment of the efficacy of zinc against specific etiological agents. Larger multicenter studies with longer follow-up periods may provide additional evidence regarding the long-term benefits of zinc supplementation [20, 21].

The present study demonstrated that zinc supplementation combined with Oral Rehydration Therapy is significantly more effective than ORT alone in the management of acute diarrhea in children. Children receiving zinc experienced a shorter duration of diarrhea, reduced stool frequency, faster clinical recovery, and shorter hospital stay. Zinc supplementation was safe, well tolerated, and associated with minimal adverse effects. Routine use of zinc as an adjunct to ORT should be encouraged to improve treatment outcomes and reduce the burden of acute diarrheal disease in children.

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