Hi Judith, In some places it is available as a combined package. PSI, supported by UNICEF and others, is working to increase access to the combined package through various methods. [url]http://www.psi.org/our-work/healthy-lives/interventions/zinc[/url]

The idea of putting Zn into ORS faces a difficult problem, as the ORS dose taken by each child is highly variable. Hence, it is impossible or very difficult to make sure that each child gets the amount of Zn he/she needs if included in ORS. Another factor to consider is that many carers consider that ORS is not a drug and ask health professionals to have a “tablet” in addition to it. Some observations suggest that giving a Zn tablet leads to a decrease of inappropriate antibiotic intake.

Dear Erin and André, thank you for your valuable Responses. So some efforts are done towards combining but still the challenge of age appropriate dose and of demand for tablets and the Advantage of preventing inappropriate antibiotics through Zn tablets are faced. Having the combined ORS+Zn differenciated for Age Groups might be challenging, since ORS is known for it's easy and undifferenciated use. So we might Need to stick on promoting the strong Need for combined use of the two... Tanks & Best, Judith

Hi everyone, I've been discussing this question and the replies with our Nigeria team and they had a queries about details and clarity of advice around ORS + Zinc for children under-5: - If Zinc is being prescribed for 10-14 days, can an age-appropriate dose of ORS also be given for 10-14 days, even if the diarrhoea stops completely (self-resolving or through antibiotics etc) and the child is well before the 10-14 days is up? Concerns about children getting too much salt... Very many thanks, Genevieve

ORS is given to correct dehydration, not to treat diarrhoea. No need to give it further when diarrhoea stops and there is no risk of dehydration. This is different for zinc which is given to correct a possible deficiency.

Hello everyone

I am preparing a training of trainers on the integrated management of acute malnutrition. Could you help me with the module on pathophysiology of acute malnutrition or CMAM training toolkit according to the new recommendations by researchers such as Michael Golden?

A child who is not dehydrated will not take much of ORS. But Sanjay is right, it is not desirable to give a salty drink to children who don’t need it. And this can be dangerous in malnourished children who already have an excess body Na and may develop heart failure if given too much Na. An excess mortality in therapeutic feeding centres giving freely Resomal to malnourished children has been reported a few years ago, although Resomal contains less salt than standard ORS. So better to stop ORS when diarrhoea is over.