{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:04:30Z","timestamp":1784307870346,"version":"3.55.0"},"reference-count":0,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"unspecified","delay-in-days":306,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Zinc supplementation is a critical adjunct therapy for managing acute childhood diarrhoea, particularly in low-income countries (LICs) and lower middle-income countries (LMICs). However, adherence to the recommended zinc regimen remains a major challenge, limiting its effectiveness in real-world settings. This systematic review and meta-analysis aimed to estimate the pooled adherence rates to zinc supplementation for diarrhoea in children under 5 and identify key determinants of adherence. A comprehensive search of PubMed, Embase, Scopus, Google Scholar, ProQuest, and CINAHL was conducted between 2000 and 2024. A total of 10 observational studies were included, with pooled adherence of 63.45% (95% CI: 51.62\u201375.28) for 10\u00a0days regimen and 34.58% (95% CI: 7.08\u201362.09) for 14\u00a0days regimen, along with high heterogeneity. Sensitivity analysis confirmed robustness of these estimates. Key factors associated with adherence included caregiver education, provider counselling, medication acceptability, and economic constraints related to caregiver buying capacity. Doi plot asymmetry suggested possible publication bias for 10 and 14 days regimen. Overall, adherence to zinc therapy remains sub-optimal, particularly for 14 days regimen compared to 10 days regimen. Targeted interventions addressing behavioural, provider, and formulation related barriers are urgently needed to optimize zinc adherence and improve diarrhoea outcomes globally.<\/jats:p>","DOI":"10.1017\/s0950268825100733","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T07:57:18Z","timestamp":1762156638000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Adherence to oral zinc supplementation in the management of acute diarrhoeal disease among under-5 children: A systematic review and meta-analysis"],"prefix":"10.1017","volume":"153","author":[{"given":"Somen Kumar","family":"Pradhan","sequence":"first","affiliation":[{"name":"Maharaja Krishna Chandra Gajapati Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swagatika","family":"Pati","sequence":"additional","affiliation":[{"name":"Regional Medical Research Centre Bhubaneswar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pritimayee","family":"Sethy","sequence":"additional","affiliation":[{"name":"Regional Medical Research Centre Bhubaneswar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshita Rajesh","family":"Dhusiya","sequence":"additional","affiliation":[{"name":"Regional Medical Research Centre Bhubaneswar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Panda","sequence":"additional","affiliation":[{"name":"Maharaja Krishna Chandra Gajapati Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debasish","family":"Pandit","sequence":"additional","affiliation":[{"name":"Shri Jagannath Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8719-4539","authenticated-orcid":false,"given":"Jaya Singh","family":"Kshatri","sequence":"additional","affiliation":[{"name":"Regional Medical Research Centre Bhubaneswar"},{"name":"Maastricht University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikanta","family":"Kanungo","sequence":"additional","affiliation":[{"name":"Regional Medical Research Centre Bhubaneswar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7717-5592","authenticated-orcid":false,"given":"Sanghamitra","family":"Pati","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,11,3]]},"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268825100733","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T07:26:47Z","timestamp":1763018807000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268825100733\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":0,"alternative-id":["S0950268825100733"],"URL":"https:\/\/doi.org\/10.1017\/s0950268825100733","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e129"}}