Guideline comparison, reviewed 27 October 2026. The WHO’s updated 2024 childhood diarrhoea guideline suggests 5 mg elemental zinc orally each day for up to 14 days for acute watery or persistent diarrhoea in children up to 10 years. However, India’s National Health Mission (NHM) 2025 STOP Diarrhoea campaign continues to specify an age-based 10/20 mg regimen for children under five. These are different guideline contexts; a global update does not automatically replace a national programme protocol.
WHO versus India: dosing comparison
| Authority | Age / situation | Regimen |
|---|---|---|
| WHO 2024 guideline | Children up to 10 years with acute watery or persistent diarrhoea | 5 mg elemental zinc orally daily, up to 14 days — conditional recommendation |
| India NHM STOP Diarrhoea 2025 | Under 2 months | Zinc not recommended in the cited campaign table |
| India NHM STOP Diarrhoea 2025 | 2 to under 6 months | 10 mg once daily for 14 days (half a 20 mg tablet where suitable) |
| India NHM STOP Diarrhoea 2025 | 6–59 months | 20 mg once daily for 14 days |
UNICEF’s 6 July 2026 supply update says 5 mg zinc tablets were not yet commercially available at scale and explains that WHO/UNICEF advise continued use of established products during transition. Prescribers should check the most current state/national protocol, age and elemental zinc content, not merely the zinc salt weight.
ORS is the essential first-line intervention
Low-osmolarity oral rehydration solution (ORS) replaces fluid and electrolyte losses. Zinc is an adjunct, not a substitute for rehydration. Mix a complete sachet with exactly the safe-water volume printed on its label: 200 mL, 500 mL and 1 L packs exist. Adding the wrong amount of water can cause harmful electrolyte concentrations. Do not add extra sugar or salt to a correctly prepared sachet. Continue breastfeeding and age-appropriate feeding.
Assessment and escalation
Assess hydration, ability to drink, mental state, urine output and severity of illness. A lethargic child, child unable to drink, infant with concerning signs, shock, blood in stool, persistent vomiting preventing oral intake or suspected severe dehydration needs urgent clinical assessment. Severe dehydration may require supervised IV rehydration. Routine antibiotics are not indicated for uncomplicated acute watery diarrhoea; specific clinical diagnoses may require them.
CHC/AAM implementation checklist
- Check the sachet’s exact mixing volume and demonstrate preparation to caregivers.
- Record age and hydration category before deciding on treatment and referral.
- Use the currently approved Indian/state zinc regimen until formally updated; avoid mixing 5, 10 and 20 mg instructions.
- Explain that zinc can cause vomiting and check tolerability and formulation.
- Provide clear return precautions, continue feeds and document counselling.
Why the recommendations differ
The WHO guideline considers newer evidence, including vomiting and tolerability. Implementation depends on national adoption, manufacturing, procurement, training and supply. The WHO 2024 recommendation should not be misquoted as an immediate directive that every Indian facility must dispense 5 mg zinc. Conversely, the older 10/20 mg regimen should not be described as the latest global WHO recommendation without context.
Official references
- WHO: Guideline on management of pneumonia and diarrhoea in children up to 10 years (31 Dec 2024)
- NHM India: STOP Diarrhoea Campaign 2025 guidance (PDF)
- UNICEF Supply: ORS and zinc market update (6 July 2026)
- WHO: Diarrhoeal disease factsheet
Educational comparison for clinicians and health workers; not an individual treatment plan. Confirm local protocols and product strengths before prescribing.