الفهرس 
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Abstract
It is estimated that diarrhea diseases cause more than 3 million deaths of children in developing countries each year and contribute substantially to malnutrition in surviving children. Treatment of acute diarrhea with oral rehydration solution has become widespread, resulting in reduced mortality from dehydrating diarrheas but no decrease in the duration of episodes or their consequences, such as malnutrition. Furthermore, adherence to recommendations regarding fluid therapy in children with diarrhea is poor because caregivers want to reduce the duration of illness and this often leads them to use antibiotics and other treatments of no proven value. The considerable reduction of mortality from diarrhea following introduction of oral rehydration therapy has revealed the seriousness of prolonged diarrhea with malnutrition. Recently, more attention is being given to those acute episodes that become persistent because of the unclear etiology, serious adverse effects on growth and nutritional status, high mortality risk, and the demanding and frustrating management problem persistent diarrhea poses. Thus, persistent diarrhea became a growing part of the global burden of diarrhea diseases. The identification of risk factors for persistent diarrhea is important because it can obtain valuable information relative to the pathogenesis and prevention of this disease. Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhea and on the nutritional status of those children. Reduced diarrhea morbidity has been documented in zinc supplementation trials, but these were not enough to assess whether zinc supplementation prevents clinically severe, recurrent or persistent diarrhea. In addition, the effect of zinc supplementation on growth of children suffering from prolonged diarrhea is a controversial issue. Before public health policy is made, it is important to assess whether zinc supplementation prevents clinically severe and prolonged diarrhea. A significant reduction in the incidence of such episodes plus positive effects on growth, would justify adoption of measures to prevent zinc deficiency in susceptible populations. Therefore, this study was held to identify the most possibly incriminated organisms, and the different risk factors (including environmental, household, clinical, nutritional, and others) associated with the prolonged diarrhea attacks. Another part of this study was conducted to elucidate the role of zinc supplementation both in the growth and diarrhea prevention and outcome. The current study included 202 preschool children; 82 children were suffering from persistent diarrhea (diarrhea = 14 days), and 120 children had recurrent diarrhea =3 diarrhea attacks semiannually). The children were attending out-patients clinics of public hospitals and MCH centers. All the studied cases were subjected to a thorough history taking from the respondents and clinical examination. Stool samples were examined macroscopically and microscopically and were cultured and biochemical examined for identification of various bacterial pathogens. Parasitological examination was also done including MIFC and acid-fast staining technique. The second follow up phase of this study included 80 zinc-supplemented group and 80 controls from the previously examined subjects. Both groups were matched as regards age, sex and nutritional status before the follow up period. The children of the zinc group were supplemented with 10 mg elemental zinc daily for the four months follow up period. Children of both groups were regularly checked for various growth parameters and the incidence and characters of developed diarrhea attacks were recorded. Analysis of the data revealed the following: 1. Persistent diarrhea was more prevalent in females while recurrent diarrhea was more prevalent in males. 2. The first child in the family is the most susceptible to both persistent and recurrent diarrhea.