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  1. 1

    The management of bloody diarrhoea in young children.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, Switzerland], WHO, 1994. [2], 17 p. (WHO/CDD/94.49)

    The clinical diagnosis of bloody diarrhea refers to any diarrheal episode in which the loose or watery stools contain visible red blood. This does not include episodes in which blood is present in streaks on the surface of formed stool, is detected only by microscopic examination or biochemical tests, or in which stools are black due to the presence of digested blood. The health practitioner may diagnose the presence of bloody diarrhea in a child by either asking the mother whether the child's stool contains red blood or by looking at the stool, but the former approach is usually more efficient than waiting for the child to pass a stool and as equally sensitive and precise. All infants and children with bloody diarrhea should be treated promptly with an antimicrobial effective against Shigella. Such antimicrobials include ampicillin, TMP-SMX (cotrimoxazole), nalidixic acid, pivvmecillinam, newer quinolones, and ceftriaxone. Dehydration when detected in children with bloody diarrhea should be treated at the health facility. Children with bloody diarrhea and signs of dehydration are at increased risk of complications and should be re-evaluated two days after treatment. The caretakers of all children should be encouraged to offer increased amounts of suitable fluids at home. Moreover, the continued provision of nutritious food is important for all children with dysentery, even though they may have to be coaxed to eat. Appetite usually improves after 1-2 days of effective antibiotic therapy. Frequent small meals with familiar foods are usually better tolerated than a few large meals. Furthermore, mothers should be advised to breastfeed as often and as long as their children want, while children convalescing from dysentery should be given an extra meal each day for at least two weeks. Severely malnourished children with bloody diarrhea are at very high risk of complications and should be referred immediately to hospital after starting treatment for shigellosis.
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  2. 2

    Report of the third meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Unpublished] 1984. 17 p. (WHO/CDD/BEI/84.5)

    The scientific topic discussed in detail by the Scientific Working Group (SWG) was recent research advances in the field of cholera. The SWG reviewed new knowlenge in areas such as epidemiology and ecology, phage-typing, pathogenesis, immunization, and related pathogens, and made recommendations for future research. The Diarrhoeal Disease Control Pragramme was continuing to emphasize the implementation of oral rehydration therapy as a means of reducing diarrheal mortality, and research aimed at an improved case-management strategy. The Steering Committee granted support to a number of projects aimed at clarifying the epidemiology of diarrhea and the pathogenesis of bacterial agents of acute diarrhea. Support was provided by the Steering Committee to projects aimed at, or closely related to the development of new vaccines against typhoid fever, cholera, and Shigella dysentery.
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  3. 3

    Validation of outpatient IMCI guidelines.

    United States. Agency for International Development [USAID]. Child Health Research Project

    SYNOPSIS. 1998 Jan; (2):1-8.

    The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
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  4. 4

    Diarrheal diseases morbidity, mortality and treatment rates in Bahrain (1986).

    Al-Khateeb M

    [Unpublished] 1988. Presented at the 13th World Conference on Health Education, Houston, Texas, August 28 - September 2, 1988. 60 p.

    This study is the report of a 1986 baseline survey, guided by the World Health Organization's "Guidelines for a Sample Survey of Diarrheal Diseases Morbidity, Mortality, and Treatment Rate." The survey method was the Expanded Program on Immunization 30 cluster 2-stage method. Baseline data were also gathered on the status of immunization against diphtheria, tetanus, whooping cough, poliomyelitis, measles, and tuberculosis. Primary health care services in Bahrain are generally good. The archipelago of 670 sq km has a population of 417,210 including 55,000 children under 5. There are 18 health centers and 480 physicians or 1 physician for every 860 people. All inhabitants of a catchment area live within 5 km of a health center, and medical care is free. Diarrhea is due to a number of different organisms, including typhoid, paratyphoid, salmonellosis, Escherichia coli, rotaviruses, and giardiasis, but there has been no cholera in Bahrain since 1979. The national diarrheal diseases control program, drafted by the World Health Organization in 1985, emphasized the use of oral rehydration therapy, breast feeding, and feeding during diarrhea. No vaccinations are compulsory in Bahrain, but immunization coverage has been reported annually since 1981, and vaccinations are in line with the World Health Organization's criteria. Diphtheria-Typhoid-Paratyphoid vaccinations were 1st given in Bahrain in 1957; polio vaccination began in 1958 with Salk vaccine and in 1962 with the Sabin vaccine. Measles vaccination began in 1974. BCG vaccination has been given to children entering school since 1972. All health centers in the country offer vaccination services. Vaccines are stored under refrigeration, and the central supply is at the Public Health Directorate. Adverse effects of vaccinations are monitored. The 1986 diarrheal diseases survey, using the 30 cluster method, looked at a sample of 4114 children under 5 from 2515 households. 378 (9.2%) of the children suffered from diarrhea, and 200 (52.9%) were treated with oral rehydration salts. The under-5 diarrheal mortality rate was .97/1000. The estimated number of episodes of diarrhea per child per year is 2.4, with a high of 8.7 episodes in the Northern Region and a low of 1.2 episodes in the Muharraq Region. Vaccination coverage of children under 2 for other diseases was found to be 96.5% for diphtheria, paratyphoid, and typhoid; 95% for polio; 82.5% for measles; and 59.8% for the trivalent mumps, measles and rubella vaccine. 96.4% of all vaccinations were given in government hospitals. 98.7% of mothers have been examined during pregnancy, and 98.9% of all deliveries are in hospitals. It is recommended that a health education campaign be concentrated on diarrhea, breast feeding, feeding during diarrhea, and hygiene; that both medical staff and mothers be trained in the use of oral rehydration salts; that they should also be informed of the adverse effects of treating diarrhea with antibiotics; that a system for reporting cases of diarrhea be developed; that health education campaigns emphasize the importance of receiving booster doses of vaccines and of vaccination against measles; that staff at health centers adjust their schedules so as to be available for immunizations as needed; and that this survey be repeated every 2 years.
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