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Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study.
BMC Public Health. 2017 Nov 21; 17(1):889.BACKGROUND: Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants. METHODS: Three waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF. RESULTS: Fifty-six percent of infants were exclusively breastfed during the first 6 months. Lack of EBF increased the odds of diarrhea, fever and ARI. Among the babies aged 6 months or less 27.37% of diarrhea, 13.24% of fever and 8.94% of ARI could have been prevented if EBF was not discontinued. If EBF was terminated during 0-2 months, 2-4 months the odds of becoming underweight were 2.16 and 2.01 times higher, respectively, than babies for whom EBF was not terminated. CONCLUSION: Children who are not offered EBF up to 6 months of their birth may suffer from a range of infectious diseases and under-nutrition. Health promotion and other public health interventions should be enhanced to encourage EBF at least up to six-month of birth. TRAIL REGISTRATION: Data of this study were collected following the guidelines of ICF International and Bangladesh Medical Research Council. The registration number of data collection is 132,989.0.000 and the data-request was registered on September 11, 2016.
Management of childhood diarrhea by healthcare professionals in low income countries: An integrative review.
International Journal of Nursing Studies. 2017 Jan; 66:82-92.Background The significant drop in child mortality due to diarrhea has been primarily attributed to the use of oral rehydration solutions, continuous feeding and zinc supplementation. Nevertheless uptake of these interventions have been slow in developing countries and many children suffering from diarrhea are not receiving adequate care according to the World Health Organization recommended guidelines for the clinical management of childhood diarrhea. Objectives The aim of this integrative review is to appraise healthcare professionals’ management of childhood diarrhea in low-income countries. Design Whittemore and Knafl integrative review method was used, in conjunction with the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting observational cohort, case control and cross sectional studies. Method A comprehensive search performed from December 2014 to April 2015 used five databases and focused on observational studies of healthcare professional's management of childhood diarrhea in low-income countries. Results A total of 21 studies were included in the review. Eight studies used a survey design while three used some type of simulated client survey referring to a fictitious case of a child with diarrhea. Retrospective chart reviews were used in one study. Only one study used direct observation of the healthcare professionals during practice and the remaining eight used a combination of research designs. Studies were completed in South East Asia (n = 13), Sub-Saharan Africa (n = 6) and South America (n = 2). Conclusion Studies report that healthcare providers have adequate knowledge of the etiology of diarrhea and the severe signs of dehydration associated with diarrhea. More importantly, regardless of geographical settings and year of study publication, inconsistencies were noted in healthcare professionals’ physical examination, prescription of oral rehydration solutions, antibiotics and other medications as well as education provided to the primary caregivers. Factors other than knowledge about diarrhea were shown to significantly influence prescriptive behaviors of healthcare professionals. This review demonstrates that “knowledge is not enough” to ensure the appropriate use of oral rehydration solutions, zinc and antibiotics by healthcare professionals in the management of childhood diarrhea.
2016 Nov; New York, New York, UNICEF, 2016 Nov. 77 p.Pneumonia and diarrhoea are responsible for the unnecessary loss of 1.4 million children each year. This report highlights current pneumonia and diarrhoea related mortality, and illustrates the startling divide between the children being reached and the considerable number of those left behind. By developing key protective, preventative and treatment interventions, collectively we are now equipped with the knowledge and the tools required to preventing child deaths due to these leading childhood killers. The report also provides recommendations to further accelerate progress in effective interventions and bridge the greatest gaps in equity.
BMC Public Health. 2013; 13 Suppl 3:S17.BACKGROUND: Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea. METHODS: We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately. RESULTS: Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet. CONCLUSIONS: Among children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.
MMWR. Morbidity and Mortality Weekly Report. 2011 Dec 2; 60:1611-4.Rotavirus disease is the leading cause of childhood morbidity and mortality related to diarrhea in Latin America and the Caribbean (LAC), where an estimated 8,000 deaths related to rotavirus diarrhea occur annually among children aged <5 years. After two safe and effective rotavirus vaccines became available, the World Health Organization (WHO) in 2007 recommended inclusion of rotavirus vaccine in the immunization programs of Europe and the Americas, and in 2009 expanded the recommendation to all infants aged <32 weeks worldwide. This report describes progress in the introduction of rotavirus vaccine in LAC, where it was first introduced in 2006 in Brazil, El Salvador, Mexico, Nicaragua, Panama, and Venezuela; by January 2011, it was included in the national immunization schedules of 14 countries in LAC. Estimated national rotavirus vaccine coverage (2 doses of the monovalent vaccine or 3 doses of the pentavalent vaccine) among children aged <1 year in 2010 ranged from 49% to 98% (median: 89%) in the 11 LAC countries with vaccine introduction before 2010. Of the 14 countries that had introduced rotavirus vaccine into their national immunization programs, 13 participate in a hospital-based rotavirus surveillance network. Data from some countries in this network and from other monitoring efforts in LAC countries have shown declines in hospitalizations and deaths related to severe diarrhea after rotavirus vaccine introduction. The rapid introduction of rotavirus vaccine in LAC demonstrates the benefits of the early commitment of national decision makers to introduce these vaccines in low-income and middle-income countries at the same time as in high-income countries.
Current Opinion in Gastroenterology. 2010 Sep 10; 26: p.PURPOSE OF REVIEW: To highlight recent advances in our understanding of prolonged episodes of acute diarrhea and persistent diarrhea in children. The focus is on the contribution of these illnesses to the global burden of diarrhea, their impact on childhood growth and development, novel epidemiologic links between prolonged and persistent diarrheal episodes, and strategies for their prevention and management. RECENT FINDINGS: Although less common than acute diarrhea, prolonged and persistent episodes of diarrhea in childhood constitute a significant portion of the global burden of diarrhea. These episodes also play a key role in the vicious cycle of childhood diarrhea and malnutrition in which undernutrition is both a risk factor and an outcome of diarrhea. Increased efforts to provide WHO-recommended zinc therapy for all children with diarrhea in developing countries will significantly reduce morbidity and mortality. In children who develop persistent diarrhea, yogurt-based or amino acid-based diets may accelerate their recovery. SUMMARY: In addition to increased implementation of strategies already known to effectively prevent and manage acute diarrhea, further research is needed to address the recognition, prevention, and treatment of prolonged episodes of acute diarrhea and persistent diarrhea in resource-limited settings.
Evidence behind the WHO guidelines: Hospital Care for Children: what is the aetiology and treatment of chronic diarrhoea in children with HIV?
Journal of Tropical Pediatrics. 2009 Dec; 55(6):349-55.This clinical review aims to address the issue of appropriate treatment for chronic diarrhea in children with HIV and evaluates the scientific evidence behind WHO's recommendations for this matter. It finds that highly active antiretroviral therapy (HAART) substantially reduces diarrhea, increases the effectiveness of antimicrobial agents, and improves weight gain.
New York, New York, UNICEF, 2009.  p.This report sets out a 7-point strategy for comprehensive diarrhoea control that includes a treatment package to reduce child deaths, and a prevention package to reduce the number of diarrhoea cases for years to come. The report looks at treatment options such as low-osmolarity ORS and zinc tablets, as well as prevention measures such as the promotion of breastfeeding, vitamin A supplementation, immunization against rotavirus -- a leading cause of diarrhoea -- and proven methods of improving water, sanitation and hygiene practices. Diarrhoea's status as the second leading killer of children under five is an alarming reminder of the exceptional vulnerability of children in developing countries. Saving the lives of millions of children at risk of death from diarrhoea is possible with a comprehensive strategy that ensures all children in need receive critical prevention and treatment measures. (Excerpt)
World Health and Population. 2008; 10(2):25-39.Our study examines factors influencing demand for contraception for spacing as well as for limiting births in India. Data on socio-economic, demographic and program factors affecting demand for contraception in India are from the National Family Health Survey, 1998--99. The recent document from the National Rural Health Mission has completely ignored the use of contraception in controlling fertility in India. Empirical results of our study suggest giving priority to and focusing attention on supply-side factors such as a regular and sustained supply of quality contraceptive methods to improve accessibility and affordability. Further, strengthening the information, education and communication (IEC) component of the reproductive and child health (RCH) package would allay misapprehensions about the side effects and health risks of contraception. Focusing attention on demand-side factors such as women's empowerment through education, gainful employment and exposure to mass-media would help reduce the unmet demand for family planning. The resulting reduction in fertility would hasten the process of demographic transition and population stabilization in India.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):251-2.Add to my documents.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):273-9.Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.
Zinc treatment to under-five children: applications to improve child survival and reduce burden of disease.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):356-65.Zinc is an essential micronutrient associated with over 300 biological functions. Marginal zinc deficiency states are common among children living in poverty and exposed to diets either low in zinc or high in phytates that compromise zinc uptake. These children are at increased risk of morbidity due to infectious diseases, including diarrhoea and respiratory infection. Children aged less than five years (under-five children) and those exposed to zinc-deficient diets will benefit from either daily supplementation of zinc or a 10 to 14-day course of zinc treatment for an episode of acute diarrhoea. This includes less severe illness and a reduced likelihood of repeat episodes of diarrhoea. Given these findings, the World Health Organization/United Nations Children's Fund now recommend that all children with an acute diarrhoeal illness be treated with zinc, regardless of aetiology. ICDDR.B scientists have led the way in identifying the benefits of zinc. Now, in partnership with the Ministry of Health and Family Welfare, Government of Bangladesh and the private sector, the first national scaling up of zinc treatment has been carried out. Important challenges remain in terms of reaching the poorest families and those living in remote areas of Bangladesh.
Pakistan Journal of Medical Sciences. 2007 Oct-Dec; 23(6):932-935.The objectives were to compare the prevailing prescribing practices of paediatricians with minor and major diploma for common paediatric problems. It was a Cross sectional study in which 10 % of children visiting the outpatient department of paediatrics, Hamdard university hospital with gastroenteritis and Acute respiratory infections, diagnosed according to UNICEF/ WHO protocol were enrolled, their prescriptions checked and results were entered in specially designed Performa. Five hundred prescriptions were reviewed of which 308 were due to Gastro enteritis, 192 were due to respiratory tract infections1). Average numbers of drugs/ prescription were 3.33 +or- 1.2. Paediatricians with minor diploma prescribed 3.5 +or- 1.2 drugs/ prescription. Paediatricians with major diploma prescribed 2.8 +or-1.2 drugs/ prescription (p-valve 0.32) Antibiotic in diarrhoea and respiratory tract infections (upper and lower respiratory tract infections were written in 81.7% cases by paediatricians with lower diploma and 77.7 % cases by paediatricians with major diploma (p-valve 0.27). In respiratory tract infections antihistamines were prescribed in 79.7% of cases by paediatricians with minor diploma and 69.5 % cases by paediatricians with major diploma (p-valve0.11). Anti emetic in Gastroenteritis were written in 69.1% cases by paediatricians with minor diploma and 56.2% cases by Paediatricians with major diploma (p-valve 0.021). More drugs and more antibiotic were given by doctors, with major diploma. Antibiotics were totally different than recommended by the National ARI programme, which the Paediatricians teach in Medical Colleges. The antibiotics prescribed for common Paediatric Problems were totally different than recommended by the National ARI programme which the Paediatricians teach in Medical College. Active intervention is needed to improve the quality of medical education of physicians who treat children, while in depth measures are required for the training of paediatricians. (author's)
[Baltimore, Maryland], Catholic Relief Services, 2006 Jul. 53 p. (USAID Development Experience Clearinghouse DocID / Order No. PN-ADJ-423)In Zambia, HIV&AIDS is still approached primarily as a health issue, and therefore, interventions focus mainly on prevention and treatment. The provision of affordable, accessible and reliable public services is essential in supporting health maintenance and reducing stress for people infected and affected with HIV&AIDS. Reliable delivery of good quality water and sound basic sanitation are critical in reducing exposure to pathogens to which HIV-positive people are particularly vulnerable. Where water services are inadequate or inaccessible, time and monetary costs of access to good quality water in sufficient quantities are high, particularly for HIV-infected people and their caregivers. CRS responded to an announcement by WHO to conduct an assessment on the adequacy of water, sanitation and hygiene in relation to home-based care strategies for people living with HIV&AIDS in Zambia. The assessment was commissioned by the WHO with the goal of producing evidence-based guidance on water and sanitation needs in home-based care strategies, particularly in resource-poor situations. In addition, WHO desired the assessments to lead to both practical and strategic recommendations to be made at the programme and policy levels, while also identifying the most critical measures to be taken by the health sector and the water and sanitation sector to provide short- and medium-term solutions in the area of water, sanitation and hygiene support to home-based care. (excerpt)
Journal of Health, Population and Nutrition. 2007 Jun; 25(2):205-211.This nationwide study was conducted to assess the extent of adherence of primary-care physicians to the World Health Organization (WHO)-recommended guidelines on the use of oral rehydration therapy (ORT), antimicrobials, and prescribing of other drugs used in treating symptoms of acute diarrhoea in Bahrain. A questionnaire-based, cross-sectional survey was carried out in primary-care health centres. During a six-week survey period (15 August-30 September 2003), 328 (25.2%) completed questionnaires were returned from 17 of 20 health centres. In a sample of 300 patients, oral rehydration salts (ORS) solution was prescribed to 89.3% (n=268) patients; 12.3% received ORS alone, whereas 77% received ORS in combination with symptomatic drugs. Antimicrobials were prescribed to 2% of the patients. In 11.4% of the cases, rehydration fluids and other drugs were given parenterally. The mean number of drugs was 2.2+0.87 per prescription. In approximately one-third of the patients, three or more drugs were used. Primary-care physicians almost always adhered to the WHO guidelines with respect to ORT and antimicrobials. However, in several instances, ORT was prescribed along with polypharmacy, including irrational use of drugs for symptomatic relief. Effective health policies are needed to reduce the unnecessary burden on the healthcare system. (author's)
Implementing the new recommendations on the clinical management of diarrhoea: guidelines for policy makers and programme managers.
Geneva, Switzerland, WHO, 2006. 34 p.WHO and UNICEF have released revised recommendations aimed at dramatically cutting the number of deaths due to diarrhoea. These new recommendations take into account two significant recent advances: demonstration of the increased efficacy of a new formulation for ORS containing lower concentrations of glucose and salt, and success in using zinc supplementation in addition to rehydration therapy in the management of diarrhoeal diseases. Prevention and treatment of dehydration with ORS and fluid commonly available at home, breastfeeding, continued feeding, selective use of antibiotics, and providing zinc supplementation for 10 to 14 days are the critical therapies that will help us achieve these goals. This manual provides policy makers and programme managers with the information they need to introduce and/or scale up a national decision to introduce the new ORS formulation and zinc supplementation as part of the clinical management of diarrhoeal diseases. (excerpt)
Lancet. 2006 Oct 7; 368(9543):1212.A joint report from UNICEF and WHO published last month showed that 1.1 billion people do not have access to clean water and 2.6 billion people do not have access to basic sanitation. Last week, UNICEF launched its own report card on water and sanitation giving detailed statistics from each global region. It is grim reading despite UNICEF's optimism that some regions may now be on track to meet the water target in the seventh Millennium Development Goal--to halve the proportion of people without sustainable access to safe drinking water and sanitation by 2015. Some areas, such as rural sub-Saharan Africa, lag way behind on the water target, and most regions are failing spectacularly on sanitation targets. The report's headline statistic is that 1.5 million children die every year from preventable diarrhoeal illnesses and many thousands more are disadvantaged by wide-reaching health and educational consequences because of these failings. Unfortunately, experience to date suggests that statistics like this numb the mind rather than shock it into action as there is a distinct lack of political will to do more. (excerpt)
Journal of the Indian Medical Association. 2006 May; 104(5): p..Acute diarrhoeal diseases rank second amongst all infectious diseases as a killer in children below 5 years of age worldwide. Globally, 1.3 billion episodes occur annually, with an average of 2-3 episodes per child per year. The important aetiologic agents of diarrhoea and the guidelines for management are discussed. Management of acute diarrhoea is entirely based on clinical presentation of the cases. It includes assessment of the degree of dehydration clinically, rehydration therapy, feeding during diarrhoea, use of antibiotic(s) in selected cases, micronutrient supplementation and use of probiotics. Assessment of the degree of dehydration should be done following the WHO guidelines. Dehydration can be managed with oral rehydration salt (ORS) solution or intravenous fluids. Recently WHO has recommended a hypo-osmolar ORS solution for the treatment of all cases of acute diarrhoea including cholera. Feeding during and after diarrhoea (for at least 2-3 weeks) prevents malnutrition and growth retardation. Antibiotic therapy is not recommended for the treatment of diarrhoea routinely. Only cases of severe cholera and bloody diarrhoea (presumably shigellosis) should be treated with a suitable antibiotic. Pilot studies in several countries have shown that zinc supplementation during diarrhoea reduces the severity and duration of the disease as well as antidiarrhoeal and antimicrobial use rate. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness. (author's)
Lancet. 2006 Jul 22; 368(9532):323-332.Rotavirus is the most common cause of severe diarrhoea in children worldwide and diarrhoeal deaths in children in developing countries. Accelerated development and introduction of rotavirus vaccines into global immunisation programmes has been a high priority for many international agencies, including WHO and the Global Alliance for Vaccines and Immunizations. Vaccines have been developed that could prevent the enormous morbidity and mortality from rotavirus and their effect should be measurable within 2--3 years. Two live oral rotavirus vaccines have been licensed in many countries; one is derived from an attenuated human strain of rotavirus and the other combines five bovine-human reassortant strains. Each vaccine has proven highly effective in preventing severe rotavirus diarrhoea in children and safe from the possible complication of intussusception. In developed countries, these vaccines could substantially reduce the number and associated costs of child hospitalisations and clinical visits for acute diarrhoea. In developing countries, they could reduce deaths from diarrhoea and improve child survival through programmes for childhood immunisations and diarrhoeal disease control. Although many scientific, programmatic, and financial challenges face the global use of rotavirus vaccines, these vaccines--and new candidates in the pipeline--hold promise to make an immediate and measurable effect to improve child health and survival from this common burden affecting all children. (author's)
Paediatric and Perinatal Epidemiology. 1998 Apr; 12(2):176-181.In children, the treatment of acute diarrhoea with the World Health Organization (WHO) standard oral rehydration solution (ORS) provides effective rehydration but does not reduce the severity of diarrhoea. In community practice, carob bean has been used to treat diarrhoeal diseases in Anatolia since ancient times. In order to test clinical antidiarrhoeal effects of carob bean juice (CBJ), 80 children, aged 4±48 months, who were admitted to SSK Tepecik Teaching Hospital with acute diarrhoea and mild or moderate dehydration, were randomly assigned to receive treatment with either standard WHO ORS alone or a combination of standard WHO ORS and CBJ. Three patients were excluded from the study because of excessive vomiting. In the children receiving ORS + CBJ the duration of diarrhoea was shortened by 45%, stool output was reduced by 44% and ORS requirement was decreased by 38% compared with children receiving ORS alone. Weight gain was similar in the two groups at 24 h after the initiation of the study. Hypernatraemia was detected in three patients in the ORS group but in none of those in the ORS + CBJ group. The use of CBJ in combination with ORS did not lead to any clinical metabolic problem. We therefore conclude that CBJ may have a role in the treatment of children's diarrhoea after it has been technologically processed, and that further studies would be justified. (author's)
Journal of Health, Population and Nutrition. 2006 Mar; 24(1):107-112.The study compared the safety and efficacy of an oral rehydration salts (ORS) solution, containing 75 mmol/L of sodium and glucose each, with the standard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses, after initial intravenous rehydration to correct dehydration. The study was conducted among patients aged 12-60 years hospitalized with diarrhoea due to cholera. One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then randomly assigned to receive either standard ORS solution (311 mmol/L) or reduced-osmolarity ORS solution (245 mmol/L). Intakes and outputs were measured every six hours until the cessation of diarrhoea. During maintenance therapy, stool output, intake of ORS solution, duration of diarrhoea, and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups. The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after randomization and the relative risk of development of hyponatraemia. However, patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with standard WHO-ORS solution. Reduced-osmolarity ORS solution was as efficacious as standard WHOORS solution in the management of cholera patients. The results indicate that reduced-osmolarity ORS solution is also as safe as standard WHO-ORS solution. However, because of the limited sample size in the study, the results will have to be confirmed in trials, involving a larger number of patients. (author's)
Emerging Infectious Diseases. 2006 Feb; 12(2):304-306.Studies published between 1986 and 1999 indicated that rotavirus causes ˜22% (range 17%-28%) of childhood diarrhea hospitalizations. From 2000 to 2004, this proportion increased to 39% (range 29%-45%). Application of this proportion to the recent World Health Organization estimates of diarrhea-related childhood deaths gave an estimated 611,000 (range 454,000-705,000) rotavirus-related deaths. (author's)
Geneva, Switzerland, WHO, Programme for the Control of Diarrhoeal Diseases, 1994. 13 p. (CDD/93.2)Why was Advising Mothers produced? Every child that is seen at a health facility with mild diarrhoea, and every dehydrated child that has been successfully treated at the facility, will be sent home to follow Plan A of the WHO/CDD Diarrhoea Management Chart, Case Management in the Home (give increased fluids, continue feeding, and seek medical care when needed). Unlike many other treatments, which are provided by the health worker, case management in the home is entirely the responsibility of the mother or other child caretaker. If correctly carried out, it can have a significant impact on the health of the child. How well the mother carries it out depends partly on how well the health worker advises her. Advising a mother on home case management is often the last activity carried out during a consultation, and often the least well done. The advice and the manner in which it is given are often not sufficient to enable the mother to understand and have confidence in her ability to care for her child's diarrhoea. There are many reasons for this: the health facility may be crowded, a health worker may have little time, and it is not always clear just how to advise the mother. When assessing and treating a child with diarrhoea at a health facility, the health worker should follow the same, systematic approach with every child: "Look, Ask, Feel, Decide, Treat." (excerpt)
Geneva, Switzerland, WHO, Programme for the Control of Diarrhoeal Diseases, 1994. 21 p. (WHO/CDD/94.49; CDD/93.1)Advising a mother on home case management is often the last activity carried out during a consultation, and often the least well done. The advice and the manner in which it is given are often not sufficient to enable the mother to understand and have confidence in her ability to care for her child's diarrhoea. There are many reasons for this: the health facility may be crowded, a health worker may have little time, and it is not always clear just how to advise the mother. When you assess and treat a child with diarrhoea at a health facility, there is a systematic approach which allows you to follow the same process each time: "Look, Ask, Feel, Decide, Treat." Advising a mother on how to care for the child at home may seem like a less structured activity; it is definitely one which calls for good judgement and understanding on your part. The purpose of this guide is to help you to improve this activity, by teaching a process which will allow you correctly and effectively to advise mothers on home case management. The process should also make it easier for mothers to remember the advice you give. The guide is to be used during a case management training course, or by health workers already trained in case management. (excerpt)
Geneva, Switzerland, WHO, Division of Diarrhoeal and Acute Respiratory Disease Control, 1994 Nov. 3 p. (Update No. 18)If diarrhoea in children is to be managed correctly, there is need to look beyond public sector health facilities. Good management has to be promoted in the home, and there is also a need to improve the practices of all providers of care, particularly in the private sector. Retail drug businesses are particularly important providers of care because: in most countries, pharmacies and over-the-counter drug stores are widely distributed geographically; they are the most frequently visited of all health-related facilities; for purposes of training, drug retail outlets are relatively easy to reach; products sold and advice given to customers for treating diarrhoea are generally inappropriate and, in some cases, dangerous. (excerpt)