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[Unpublished] 1991 Apr 24. , 28 p. (SEA/DD/43; Project: ICP CDD 001)Physicians collected data on 4319 households and 3766 0-5 year old children living in rural areas of Dhaka Division in Bangladesh to determine the prevalence of diarrhea among the children, the percentage of diarrhea cases treated with various forms of oral rehydration therapy and with drugs, and caretaker awareness of when to refer children with diarrhea to a health facility. 60.3% received no treatment at all. The 24-hour point prevalence of diarrhea stood at 5.2%. Blood accompanied the diarrhea of 22.3% of these children. Yet only 12% of bloody diarrhea cases received appropriate antibiotic therapy. 13.4% of the children had experienced a diarrheal episode during the 2 weeks before the interview. Mean duration was 7 days, but 22.4% of the children had diarrhea for at least 14 days. The adjusted annual diarrhea incidence rate was 2.3 episodes/child. 33.7% of caretakers asked others for help in treating diarrhea. The advisers tended to be village doctors or quacks (21%), government health workers (17%), and homeopaths (17%). 75% of advisors, except family and friends, suggested drugs. Only 27% and 16% recommended administering oral rehydration solution (ORS) and various home fluids, respectively. Only 22% and 17% suggested caretakers to continue feeding and breast feeding, respectively. The ORS use rate during the previous 24 hours was only 11.9% and just 3.6% of cases drank properly prepared ORS. Yet 93.8% knew about ORS. Most caretakers did not use enough water or all the contents of the ORS packet. Use rate for home fluids was 16.5%. 97.5% of lactating mothers continued to breast feed during the diarrhea episode. 36.1% of children received drugs compared with 25.8% for use of oral rehydration therapy. 70.7% of caretakers gave ill children at least the same amount of solid or semisolid foods during the episode. 70% of caretakers preferred ORS to drugs. The leading reasons for referring cases to a health facility included too many stools (79.7%), failure to improve (28.3%), and fever (26.7%). The researchers deemed only 23.5% to have adequate referral knowledge (=or> 3 reasons).
Evaluating the progress of national CDD programmes: results of surveys of diarrhoeal case management.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Sep 6; 66(36):265-70.National diarrhea disease control (CDD) programs need to evaluate their effect on diarrhea morbidity and mortality, but this is often difficult. So national CDD programs often follow the WHO Global CDD Programme model. It uses 13 indicators designed to measure the extent the CDD program is being effectively administered. These indicators are mainly concerned with diarrhea case management in the home and in health facilities, e.g., oral rehydration therapy (ORT) use rate. WHO is enlarging the list to include breast feeding. It suggests that national CDD programs use WHO developed household and health facility surveys to evaluate their programs. These surveys can also identify problems and demonstrate possible solutions to bring about effective implementation. Evaluation teams have used WHO's Morbidity, Mortality, and Treatment survey almost 400 times. China, Ethiopia, the Philippines, and Viet Nam habitually conduct 1-2 evaluation surveys/year. Ecuador and Kenya use them to train professionals in conducting WHO surveys. 1989-1990 surveys in 17 developing countries reveal positive findings: 89.8-100% of mothers in 16 of the countries (49% in Iran) still breast feed during a diarrhea episode and 60-70% of mothers offer ill children at least the same amount of food as they are offered when well. On the other hand, caregivers do not always use ORT (13.4 [India]-91.8% [Indonesia]) and increased fluid intake is low (15-30%). 13 surveys show that water was the most commonly given nonmilk fluid offered. This information helps programs to identify appropriate home fluids. A 1990 addendum to the WHO household survey allows program managers to assess antidiarrheal drug use. WHO's 1990 manual provides protocols for observing case management practices, interviews with caretakers and health workers, assessing health facilities and supplies, and reviewing records.