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Epidemiological factors in admissions for diarrhoea in 6 - 60-month-old children admitted to Morogoro Regional Hospital, Tanzania
R Oketcho, ED Karimuribo, CNM Nyaruhucha, S Taybali
South African Journal of Child Health , 2012,
Abstract: Objectives. To describe the diarrhoea admissions and the influencing factors in 6 - 60-month-old children at Morogoro Regional Hospital. Design. A retrospective descriptive study of the type of diarrhoea, patient age, home address, nutritional status, diagnosed infection, month of admission, admission duration and outcome. Setting. A hospital-based study: paediatric admissions at Morogoro Regional Hospital. Subjects. All children aged 6 - 60 months admitted to the infectious diseases ward over the 60-month period from May 2006 to April 2011. Results. A total of 4 988 records were extracted, among which the prevalence of diarrhoea was 2 855 (57.2%). Among the 2 855 children with diarrhoea, the majority (2 536 (88.8%)), were 6 - 24 months old, with peak admissions at 7 months and 12 months. District of residence, season, undernutrition and infection were the factors significantly associated (p<0.001) with the age at which children were admitted with diarrhoea. Conclusions. There were increased numbers of admissions for diarrhoea at the ages of 7 months and 12 months, during the dry season and together with diagnosed infection, particularly malaria. However, further study on causes of childhood diarrhoea, given the identified risk factors, may better explain the epidemiology of diarrhoea in Morogoro.
Lactose intolerance among severely malnourished children with diarrhoea admitted to the nutrition unit, Mulago hospital, Uganda
Richard Nyeko, Israel Kalyesubula, Edison Mworozi, Hanifa Bachou
BMC Pediatrics , 2010, DOI: 10.1186/1471-2431-10-31
Abstract: The standard management of severe malnutrition involves nutritional rehabilitation with lactose-based high energy formula milk. However, some of these children may be lactose intolerant, possibly contributing to the high rate of unfavorable treatment outcomes. This study was therefore designed to establish the prevalence of lactose intolerance and associated factors in this population.A descriptive cross sectional study involving 196 severely malnourished children with diarrhoea aged 3-60 months was done in Mwanamugimu Nutrition Unit (MNU), Mulago hospital between October 2006 and February 2007.During the study period, 196 severely malnourished children with diarrhoea were recruited, 50 (25.5%) of whom had evidence of lactose intolerance (stool reducing substance ≥ 1 + [0.5%] and stool pH < 5.5) and it occurred more commonly in children with kwashiorkor 27/75 (36.0%) than marasmic-kwashiorkor 6/25 (24.0%) and marasmus 17/96 (17.7%). Oedematous malnutrition (p = 0.032), perianal skin erosion (p = 0.044), high mean stool frequency (p = < 0.001) and having ≥2 diarrhoea episodes in the previous 3 months (p = 0.007) were the independent predictors of lactose intolerance.Other factors that were significantly associated with lactose intolerance on bi-variate analysis included: young age of 3-12 months; lack of up to-date immunization; persistent diarrhoea; vomiting; dehydration, and abdominal distension. Exclusive breastfeeding for less than 4 months and worsening of diarrhoea on initiation of therapeutic milk were the other factors.The prevalence of lactose intolerance in this study setting of 25.5% is relatively high. Routine screening by stool pH and reducing substances should be performed especially in the severely malnourished children with diarrhoea presenting with oedematous malnutrition, perianal skin erosion, higher mean stool frequency and having had ≥2 diarrhoea episodes in the previous 3 months.Use of lactose-free diets such as yoghurt should be considered for
CARE SEEKING PRACTICES ON DIARRHOEA IN A RURAL COMMUNITY IN NIGERIA
JF Olawuyi, BE Egbewale, LA Anifalaje, EA Okochi
African Journal of Clinical and Experimental Microbiology , 2004,
Abstract: Although diarrhoea is a preventable disease, it still remains a major cause of morbidity and mortality among Nigeria children. A Nigerian child under age of five has an average of 4.3 diarrhoea episodes each year. The transfer to 70 million episodes of diarrhoea in children under five, based on the 1991 census. With case fatality rate of 0.4% (1), Nigeria records 300,000 diarrhoea related deaths each year in children under five years of age. This community survey was conducted in the south west of Irepodun Local Government Area of Kwara state, Nigeria, to enable us determine care-seeking and diarrhoea management practices in a typical rural setting. Four thousand and sixty one (4,061) children under five year of age from nine villages were studied using the standard WHO questionnaire on diarrhoea case management and morbidity. The survey focused mainly on children who had diarrhoea in the 24-hour period prior to the study. Of the 4061 children who were 5 years or below, 876(21.6%) had diarrhoea two weeks prior to the study. There were 207 children (5.1%) who had diarrhoea within 24 hours prior to the study. The rate of use of salt sugar solution (SSS) was 16%, while that of oral rehydration salt (ORS) was 6%. Seventy three percent of mothers interviewed did nothing for the treatment of diarrhoea, nor understood what to do. 16% used various drugs. 69% of the health facilities in these rural districts used antibiotics as their first line anti-diarrhoea treatment. Health education on oral rehydration therapy (ORT) needs to be intensified at the grassroots level.
Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya
Charles Opondo, Philip Ayieko, Stephen Ntoburi, John Wagai, Newton Opiyo, Grace Irimu, Elizabeth Allen, James Carpenter, Mike English
BMC Pediatrics , 2011, DOI: 10.1186/1471-2431-11-109
Abstract: Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention.9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7%) were diagnosed with diarrhoea, with 130 of these being bloody (dysentery) therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7%) of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02).We found some evidence that the multi-faceted, sustained intervention described in this paper led to a reduction in the inappropriate use of antibiotics in treating children with non-bloody diarrhoea.International Standard Randomised Controlled Trial Number Register ISRCTN42996612Diarrhoea remains one of the leading causes of mortality in childhood, accounting for 15% of the approximately 8.7 million deaths of under-5 year olds worldwide in 2008 alone [1]. Current best-practice guidance for treatment of diarrhoea is contained within the World Health Organisation's strategy for Integrated Management of Childhood Illness (IMCI), a strategy adopted by over 100 countries worldwide [2]. This strategy is intended to foster correct diagnosis and treatment of common childhood illnesses in ou
Educational Video Increases Maternal Self-Efficacy for Prevention of Diarrhoea in Young Children: A Randomised Clinical Trial  [PDF]
Emanuella Silva Joventino, ádria Marcela Vieira Ferreira, Maria de Fátima Pereira de Sousa, Jardeliny Corrêa da Penha, M?nica Oliveira Batista Oriá, Paulo César de Almeida, Lorena Barbosa Ximenes
Health (Health) , 2014, DOI: 10.4236/health.2014.621325
Abstract: The aim of this study was to compare the scores of maternal self-efficacy for child diarrhoea prevention, between intervention and control groups, according to sanitary, social and demographic characteristics. A randomised clinical trial was carried out on 163 mothers of children under 5 years old. Data collection was conducted during two months, at two different moments (M0 and M1); at the moment M0 only the intervention group watched the educational video to promote self-efficacy for child diarrhoea prevention; at M1 (two months later) the scale was applied to both groups. In the intervention group, greater mean self-efficacy scores were obtained compared with the control group. The following variables showed statistically significant associations (p < 0.05) with maternal self-efficacy: age 35 or over; high school education; working outside the home; residence with 4 to 5 people; house not of brick or mortar; public refuse collection; piped water supply; consumption of mineral water; and public sewerage network. After use of the video “Diarrhoea: you can prevent it”, the maternal self-efficacy increased, proving that this strategy is able to assist the nursing staff in educational practices.
Oral zinc for treating diarrhoea in children
Lazzerini, Marzia;Ronfani, Luca;
Sao Paulo Medical Journal , 2011, DOI: 10.1590/S1516-31802011000200013
Abstract: background: diarrhoea causes around two million child deaths annually. zinc supplementation could help reduce the duration and severity of diarrhoea, and is recommended by the world health organization and unicef. objective: to evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea. criteria for considering studies for this review: in november 2007, we searched the cochrane infectious diseases group specialized register, central (the cochrane library 2007, issue 4), medline, embase, lilacs, cinahl, mrct, and reference lists. we also contacted researchers. selection criteria: randomized controlled trials comparing oral zinc supplementation (≥ 5 mg/day for any duration) with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery. data collection and analysis: both authors assessed trial eligibility and methodological quality, extracted and analysed data, and drafted the review. diarrhoea duration and severity were the primary outcomes. we summarized dichotomous outcomes using risk ratios (rr) and continuous outcomes using mean differences (md) with 95% confidence intervals (ci). where appropriate, we combined data in meta-analyses (using the fixed- or random-effects model) and assessed heterogeneity. main results: eighteen trials enrolling 6165 participants met our inclusion criteria. in acute diarrhoea, zinc resulted in a shorter diarrhoea duration (md -12.27 h, 95% ci -23.02 to -1.52 h; 2741 children, 9 trials), and less diarrhoea at day three (rr 0.69, 95% ci 0.59 to 0.81; 1073 children, 2 trials), day five (rr 0.55, 95% ci 0.32 to 0.95; 346 children, 2 trials), and day seven (rr 0.71, 95% ci 0.52 to 0.98; 4087 children, 7 trials). the four trials (1458 children) that reported on diarrhoea severity used different units and time points, and the effect of zinc was less clear. subgroup analyses by age (trials with only children aged less than six months) showed no benefit with zinc.
An Epidemiological Survey Of Diarrhoea Among Children In The Karnataka Region of Kaveri Basin  [cached]
Sudarshan M.K,Parasuramalu B.G
Indian Journal of Community Medicine , 1995,
Abstract: Research Question: Whether the source of drinking water influences the occurrence of diarrhoea in under fives? Objectives: i) To know the incidence of morbidity and mortality due to diarrhoea. ii) To identify the relationship of occurrence of diarrhoea with source of drinking water. iii) To study the treatment practices in diarrhoea. Study Design: Cross sectional. Participants: 7141 under five children. Setting: Rural and Urban clusters. Analysis: Simple proportions. Results: Nearly 7% of children experienced diarrhoea in the past two weeks and 4% had an attack of diarrhoea in the last 24 hours. Incidence of diarrhoea was significantly higher amongst 1-3 years male children. The source of drinking water per se did not influence the incidence of diarrhoea. Low (12.7%) ORS use rare was reported 31% of mothers stopped breast-feeding and 15% of mothers stopped oral fluid during diarrhoea. The overall under five-mortality rate in the area was 6.5 per 1000 children and of these one third deaths could be attributed to diarrhoea.
Endocrine causes of systemic hypertension in children and adolescents: a clinical review  [cached]
Kamboj M,Gupta V,Torres A,Patel DR
Pediatric Health, Medicine and Therapeutics , 2011,
Abstract: Manmohan Kamboj1, Vibha Gupta2, Alfonso Torres2, Dilip R Patel21Nationwide Children's Hospital, Columbus, OH, USA; 2Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, MI, USAAbstract: Hypertension has been well recognized as a major contributor of chronic cardiovascular disease, resulting in significant morbidity and mortality not only in adults but also in children and adolescents. Primary or essential hypertension refers to cases where no underlying etiology is apparent for the high blood pressure, and accounts for a majority of the patients. Secondary hypertension refers to a much smaller group of patients in whom the blood pressure elevation may be attributed to an underlying cause. With improved diagnostic techniques, some cases of previously diagnosed essential hypertension may be found to have an underlying etiology. Endocrine causes account for a relatively small proportion of all patients with hypertension. In the following discussion, only secondary hypertension due to endocrine-related causes will be discussed.Keywords: primary hyperalsosteronism, paraganglioma, beta-hydroxy-steroid dehydogenase deficiency, Liddle syndrome, Gordon syndrome
Endocrine causes of systemic hypertension in children and adolescents: a clinical review
Kamboj M, Gupta V, Torres A, Patel DR
Pediatric Health, Medicine and Therapeutics , 2011, DOI: http://dx.doi.org/10.2147/PHMT.S15789
Abstract: docrine causes of systemic hypertension in children and adolescents: a clinical review Review (3300) Total Article Views Authors: Kamboj M, Gupta V, Torres A, Patel DR Published Date April 2011 Volume 2011:2 Pages 39 - 47 DOI: http://dx.doi.org/10.2147/PHMT.S15789 Manmohan Kamboj1, Vibha Gupta2, Alfonso Torres2, Dilip R Patel2 1Nationwide Children's Hospital, Columbus, OH, USA; 2Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, MI, USA Abstract: Hypertension has been well recognized as a major contributor of chronic cardiovascular disease, resulting in significant morbidity and mortality not only in adults but also in children and adolescents. Primary or essential hypertension refers to cases where no underlying etiology is apparent for the high blood pressure, and accounts for a majority of the patients. Secondary hypertension refers to a much smaller group of patients in whom the blood pressure elevation may be attributed to an underlying cause. With improved diagnostic techniques, some cases of previously diagnosed essential hypertension may be found to have an underlying etiology. Endocrine causes account for a relatively small proportion of all patients with hypertension. In the following discussion, only secondary hypertension due to endocrine-related causes will be discussed.
Serum zinc status of children with persistent diarrhoea admitted to the diarrhoea management unit of Mulago Hospital, Uganda
Edward Bitarakwate, Edison Mworozi, Addy Kekitiinwa
African Health Sciences , 2003,
Abstract: Introduction: Despite great advances in the management of diarrhoeal diseases, persistent diarrhoea remains a major problem in developing countries due to its syndromic nature. Zinc depletion ranks high among the factors contributing to the detrimental effects of persistent diarrhoea on the human body. This however, has not been investigated in the Ugandan population. Objective: To determine the serum zinc status of children with persistent diarrhoea. Design: Cross-sectional descriptive study. Methods: Children aged 6-36 months with persistent diarrhoea were enrolled from the diarrhoea management unit of Mulago hospital. Socio-demographic and morbidity data were collected, and laboratory investigations were carried out after recruitment. Healthy children of similar age and sex were recruited to determine reference levels of serum zinc for comparison. Results: The mean serum zinc level in the children with persistent diarrhoea was 5.83mol/l while that of children without diarrhoea was 8.99mol/l with no age or sex difference. The serum zinc concentration of children with persistent diarrhoea was significantly lower than that of children without diarrhoea (p<0.001). The prevalence of zinc deficiency in children with persistent diarrhoea was 47.9%. Of the children with persistent diarrhoea, 64 (66.7%) were stunted, wasted or both. However no significant association was observed between nutritional status and serum zinc levels. Only hypoproteinaemia was significantly associated with serum zinc levels in these children (p=0.03). Conclusion: There is a high prevalence of zinc deficiency and malnutrition among Ugandan children with persistent diarrhoea. African Health Sciences 2003 3(2); 54-60
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