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Malnutrition continues to be a major public health problem in Nigeria, and this contributes substantially to childhood mortality. Culturally related food restriction and reduction in feeding frequency during common childhood illnesses such as diarrhoeal diseases further contributes to the burden of malnutrition and thus to childhood morbidity and mortality. This study was designed to determine the knowledge, attitudes and practices of nursing mothers with respect to food restriction during acute diarrhoea in Ibadan, South West Nigeria. This single round cross-sectional study adopted a purposive sampling procedure to select 250 nursing mothers aged between 17 and 45 years from the sick-baby and immunization clinics of two health facilities in Ibadan, between November 2003 and February 2004. Information on nutritional management of acute diarrhoea was collected with a structured interviewer-administered questionnaire and two focus group discussions exploring food withdrawal practices during acute diarrhoea. Data analysis was done using SPSS 11.0. Descriptive and inferential statistics were generated to test for associations. About half (46.8%) of the respondents had secondary education. Only 6.0% had knowledge of nutritional management of diarrhoea while 54.8% had knowledge of oral rehydration therapy. Seventy-one percent of respondents reported food withdrawal during acute diarrhoea in infants, 44% also reported reduction in breastfeeding frequency during acute diarrhoea and more than two-thirds of these (71.2%) cited cultural reasons for withholding breastfeeding. Mothers' educational level had no significant effect on their knowledge of nutritional management of acute diarrhoea in infants (p =0.610). Mothers' knowledge of nutritional management of acute diarrhoea had a significant effect on their attitude (p = 0.03) but not on their practice (p = 0.257). Relatives and health care providers were the sources of advice on food restriction/withdrawal during acute diarrhoea. Appropriate nutritional management during acute illness is important, and this has been found to be deficient among caregivers in the family setting. Targeting appropriate health and nutrition education to caregivers particularly mother would reduce morbidity and mortality commonly associated with childhood diarrhoea. Key words: Infants, diarrhoea, food restriction, mothers, INTRODUCTION Each year about 12 million infants and children die in the developing countries [1]. Specifically in Africa, more than 20% on average do not reach their fifth birthday [2]. [...]

A genome-wide SNP scan is used to study the characteristics and causes of the syndromic form of the autosomal-recessive congenital sodium diarrhea (CSD). The classic CSD is shown to be distinct from the syndromic CSD, which is shown to be caused by the mutations caused in SPINT2.

BACKGROUND. The quantified effect of zinc supplementation to prevent childhood diarrhea and respiratory illnesses is unclear. We conducted a meta-analysis of randomized, controlled trials on the subject. METHODS. We searched PubMed, Science Citation Index, and the Cochrane Database of Controlled Trials and hand-searched the reference lists of identified articles. All randomized, controlled trials of zinc supplementation for [greater than or equal to] 3 months for children RESULTS. Children who received a zinc supplement had fewer episodes of diarrhea (rate ratio: 0.86) and respiratory tract infections (rate ratio: 0.92) and significantly fewer attacks of severe diarrhea or dysentery (rate ratio: 0.85), persistent diarrhea (rate ratio: 0.75), and lower respiratory tract infection or pneumonia (rate ratio: 0.80) than did those who received placebo. They also had significantly fewer total days with diarrhea (rate ratio: 0.86) but not days with respiratory illness (rate ratio: 0.95). Published studies showed a publication bias and significant heterogeneity; however, no cause for the latter could be identified. CONCLUSIONS. Zinc supplementation reduced significantly the frequency and severity of diarrhea and respiratory illnesses and the duration of diarrheal morbidity. The relatively limited reduction in morbidity and the presence of significant heterogeneity and of publication bias indicate the need for larger, high-quality studies to identify subpopulations most likely to benefit. Key Words diarrhea, respiratory illness, meta-analysis, nutrition, supplementation, zinc, ZINC IS A vital micronutrient in humans and is essential for protein synthesis, cell growth, and differentiation. (1,2) Severe zinc deficiency has been shown to be associated with stunting of [...]

Diarrhoea remains one of the leading killers of young children. A recent meta-analysis demonstrated that a two-week course of zinc tablets once daily significantly reduces the severity and duration of diarrhoea and mortality in young children (Bhutta et al., 2000. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis of randomized controlled trials. American Journal of Clinical Nutrition, 72(6), 1516-1522). Formative research is being conducted in a number of countries to prepare for the large-scale promotion of this new treatment. In-depth and semi-structured interviews with parents, community health workers, and traditional healers were conducted to examine the household management of diarrhoea in the Sikasso region of southern Mall in preparation for the introduction of a short-course of daily zinc for childhood diarrhoea at the community level. Supporting data from a subsequent household survey are also presented. Although nearly all parents knew oral rehydration solution (ORS) could replace lost fluids, its inability to stop diarrhoea caused parents to seek antibiotics from local markets, traditional medicines or anti-malarials to cure the illness. The notion of combining multiple treatments to ensure the greatest therapeutic benefit was prevalent, and modern medicines were often administered simultaneously with traditional therapies. As parents often deem ORS insufficient and judge that an additional treatment should be combined with ORS to cure diarrhoea, the concept of joint therapy of zinc and ORS should be well accepted in the community. Mothers-in-law and fathers, who play a significant role in decisions to seek treatment for sick children, as well as traditional healers, should also be considered when designing new programs to promote zinc. Similarities with formative research conducted for a previous generation of diarrhoea control programmes are discussed. Keywords: Diarrhoea; Zinc; Oral rehydration therapy; Ethnomedicine; Child health: Mali

Enteropathogenic Escherichia coli (EPEC) induces a severe watery diarrhea responsible for several hundred thousand infant deaths each year by a process correlated with the loss (effacement) of absorptive microvilli. Effacement is linked to the locus of enterocyte effacement pathogenicity island that encodes an 'injection system,' 'effector' proteins, and the Intimin outer membrane protein. Here, we reveal that effacement (i) is a two-step process, (ii) requires the cooperative action of three injected effectors (Map, EspF, and Tir) as well as Intimin, and (iii) leads to the retention, not release (into the extracellular milieu), of the detached microvillar material. We also discover that EPEC rapidly inactivates the sodium-D-glucose cotransporter (SGLT-1) by multiple mechanisms. Indeed, the finding that one mechanism occurs more rapidly than microvilli effacement provides a plausible explanation for the rapid onset of severe watery diarrhea, given the crucial role of SGLT-1 in the daily uptake of [approximately equal to] 6 liters of fluids from the normal intestine. The importance of SGLT-1 in the disease process is supported by severe EPEC diarrheal cases being refractory to oral rehydration therapy (dependent on SGLT-1 function). Moreover, the identification of effector activities that alter microvilli structure and SGLT-1 function provides new tools for studying the underlying regulatory processes. Caco-2 | diarrhea | effacement | SGLT-1

Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children of developing countries. In a randomized, placebo-controlled trial, we assessed the effectiveness and efficacy of giving 3 Recommended Daily Allowances of elemental zinc to 6- to 35-month-old children with acute diarrhea. Methods. Seventeen hundred ninety-two cases of acute diarrhea in Nepalese children were randomized to 4 study groups. Three groups were blinded and the children supplemented daily by field workers with placebo syrup, zinc syrup, or zinc syrup and a massive dose of vitamin A at enrollment. The fourth group was open and the caretaker gave the children zinc syrup daily. Day-wise information on morbidity was obtained by household visits every fifth day. Results. The relative hazards for termination of diarrhea were 26% (95% confidence interval [CI]: 8%, 46%), 21% (95% CI: 4%, 38%), and 19% (95% CI: 2%, 40%) higher in the zinc, zinc-vitamin A, and zinc-caretaker groups, respectively, than in the placebo group. The relative risks of prolonged diarrhea (duration >7 days) in these groups were 0.57 (95% CI: 0.38, 0.86), 0.53 (95% CI: 0.35, 0.81), and 0.55 (0.37, 0.84); zinc accordingly reduced the risk of prolonged diarrhea with 43% to 47%. Five percent and 5.1% of all syrup administrations were followed by regurgitation in the zinc and zinc-vitamin A group, respectively, whereas this occurred after only 1.3% of placebo administrations. Vomiting during diarrhea was also more common in children receiving zinc. Conclusions. Three Recommended Daily Allowances of zinc given daily by caretakers or by field workers substantially reduced the duration of diarrhea. The effect of zinc was not dependent on or enhanced by concomitant vitamin A administration. Pediatrics 2002;109:898-903; zinc, vitamin A, acute diarrhea, young children, randomized placebo controlled trial, effectiveness, Nepal, treatment., Intervention trials indicate that zinc given during acute diarrhea is efficacious in reducing the duration and severity of the illness. (1-7) Thus, therapeutic use of zinc has the potential of [...]

Objective. Childhood diarrhea accounts for substantial morbidity and mortality worldwide. Multiple studies in children have shown that Lactobacillus, administered orally, may have antidiarrheal properties. We conducted a meta-analysis of randomized, controlled studies to assess whether treatment with Lactobacillus improves clinical outcomes in children with acute infectious diarrhea. Methods. Studies were sought in bibliographic databases of traditional biomedical as well as complementary and alternative medicine literature published from 1966 to 2000. Search terms were "competitive inhibition," "diarrhea," "gastroenteritis," "Lactobacillus," "probiotic," "rotavirus," and "yog(h)urt." We included studies that were adequately randomized, blinded, controlled trials in which the treatment group received Lactobacillus and the control group received an adequate placebo and that reported clinical outcome measures of diarrhea intensity. These inclusion criteria were applied by blind review and consensus. The original search yielded 26 studies, 9 of which met the criteria. Multiple observers independently extracted study characteristics and clinical outcomes. Data sufficient to perform meta-analysis of the effect of Lactobacillus on diarrhea duration and diarrhea frequency on day 2 were contained in 7 and 3 of the included studies, respectively. Results. Summary point estimates indicate a reduction in diarrhea duration of 0.7 days (95% confidence interval: 0.3-1.2 days) and a reduction in diarrhea frequency of 1.6 stools on day 2 of treatment (95% confidence interval: 0.7-2.6 fewer stools) in the participants who received Lactobacillus compared with those who received placebo. Details of treatment protocols varied among the studies. A preplanned subanalysis suggests a dose-effect relationship. Conclusion. The results of this meta-analysis suggest that Lactobacillus is safe and effective as a treatment for children with acute infectious diarrhea. Pediatrics 2002; 109:678-684; gastroenteritis, infectious diarrhea, Lactobacillus, meta-analysis, rotavirus. ABBREVIATIONS. ID, acute infectious diarrhea; ORS, oral rehydration solution; CI, confidence interval., Diarrhea is common among children and contributes substantially to pediatric morbidity and mortality worldwide. In the United States, an estimated 21 million to 37 million episodes of diarrhea occur among [...]

Promotion of oral rehydration therapy (ORT) for the treatment of diarrheal diseases and the WHO case management strategy for acute respiratory infections (ARI) have contributed to significant reductions in infant mortality, but these two conditions remain the leading causes of infant deaths in most developing countries. Identification of the factors contributing to these deaths may contribute to reduce infant mortality from preventable causes. To gain insight into the circumstances and maternal and health services factors that may contribute to infant deaths we used a verbal autopsy method to interview mothers of all infants who died during the previous 12 months (June 1995 - May 1996) in 11 municipalities in the State of Ceara, Northeast Brazil. Our results revealed that one-third of the deaths occurred in a hospital and two-thirds at home. Almost all the infants who died at home, however, had been examined one or more times by a doctor, and 36% of them had been hospitalized during the disease episode that resulted in death. For most (85%) of these children the causes of death were diarrhea or acute respiratory infection, and it is likely that death could have been averted if appropriate treatment had been initiated promptly. Three major groups of factors that alone or in combination appeared to contribute to most deaths were delays in seeking medical care on behalf of the parents, medical interventions reported as ineffective by mothers and delays in providing medical care to children who arrived at the hospital too late in the day to be scheduled for consultation. Our findings suggest that government efforts to further reduce infant mortality in Ceara should focus on health education interventions that address quality of home care, recognition of signs of severity and danger and importance of seeking timely medical care; and on improving the quality of care provided at community health centers and hospitals. Measures likely to improve infants' chance of survival include: ensuring prompt access to medical consultation for young children brought to health centers or hospitals with potentially life-threatening symptoms related to infections, health education to mothers on the need for continued home care after discharge and to return to the medical care facility if the child does not recover, and that they have access to medicine prescribed by hospital physicians. Further benefits could be obtained by using community health workers, now integrated into the Family Medicine Program (PSF) health teams, to provide health education, supervise home care, refer mothers to health centers and facilitate their access to hospitals.

In a study of 135 boys aged 3 to 35 months suffering from diarrheal disease of viral or non viral nature, use of racecadotril (acetorphan) was found to be an effective and safe treatment.

Research presented concerns the treatment of diarrhea in children caused by rotavirus infections, focusing on the ability of oral rehydration solutions to promote intestinal healing. An evaluation of several oral rehydration therapies is presented.

Described are the findings of a multicentre cohort study to test an algorithm for the treatment of persistent diarrhoea relying on the use of locally available, inexpensive foods, vitamin and mineral supplementation, and the selective use of antibiotics to treat associated infections. The initial diet (A) contained cereals, vegetable oil, and animal milk or yoghurt. The diet (B) offered when the patient did not improve with the initial regimen was lactose free, and the energy from cereals was partially replaced by simple sugars. A total of 460 children with persistent diarrhoea, aged 4-36 months, were enrolled at study centres in Bangladesh, India, Mexico, Pakistan, Peru, and Viet Nam. The study population was young (11.5 [+ or -] 5.7 months) and malnourished (mean weight-for-age Z-score, -3.03 [+ or -] 0.86), and severe associated conditions were common (45% required rehydration or treatment of severe infections on admission). The overall success rate of the treatment algorithm was 80% (95% Cl, 76-84%). The recovery rate among all children with only diet A was 65% (95% Cl, 61-70%), and was 71% (95% Cl, 62-81%) for those evaluated after receiving diet B. The children at the greatest risk for treatment failure were those who had acute associated illnesses (including cholera, septicaemia, and urinary tract infections), required intravenous antibiotics, and had the highest initial purging rates. Our results indicate that the short-term treatment of persistent diarrhoe can be accomplished safety and effectively, in the majority of patients, using an algorithm relying primarily on locally available foods and simple clinical guidelines. This study should help establish rational and effective treatment for persistent diarrhoea., Introduction Persistent diarrhoea, defined as diarrhoea lasting for [greater than or equal to] 14 days (1), usually accounts for The pathogenesis of persistent diarrhoea is unknown but is probably multifactorial [...]

Previously we reported that standard oral rehydration salts (ORS) solution is not as effective as a reduced-osmolarity glucose-based ORS for the treatment of children with acute noncholera diarrhoea: with standard ORS the diarrhoea lasts longer, stool output is greater, serum sodium is higher, and there is more need for supplemental intravenous infusion. We studied a reduced-osmolarity maltodextrin (Md)-based ORS to determine whether it had similar benefits, and also the effect of sugar malabsorption on the efficacy of standard and MD-based ORS. A total of 90 boys aged 3-24 months with acute noncholera diarrhoea and moderate dehydration were randomly assigned to either standard ORS (glucose 20g/l, osmolarity 311 mmol/l) or MD-ORS (MD 50g/l, osmolarity 227mmol/l). There were no differences in treatment results. Some 46% of subjects had a high total stool output ( >300g/kg), which was unrelated to the type of ORS given. High stool output was significantly associated with a longer duration of diarrhoea (33 vs. 15 hours; P < 0.001), a persistently elevated serum sodium (149 vs. 144mmol/l at 24h; P < 0.02), the need for intravenous infusion (11/41 vs. 0/48,- P < 0.002), and an increase in faecal reducing substances (10.8 vs. 3.4 g/l at 24 h; P < 0.001). We conclude that some children given standard ORS develop osmotic diarrhoea owing to the combined effect of transient sugar malabsorption and slight hypertonicity of the ORS. Earlier studies show that this adverse outcome can largely be avoided when extra water is given in reduced-osmolarity glucose-based ORS. Reduced osmolarity has no benefit, however, when glucose is replaced by maltodextrin, probably because the sugars released by hydrolysis of MD, when malabsorbed, raise the intraluminal osmolarity to equal or exceed that of standard ORS. Thus, reduced-osmolarity glucose-based ORS is superior to both standard ORS and reduced-osmolarity solutions based on maltodextrin and probably other complex carbohydrates. Studies are in progress to define the optimal formulation of reduced-osmolarity glucose-based ORS., Introduction The standard glucose-based oral rehydration salts (ORS) solution (containing glucose, 111 mmol/l and sodium, 90mmol/l; total osmolarity, 311mmol/l), which has been recommended globally by WHO and UNICEF, has proved [...]

Reported are the results of an analysis of mortality trends from diarrhoeal diseases among under-5-year-olds in Mexico between 1978 and 1993 in relation to the impact of education, basic sanitation, and selected medical care practices. The study period was divided into three stages; the first pre-dated the widespread application of oral rehydration therapy (ORT); the second, covered the implementation of a nationwide programme promoting ORT; and the third included additional measures, such as immunization and improvements in basic sanitation. Mortality rates decreased progressively, at an average of 1.8% per year in the first stage, 6.4% in the second, and 17.8% in the third. The importance of literacy campaigns for women and the promotion of ORT was confirmed. Both of these measures reduced mortality; however, a greater reduction resulted from a massive immunization campaign against measles and improvements in sanitation (expansion of the drainage and piped water systems, improved water chlorination procedure, and effective prohibition of the use of sanitary sewage for vegetable irrigation)., Introduction Experiences in several countries indicate that selected public health interventions reduce mortality from diarrhoeal diseases (1, 2). Historically, improvements in basic sanitation, nutritional status, and hygiene education have had [...]

Treatment patterns for childhood diarrhoea among providers in public and private settings have been examined using data from 28 surveys in the Demographic and Health Surveys programme. In the majority of surveys, at least 50% of the children with diarrhoea who sought care from a health provider (public or private) received treatment that included oral rehydration salts (ORS). Private providers are a significant source of care for children with diarrhoea, but they are less likely to use ORS and more likely to prescribe unneeded drugs than providers in public settings. In countries where data are available, bloody diarrhoea appears to be undertreated. The results indicate that national public health programmes must continue to improve their strategies to ensure correct treatment of childhood diarrhoea by all health providers., Background Diarrhoea is responsible for about one in four deaths among under-five-year-olds in developing countries (1). In most cases, diarrhoea illness can normally be managed successfully with oral rehydration therapy [...]

A recently published study of homeopathic treatment for acute diarrhea was seriously deficient. In the study, children who did not have diarrhea severe enough to require hospitalization were treated with oral rehydration therapy and assigned to receive a homeopathic remedy or placebo. The diagnostic scheme was subjective, based on symptoms that would change over time, and would not be reproducible by others. Numbers in the tables did not add up. Groups that were not statistically comparable were compared. The results of the statistical analysis suggest that the conclusion that homeopathic treatment was effective may be due to a few children with an unusually strong positive response and not a benefit to the overall group. The difference of one stool per day had no clinical importance, yet the authors conclude that homeopathic treatment could have an important health impact based on this non-evidence. Studies cited as buttressing the value of homeopathic medications had themselves been discredited or were poorly done or misquoted., The article entitled "Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Clinical Dual in Nicaragua" by Jacobs et al (Pediatrics. 1994;93:719-725) reported a study of the efficacy of [...]

To identity clinical disorders associated with severe illness in African children with diarrhoea, we studied a group of under-5-year-olds with diarrhoea who had been brought to a large public hospital in central Cote d&apos;lvoire. The general condition of children with diarrhoea was assessed and classified according to criteria recommended by WHO, and then used as a nonspecific indicator of severity. Of the 264 children with diarrhoea who were enrolled in the study, 196 had nonsevere illness and 68 severe illness. Children with severe illness were significantly more likely than those with nonsevere illness to be dehydrated (45% versus 11%), moderate-to-severely wasted (47% versus 29%), bacteraemic (26% versus 9%), severely anaemic (haemoglobin level The study demonstrates the need for a more comprehensive approach to assessment and management of children with diarrhoea that ensures prompt recognition of bacteraemia, anaemia, wasting and malaria, as well as dehydration. Simple nonspecific observational criteria, such as those recommended by WHO for assessing and classifying general condition, are useful for identifying children with diarrhoea who are at high risk of having life-threatening clinical disorders, and can readily be used by health workers whose clinical training and access to diagnostic laboratory facilities are both limited., Introduction In sub-Saharan Africa, children suffer an average of four-to-five episodes of diarrhoea each year and diarrhoea is a leading cause of morbidity and mortality among under-5-year-olds (I).(a) Although most [...]

Diarrhoea, pneumonia, measles, malaria and malnutrition account for more than 70% of deaths and health facility visits among children under 5 years of age in developing countries. A number of programmes in WHO and UNICEF have developed an approach to the integrated management of the sick child, which is being coordinated by WHO&apos;s Division for the Control of Diarrhoeal and Acute Respiratory Disease. Integrated clinical guidelines have been developed and a training course for health workers in outpatient (first level) health facilities has been completed. In addition to case management of these diseases, the course incorporates significant prevention of disease through promotion of breast-feeding, counselling to solve feeding problems, and immunization of sick children. Other materials to train and support health workers are also being developed: an inpatient case management training course, medical school curricular materials, a drug supply management course, and materials to support monitoring and reinforcement of skills after training. A planning guide for interventions to improve household management of childhood illness is also being developed. Since management of the sick child is a cost-effective health intervention, which has been estimated to have a large impact on the global burden of disease in developing countries, the completion of these materials and their wide implementation should have a substantial impact on child mortality., Introduction The need for an integrated approach to sick children Every year some 12 million children die before they reach their fifth birthday, many of them during the first year [...]

Zinc supplementation in young children may be effective in treating severe diarrhea. In New Delhi, India, 462 children with severe diarrhea received 20 milligrams a day of zinc supplement along with a vitamin mixture including vitamins A, B, D, and E. An additional 485 children with diarrhea received a placebo. The parents of dehydrated children in both groups were encouraged to give water and dissolved salts to their children. The risk that the diarrhea would continue on any given treatment day was reduced by 23% in the zinc group. In addition, the frequency of diarrhea episodes lasting over seven days was reduced by 39% in the zinc group. The average number of watery stools per day was reduced by 39% with zinc treatment. Zinc supplementation reduced both the intensity and the time span of diarrhea.

Two types of oral rehydration solutions (ORS) may be equally effective against infant diarrhea. Although the American Academy of Pediatrics has recommended ORS therapy with sodium levels above 75 mEq/L, liquids with lower sodium contents may be as effective. Very common ORS brands are Pedialyte and Infalyte with sodium concentrations of 45 mEq/L and 50 mEq/L, respectively. Pedialyte is glucose-based and Infalyte is based on rice syrup solids. Researchers measured rehydration with Pedialyte or Infalyte by stool output and fluid levels among 60 male infants under 2 years old. Diarrhea had lasted less than one week and all babies were moderately dehydrated below 10% of their weight. There was no overall therapeutic difference between the two types of ORS and diarrhea resolved after 48 hours in 57% of the patients. Contrary to expectations, the stool output was not lower in the Infalyte group., Objective. To compare the efficacy of two commonly used solutions in the rehydration of infants with mild to moderate dehydration caused by acute diarrhea in the United States. Design and setting. Double-blind, parallel-group, randomized study performed at Children&apos;s Hospital Medical Center. Patients. Sixty infant boys ([less than or equal to] 2 years old), with mild ([less than or equal to] 5%) or moderate (6 to 9%) dehydration caused by acute diarrhea of less than 1 week&apos;s duration were included in the study. Interventions. Infants were randomly assigned to receive treatment with either a glucose-based oral rehydration solution (ORS) (Pedialyte, Ross Laboratories, Columbus, OH) or a rice syrup solids-based ORS (Infalyte, Mead Johnson Nutritional Group, Evansville, IN). After rehydration was achieved, patients entered a maintenance phase during which, in addition to a maintenance ORS, breast milk or a soy-based formula was offered, infants older than 1 year were also given a lactose-free diet. Outcome measures. Rehydration was judged clinically. Infants remained on a metabolic bed during the study in to separate and quantitate urine and stool output. Therefore, in addition to clinical outcome, we compared intake, output and apparent absorption and retention of fluid, sodium, and potassium between groups. Results. All patients were successfully rehydrated using an ORS without the use of intravenous fluids. No differences were detected between treatment groups in time to rehydration, percentage of weight gain after rehydration, consumption of ORS to achieve rehydration, or stool output. However, the apparent sodium absorption (net intake less fecal output) was greater in the Infalyte group than the Pedialyte group during the first 24 hours. Conclusion. The two maintenance oral electrolyte solutions (Pedialyte and Infalyte) most commonly used in the United States are effective as rehydration solutions for infants with mild to moderate dehydration. We speculate that a strategy for oral rehydration therapy in the United States, based on the use of a single solution during the rehydration and maintenance phase, might gain additional acceptance by practicing pediatricians and family physicians. Pediatrics 1995;95:639-645; oral rehydration therapy, oral rehydration solutions, diarrhea, dehydration, rotavirus., ABBREVIATIONS. ORT, oral rehydration therapy; ORS, oral rehydration solution; AAP American Academy of Pediatrics. Acute diarrheal disease is a major cause of childhood morbidity. Recent estimates of the magnitude of [...]

Oral rehydration of children with acute diarrhea and mild-to-moderate dehydration may be slightly more effective using rice flour (RF) oral rehydration solution (ORS), but conventional ORS may still be adequate. A total of 134 male infants between 3 and 36 months of age with diarrhea were randomly assigned to one of three ORS treatment groups. Forty-three children were treated with glucose ORS, 46 with rice dextrin ORS and 45 with RF-ORS. Time until rehydration was similar between the three groups. During the first six hours of treatment, stool output decreased by 24% to 27% among infants receiving RF-ORS. By 12 hours there were no significant differences in stool output between the groups. ORS with rice components may reduce stool output better than other carbohydrates because of its low osmolality and additional organic substances. RF-ORS may be more difficult to prepare and may have a higher risk of microbial contamination compared to the other ORSs., Objective. To assess the effects of glucose (G)-oral rehydration solution (ORS), rice dextrin (RD)-ORS, and rice flour (RF)-ORS on fluid intake, rapidity of rehydration, and stool output of children with acute diarrhea and mild or moderate dehydration. Methods. The study was a randomized, double-asked clinical trial. One hundred forty-six male infants, ages 3 to 36 months, were randomly assigned to one of three treatment groups. Clinical evaluations and fluid balances were conducted every 2 to 4 hours for 48 hours. Principal outcome variables were ORS consumption, recovery of hydration status, and fecal output. Results. The groups were similar at admission with regard to age, nutritional status, history of the current episode, and clinical status. There were no differences in ORS consumption by treatment group during any period of study. During the first 6-hour period, patients in group RF had less stool output (16 [+ or -] 14 g/kg/body weight) than those in group G (22 [+ or -] 20 g/kg) or RD (21 [+ or -] 19 g/kg; P < .05). After 12 hours of hospitalization, there were no differences by treatment group. Recovery of hydration status, changes in serum sodium and potassium, and duration of diarrhea in the hospital were similar in all three groups. Conclusion. There was a 24% to 27% reduction in stool output during the first 6 hours of treatment among children who received RF-ORS compared with those who received G-ORS or RD-ORS, but this effect did not persist after the first 12 hours of therapy. Because this difference was of small magnitude and limited duration, it has minor clinical importance. Thus, we conclude that the three solutions had similar efficacy for children with acute, watery diarrhea and mild or moderate dehydration. Pediatrics 1995;95:191-197; diarrhea, rehydration therapy, electrolytes, oral rehydration solution, clinical trial., ABBREVIATIONS. ORS, oral rehydration solution; G-ORS, glucose-ORS; RD-ORS, rice dextrin-ORS; RF-ORS, rice flour-ORS; SD, standard deviation. Therapy for diarrheal dehydration consists of providing fluid and electrolytes either orally or intravenously, [...]

A rice-based oral rehydration solution (ORS) known as Amylyte may rehydrate children with acute diarrhea more effectively than the World Health Organization's (WHO) glucose-ORS. A total of 127 male children with diarrhea, ages four months to three years, in five medical centers in Asia, were randomly assigned to treatment with either WHO-ORS or Amylyte-ORS. The Amylyte-ORS contains rice proteins, short glucose polymers, fat, and five times as many calories as the WHO-ORS. The duration of diarrhea was reduced by 15% in children treated with Amylyte-ORS. Children in the Amylyte-ORS group also required significantly less ORS, and gained significantly more weight. Five children receiving WHO-ORS and three receiving Amylyte-ORS were considered treatment failures. The rice-ORS may be especially beneficial for patients with cholera in reducing stool output and duration of diarrhea. A smaller benefit from rice-ORS may be seen for acute, non-cholera diarrhea., Objective. To compare the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (Amylyte-ORS) and five times the caloric density of current ORS to the standard glucose-ORS (World Health Organization [WHO]= ORS) in the treatment of acute diarrhea in children. Methods. The rice ORS (Amylyte-ORS) was obtained by adding thermophilic amylase (252 500 MW units) and salts (1.5 g NaCl, 600 mg KCI, and 150 mg [CaCl.sub.2]) to 100 g rice and boiling for 10 minutes in 500 mL water. This yields 250 mL Amylyte-ORS, which contains 92% to 96% short-chain glucose polymers, three to nine molecules in length, and provides 425 kcal/L, compared to 80 kcal/L for the WHO-ORS. One hundred forty-four male children, 4 months to 3 years of age, presenting with acute diarrhea and mild, moderate, or severe dehydration, were assigned by random allocation to receive either WHO-ORS or Amylyte-ORS. Data from 127 children were analyzed (57 received the WHO-ORS and 70 the Amylyte-ORS). Two children given Amylyte-ORS and 15 given the WHO-ORS were not included in the analysis because of improperly collected data or lost urine or fecal specimens. None were given antibiotics during the study. Free water and feeding were allowed after the children were rehydrated. Results. The clinical characteristics of the children in the two treatment groups were comparable. Five children who received the WHO-ORS and three children given Amylyte-ORS were treatment failures. Amylyte-ORS reduced diarrhea duration by 15% (41.4 [+ or -] 2.5 vs 34.7 [+ or -] 1.8 hours; P < .03) compared to the WHO-ORS, regardless of the severity of dehydration. In the Amylyte-treated group, ORS requirements were significantly less (234 [+ or -] 15.2 vs 295 [+ or -] 17.6 mL/kg; P < .01) and weight gain was significantly more (367.7 [+ or -] 45.1 vs 199.2 [+ or -] 38.2 g; P < .01) than in those given the WHO-ORS. The net intestinal fluid balance and total body fluid balance were similar in the two groups. Conclusions. Amylyte-ORS efffectively rehydrates children with acute diarrhea, reduces diarrhea duration, decreases ORS requirements, and improves weight gain compared to the WHO-ORS. Pediatrics 1995;95:198-202; rice, oral rehydration solutions, diarrhea, glucose polymers, thermophilic amylase., ABBREVIATIONS. ORS, oral rehydration solution(s); WHO, World Health Organization. The glucose-electrolyte oral rehydration solutions recommended by the World Health Organization (WHO-ORS) effectively correct the dehydration and electrolyte imbalance due to [...]

This study documented what retail pharmacists and operators of patent medicine shops prescribe for childhood diarrhoeas in Borno State in the northeastern part of Nigeria. Data was generated by a combination of open and confederates survey of 135 pharmacies and patent medicine shops in the state. The study found that retail pharmacies and patent medicine shop operators, in the overwhelming majority routinely prescribe drugs, particularly, antibiotics, for both watery and bloody diarrhoea. Very few of the pharmacists and almost none of the patent medicine shop operators prescribed any form of oral rehydration therapy (ORT) for watery diarrhoea. There was very high discrepancy between what respondents told interviewers they usually prescribe and what was actually prescribed to confederates in their facilities. It is suggested that the non-prescription of ORT by the majority of facilities could be accounted for by pharmacists' permissive attitude to the norms. This permissive attitude was generated by the profit motive and reinforced by mothers' expectations. The study conclude that more operators can be made to prescribe ORT by instituting incentives for those who prescribe and overt sanctions for those who do not.

Contemporary issues in the dietary management of children with acute diarrhea include the optimal timing of introduction of foods during illness, the appropriate use of milk-containing treatment regimens and mixed diets containing common staple foods, and the proper use of specific micronutrient supplements. Results of recent clinical trials indicate that children should be fed continuously during illness with their usual diets. Most young children fed exclusively with nonhuman milks can continue to consume these products. However, the subgroup of patients with more severe diarrhea and dehydration may have a slightly increased rate of complications and would, therefore, benefit from close supervision or a modification of their diet. Breastfed infants should continue to nurse at the breast during diarrhea. Treatment of anorexia consists of correction of the underlying metabolic derangements and antimicrobial therapy when indicated. Despite the previous focus of dietary management during diarrhea, attention to convalescent feeding is also necessary to assure complete nutritional recovery following illness. J. Nutr. 124: 1455S--1460S, 1994.

This study examined the volume of oral rehydration solutions given to children during diarrhea and the length of time the solutions are administered. It also attempted to test the importance of individual and contextual factors - especially mothers' knowledge - in explaining the administration of oral rehydration solutions. Data about the treatment of an episode of child diarrhea within the last three months were collected from large samples of mothers in seven sites in Africa, Asia, and Latin America. The results showed that oral rehydration solutions were given in smaller volumes and for shorter periods of time than recommended. The majority of children received at least a glass (200-250 ml) of solution on the first day, but few received more than that. Daily administration of packet-based solutions or of sugar-salt solutions (promoted in two of the countries) during diarrhea was generally quite low, ranging from 16 to 60% of cases given an oral rehydration solution. However, in four out of six sites, at least half of the children with diarrhea for more than one day were given an oral rehydration solution for more than one day. The majority of children were given some form of other fluids (e.g. more water, special teas, or continued breastfeeding), but their value in preventing dehydration was not clear because the volume of other fluids given could not be assessed. Few of the hypothesized predictors of administration explained the variation in volume or duration of ORS/SSS administration within any specific country or across sites. The research points to the need for more information on the decision process used by mothers when treating their children's diarrhea and on outside factors influencing this process.

Homeopathic treatment for childhood diarrhea may be successful in decreasing the amount and duration of diarrhea. In a study of 81 children under the age of five in Nicaragua, researchers used both oral rehydration therapy (ORT) and either homeopathic treatment or a placebo. Children who received the homeopathic treatment experienced a quicker recovery from diarrhea (two days as opposed to four). They may also not become as dehydrated and malnourished when treated with homeopathic substances because of the shorter duration of diarrhea. Homeopathic substances used in the study were solutions of arsenic, chamomile, mercury, May-apple and sulphur., Objective. Acute diarrhea is the leading cause of pediatric morbidity and mortality worldwide. Oral rehydration treatment can prevent death from dehydration, but does not reduce the duration of individual episodes. Homeopathic treatment for acute diarrhea is used in many parts of the world. This study was performed to determine whether homeopathy is useful in the treatment of acute childhood diarrhea. Methodology. A randomized double-blind clinical trial comparing homeopathic medicine with placebo in the treatment of acute childhood diarrhea was conducted in Leon, Nicaragua, in July 1991. Eighty-one children aged 6 months to 5 years of age were included in the study. An individualized homeopathic medicine was prescribed for each child and daily follow-up was performed for 5 days. Standard treatment with oral rehydration treatment was also given. Results. The treatment group had a statistically significant (P < .05) decrease in duration of diarrhea, defined as the number of days until there were less than three unformed stools daily for 2 consecutive days. There was also a significant difference (P < .05) in the number of stools per day between the two groups after 72 hours of treatment. Conclusions. The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea. Further study of this treatment deserves consideration. Pediatrics 1994;93:719-725; diarrhea, diarrhea, infantile; homeopathy, Nicaragua.

Most pediatricians know how to prescribe oral rehydration therapy (ORT) for acute diarrhea. However, they choose intravenous rehydration for reasons of convenience, support staff preference, and financial reimbursement, according to a survey of doctors attending an American Academy of Pediatricians (AAP) conference. In addition, doctors do not give specific instructions to patients for ORT, nor do they strictly follow the American Academy of Pediatrics treatment guidelines. One-third of the 100 pediatricians surveyed incorrectly withhold ORT in patients with vomiting or moderate dehydration, and half the doctors surveyed incorrectly fail to advise patients to resume eating within 24 hours of the onset of diarrhea., Objective. To identify potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners. Design. Cross-sectional, anonymous, self-administered survey of physicians&apos; ORT knowledge, attitudes, and practice. Setting. A national continuing medical education conference. Participants. One hundred four general pediatricians primarily in private practice (66%) who completed training after 1980 (76%). Measurements and results. Most respondents (83%) reported that ORT plays an important role in their management of dehydration. However, compliance with guidelines from the American Academy of Pediatrics for use of oral therapy is limited: 30% withhold ORT in children with vomiting or moderate dehydration, 50% fail to advise prompt refeeding, and only 3% advise use of a spoon or syringe. The degree of importance of ORT in physicians&apos; practice was negatively associated with reported lack of convenience of ORT administration in the practice setting (P < .001), support staff preference f or intravenous versus ORT (P

Young children with severe diarrhea may be able to safely tolerate a diet of undiluted, nonhuman milk. In a meta-analysis of 14 clinical studies, researchers studied the treatment, outcome and diet of children up to 59 months old. In six of 13 studies which discussed treatment outcomes, treatment failure rates were much greater among children who received diets containing lactose. Overall, 22% percent of the children with lactose-containing diets were therapeutic failures versus 12% of those without lactose in their diets. The bowel movements of those with lactose-containing diets were not much more frequent than in the lactose-free diet group. Treatment failure rates for those receiving diluted versus undiluted milk were not statistically different. The number of bowel movements were greater in the undiluted milk group. The overall results from these trials indicate that a majority of children with acute diarrhea may be able to safely continue a diet of undiluted, nonhuman milk if severe dehydration and malnutrition are not complicating factors., ABSSTRACT. Objective. To assess the effects of continued feeding of nonhuman milks or formulas to young children during acute diarrhea on their treatment failure rates, stool frequency and amount, diarrheal duration, and change in body weight. Methods. A total of 29 randomized clinical trials of 2215 patients were identified by computerized bibliographic search and review of published articles. Data were abstracted and analyzed using standard metal-anlytic procedures. Results. Among studies that compared lactose-containing milk of formula diets with lactose-free regimens, those children who received the lactose-containing diets during acute diahhrea were twice as likely to have a treatment failure as those who received a lactose-free diet (22% vs 12%, respectively; P

This paper discusses results from a study of the household management of childhood diarrhea in a poor, urban neighborhood of Managua, Nicaragua, carried out between February 1987 and April 1988. Eight key informants and a random sample of 109 mothers were interviewed. Appropriate use of ORS was not found to be a common feature of the household management of diarrhea despite health education efforts to change mothers' beliefs and practices, and the provision of oral rehydration solution (ORS) packets by state health facilities, pharmacies and informal drug vendors. Although mothers knew about dehydration and ORS, their explanatory models for diarrhea, as well as actual practices, reflected heavy reliance on self-prescribed pharmaceuticals and home remedies, while ORS use was associated with clinic attendance. These findings point to the difficulties inherent in changing people's explanatory models for illness and illness management, and the importance of understanding the context in which treatment options are assessed and utilized.

As a component of a series of studies of childhood diarrhoea in rural Nicaragua, lay knowledge regarding the condition and its appropriate management has been investigated through semistructured interviews with 70 mothers. These data have been combined with information from focus group discussions and observations from investigators who have been resident in the study area for many years. For any episode of childhood diarrhoea, the lay nosology influences the treatment path followed. Thus for some types of diarrhoea, treatment at a health centre or health post and the use of rehydration fluids is seen to be appropriate, while for other types the use of traditional healers or home-based treatment, often explicitly without the use of rehydration fluids, is applicable. The implications of lay nosological systems for the interpretation of epidemiological studies and for the implementation of health promotion programmes are discussed.

The incidence of diarrhea and respiratory infection and the subsequent effect on growth of large dose vitamin A supplementation was studied in 172 0.5 to 3.0-year-old children from Lai Yuan county, Hebei Province, China. Results show that there was a significant decrease in the incidence of diarrhea and respiratory disease in the experimental group given 200,000 IU vitamin A as compared to the control group.No significant differences in growth were observed.

Data from the 1984 National Maternal-Child Health and Family Planning Survey in Honduras showed that one fifth (n = 711) of the children under five had experienced diarrhea on the day of the interview or the two days preceding the interview. The health care behaviors of the mothers of these children and the factors associated with these behaviors were the focus of this study. Only 22% of the mothers consulted medical personnel concerning the diarrhea episode; 74% treated their children with some type of medication while only 17% of the children received the recommended treatment, oral rehydration therapy. Most children were treated inappropriately, often receiving a combination of antibiotics, antidiarrheals and other drugs. Bivariate and multivariate analyses showed that the variables that most consistently predicted any and all three of the behaviors were the child's age and the severity of symptoms. Mothers of children two years and older were less likely to consult or use ORT than mothers of children 6-23 months of age. Mothers whose children's diarrhea had lasted three or more days or who were vomiting were usually twice as likely to consult, give any type of treatment, or give ORT than mothers whose children had diarrhea for fewer days or who were not vomiting.

Oral rehydration salt solutions (ORS), in specific formulas containing glucose and salts in varying combinations, are effective for treating patients with acute noncholera diarrhea. The recommended formulas have no effect on the volume, frequency, or duration of diarrhea, a factor that creates problems of user acceptance. The possibility of an improved effect from the addition of glycine to ORS was considered on the basis of studies that reported reduced stool volume and shorter duration of toxic diarrhea. Seven clinical trials that included various concentrations of glycine added to ORS were subjected to meta-analysis. Meta-analysis is a comprehensive evaluation of previously obtained data that reexamines pooled results. The resultant data set is subject to additional statistical analysis that measures the collective impact of the findings. The seven studies were conducted in Asia, Africa, and South America. The baseline data of six of these were similar. The seventh study probably included a larger number of children with cholera. The combined population consisted of 643 children with acute noncholera diarrhea. The results of the analysis showed that neither the volume of stool output nor the duration of diarrhea was reduced by the ORS formulations with glycine. A statistically significant weight gain was noted in the groups who received glycine supplemented ORS. The findings further suggest that ORS solutions with glycine were not clinically more effective than the standard WHO formulation for rehydration. (Consumer Summary produced by Reliance Medical Information, Inc.), The results are described of a meta-analysis of seven randomized trials that compared the clinical effects of the standard solution of WHO oral rehydration salts (ORS), containing 20 g/l of glucose, and experimental ORS solutions, containing glycine, on 643 children with acute noncholera diarrhoea. The availability of data on individual patients in each trial permitted the scope of the meta-analysis to be enhanced because the data could be pooled after adjusting for differences in baseline patient characteristics; also, the statistical strategy in terms of data quality, post-randomization exclusion of patients, and regression modelling could be standardized for all trials. The results of the analysis showed that neither stool output nor duration of diarrhoea was reduced by the experimental formulations. Only for weight gain was there a statistically significant difference between the treatment groups (those given the WHO-ORS solution gained less weight). This probably reflects transient excess fluid retention within the gut lumen or tissues of the patients who received the glycine-containing solutions. ORS formulations that contain glycine are therefore not clinically superior to the WHO-ORS solution., The International Study Group on Improved ORS(*) Introduction The current formulation of oral rehydration salts (ORS) recommended by WHO and UNICEF is effective for treating patients of all ages who [...]