Prognostic factors for persistent diarrhoea managed in a community setting
- 33 Downloads
Two hundred and five cases (mean age 13.4, SD 9.5) of persistent diarrhoea (PD) of 14–28 days duration, attending an urban slum clinic and treated according to standard WHO guidelines, were monitored at weekly intervals to obtain an estimate of treatment failure rates and to identify its clinical predictors. Vitamin and micronutrients (daily 2RDA) were additionally provided. Only 9 (8.2%) of 109 children with criteria for hospital care accepted in-patient care.
Weight gain was considered inadequate if the daily increment between enrolment and day 7 of follow up was < 10 g at age 0–3 months, < 5 g at 4–6 months, and any weight loss for those older than 6 months. Recovery was considered delayed if diarrhoea ceased 7 days after enrolment. Overall, 28.3 % cases had inadequate weight gain and 25.6% had delayed recovery. The non-breast milk calorie intake was 11.2 % during infancy and 40.6 % at later ages of the recommended intakes.
In a logistic regression model, initial watery stool frequency greater than median (adjusted OR 2.30, p=0.01), age < 6 months (adjusted OR 2.24, p=0.04) and low consumption of micronutrient mixture (adjusted OR 2.62, p=0.01) were associated with an increased risk of delayed recovery. In a Cox proportional hazards model for time to recovery from diarrhoea, low consumption of the micronutrient mixture and age < 6 months reduced the chances of recovery by 29 % and 37 % respectively. Low consumption of the prescribed micronutrient mixture (adjusted OR 2.21, p=0.04), fever (adjusted OR 1.91, p=0.05) and diarrhoea continuing beyond study day 7 (adjusted OR 2.29, p=0.03) increased the risk of inadequate weight gain. Breast feeding status and animal milk consumption did not influence weight gain or recovery.
Due to the low compliance for advised hospitalisation, approaches for care at community level itself need to be evolved. Focus should be on increasing the overall dietary intake and provision of generous but safe amount of micronutrients; our findings do not support need for routine elimination of animal milk. The efficacy of individual micronutrients needs evaluation in controlled trials.
Key wordsPersistent diarrhoea Community Prognostic factors
Unable to display preview. Download preview PDF.
- 1.World Health Organization. Persistent diarrhoea in children in developing countries-report of a WHO meeting. WHO/CDD/88.27.Google Scholar
- 3.Bhandari N, Bhan MK, Sazawal S. Mortality associated with acute watery diarrhoea, dysentery and persistent diarrhoea in rural North India.Acta Pediatr 1992; 81 (Suppl 381): 3–6.Google Scholar
- 4.Fauveau V, Henry FJ, Briend A, Yunus M, Chakraborty J. Persistent diarrhoea as a cause of child mortality in rural Bangladesh.Acta Pediatr 1992; 81 (Suppl 381): 12–14Google Scholar
- 5.World Health Organization. Management of childhood illness. WHO/CDR/95.14.DGoogle Scholar
- 7.Lanata CF, Black RE, Creed-Kanashiro Heet al. Feeding during acute diarrhoea as a risk factor for persistent diarrhoea.Acta Pediatr 1992; 81 (Suppl 381): 98–103.Google Scholar
- 11.Henry FJ, Udoy AS, Wanke CA, Aziz K. Epidemiology of persistent diarrhoea and etiologic agents in Mirzapur, Bangladesh.Acta Paediatr 1992; 81 (Suppl 381): 27–31.Google Scholar
- 13.Lanata CF, Black RE, Gil AEt al. Etiological agents in acute vs. persistent diarrhoea in children under three years of age in peri-urban Lima, Peru.Acta Pediatr 1992; 81 (Suppl 381): 32–38.Google Scholar
- 16.Hodges MEH. Clinical implications of growth monitoring experiences from Sierra Leone.J Trap Pediatr 1991; 37 (5): 244–9Google Scholar