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Query: UMLS:C0740441 (acute diarrhea)
 2,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transient risk factors may play an important role in the aetiology of acute diarrhoea. These factors have not been well elucidated. To assess them, we monitored 479 children below the age of 5 years living in a well-defined urban community in Port Moresby, Papua New Guinea, for one year, using the nested case-control method with density sampling. Comparing the odds ratios, we found that eating food that had been kept for more than 12 h, eating away from home, temporary absence of mother from home for more than one day, and the presence of respiratory infection in the child, were statistically associated with an increased risk of diarrhoea. We conclude that these transient factors must be addressed if effective control of diarrhoea is to be achieved. We believe that further studies will identify the factors more precisely and provide a better understanding of the method we have employed.
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PMID:Transient risk factors for acute childhood diarrhoea in an urban community of Papua New Guinea. 209 24

A comprehensive program review of Indonesia's Control of Diarrheal Diseases (CDD) program conducted in 1983 indicated that considerable success has been achieved in this area. Oral rehydration solution (ORS) is widely available, there has been community involvement, a strong managerial structure has developed, baseline data on diarrhea morbidity and mortality are being collected, and staff have received adequate training. At the same time, there have been some problems: inadequate use of ORS, a lack of coordination among CDD programs, insufficient surveillance, budgetary problems, and a lack of laboratory support. During the last 10 years, diarrhea mortality in Indonesia has been reduced by 50-70%, to about 20,000 (20% of child mortality). The Government has established the goal of reducing mortality from diarrhea to less than 1% of child deaths by the year 2000. A major strategy for achieving this goal is integrating family planning, nutrition, maternal-child health, immunization, and CDD programs. Another strategy involves improving research in this area. Areas for further research include: epidemiologic studies, rehydration treatment, antidiarrheal agents, social aspects, immunity and vaccine development, and laboratory examination. The cause of diarrheal diseases is not only enteric infection, it is indirectly caused by acute respiratory infection, malnutrition, measles and other systemic infection as well as the health knowledge and education of the mother. Priority is to be given to 7 areas of research: 1) the use of home-prepared rehydration fluids, 2) feeding practices during acute diarrhea that can prevent chronic diarrhea and malnutrition, 3) the determinants of progression to chronic diarrhea, 4) the impact of simple health information on hygienic and feeding practices on mortality, 5) the potential of using traditional birth attendants in ORS campaigns, 6) traditional attitudes and practices, and 7) the effectiveness of traditional medicines in diarrhea treatment.
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PMID:Research priorities on diarrhoeal diseases to support the Control of Diarrhoeal Diseases (CDD) programme in Indonesia. 370 66

In 1991, in the rural Butajira district in southcentral Ethiopia, field workers visited every household weekly to collect morbidity data on 1315 under-five children so researchers could estimate morbidity and public health risk factors of childhood disease. The Butajira Rural Health Project, begun in 1986, is a continuous demographic surveillance system. 13.2% of the children had more than five episodes of illness. 24.2% had no episodes. 22% of the children had more than 50% of all illness episodes. The incidence of overall illness was 2.34 episodes/person-year, equalling 5.8% of child days. The incidence of reported illness and derived entities fell sharply after a child reached 1 year. The peak incidences of acute respiratory infection (ARI) and acute lower respiratory infection (ALRI) were 3-6 months and 1-6 months, respectively. Gastroenteritis incidence peaked at 1-6 months. The most prevalent conditions were ARIs (prevalence 2.8%) and acute diarrhea (2.4%). The sanitation index had a significant impact on gastroenteritis and ARI, especially gastroenteritis. Parental indices also affected gastroenteritis and ARI. Living in a rural area increased the likelihood of ARI. Lack of electricity or piped water were also important determinants of illness. Illiteracy among parents was associated with an increased morbidity rate among under-fives.
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PMID:A one-year community study of under-fives in rural Ethiopia: patterns of morbidity and public health risk factors. 771 57

The study focuses on children between 72 hours and five years of age who died of acute respiratory infection (ARI) or acute diarrhea (AD) in the State of Tlaxcala. Peer Review Mortality Committee of the State contributed with the staff to the deaths analysis. Cases were included only when diagnosis was confirmed by verbal autopsy (VA). One hundred and thirty two cases were included (98 corresponding to ARI deaths and 34 to AD). The process related to medical care-seeking behaviors and prescribing practices by private and non-private physicians was analyzed through the VA. During the study period, 60% of children with ARI and 58.9% of children with AD died at home. More than 80% of these children had received medical care within three days preceding their death, and 50% of them had been seen by a physician within 12 hours prior to their death. Most of these visits were to a private doctor (71% for ARI and 86% for AD). Forty seven percent of treatments prescribed for ARI were judged to be wrong, either because of a bad choice of antibiotic or because the physician did not prescribe an antibiotic when the patient required it. Similarly, 65% of treatments for AD were considered erroneous, either due to the use of an antibiotic which was not justified or due to the lack of oral rehydration therapy when it was needed. Additionally, late referral to a hospital was considered as having direct influence at the death in half of the consultation. Families were too late in demanding medical care or demanded no care at all in 21.9% of cases of ARI and in 6.1% of cases of AD. We have found the VA to be useful in identifying problems related to the process of health-seeking behaviors and medical care. Our results suggest interventions that may lower the high mortality rates in Tlaxcala, such as training workshops directed to institutional and private physicians, and the implementation of top-of-line treatment centers where high-risk patients can be referred and also the health care workers can learn the correct treatment of both diseases. Future studies should focus on the identification of alarm signs and risk factors that may help to lower mortality due to ARI or AD, when recognized and treated at early stages.
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PMID:[The verbal autopsy on children with a respiratory infection and acute diarrhea. An analysis of the disease-care-death process]. 842 54

Risk factors associated with the recall of a recent episode of acute respiratory infection (ARI) were evaluated in 1,553 Ecuadorian preschool children enrolled into a cross-sectional health and nutrition survey. In a univariate analysis, ARI recall was significantly higher in children living in low altitude regions (Relative Risk, RR = 2.4), in younger children (RR = 1.6), in children from larger families (RR = 1.3), in children with diarrhoea recall (RR = 1.9), in children served with poor quality drinking water (RR = 1.3) and in anaemic children (RR = 1.2) than that in the appropriate control groups. After taking into account the confounding effect of altitude, no association was found between ARI recall and low height-for-age values. Stepwise logistic regression analysis identified living in low altitude regions, diarrhoea recall, and younger age as independent factors associated with a higher recall of ARI. In contrast to the recall of acute diarrhoea, no association between ARI recall and nutritional status was found. The impact of nutritional interventions in children from developing countries may be greater on enteric than on respiratory diseases.
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PMID:Risk factors associated with the recall of respiratory diseases in the Ecuadorian children. 883 22

Errors in treating common diseases occur very frequently in primary health care practice. While many of these mistakes are not life-threatening, the costs of abuse in drug prescription may be greatly increased. An educational strategy aimed to improve physicians' prescribing practices for acute diarrhea (AD) and acute respiratory infection (ARI) was developed as a research study, involving three medical care units. The strategy was largely based on promoting active participation of the trainees in the whole process, including: (a) group participation in a literature review of updated articles related to management of AD and ARI; (b) analysis of prescribing practices before the intervention; (c) participation in the development of a clinical algorithm for the therapeutic management of these illnesses; and (d) discussion of the usefulness of the algorithm during peer review committee meetings. Successful results of this intervention, as judged by the improvement of treatment practices and the persistence of changes for up to 2 years after the intervention, as well as its ease of application and low costs, motivated its extension to a health District and a State. In these sites, the intervention was in charge of medical leaders from the clinics and medical heads of the local health systems, respectively. The extension of the educational strategy was accompanied by a relative reduction in AD from 46.7% to 6.5% and in ARI from 32.6% to 8.5%. However, the benefit-cost ratio showed a dramatic increase when comparing results from the research study and from the State intervention, for both AD (from 3.3 to 4.4) and ARI (from 16.2 to 21.6), for an overall net increase of 33.3%. Based on these results, the educational strategy was adopted by the National Program for the Control of Diarrheal Diseases, and was used to train public health physicians throughout the country, from 1992 to 1994.
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PMID:From research to public health interventions. I. Impact of an educational strategy for physicians to improve treatment practices of common diseases. 884 56

Urinary tract infection (UTI) in infancy and childhood has received scant attention at primary health care (PHC) level, rarely featuring as one of the common diseases. In a prospective study conducted at a PHC clinic, 16 of 94 children (17%) from whom urine was collected by strict aseptic catheterization had bacteriuria (BU). Twelve of these had associated leucocyturia (> 5 WBC/HPF). The median age of those with BU was 9 months (range 1-30 months). BU rarely occurred in isolation (6%), but was most often detected in association with acute respiratory infection (43%) and acute diarrhoea (19%). No association of BU with mild malnutrition was detected in the 50% of children who were underweight for age. Gram-negative pathogens accounted for 14 cases (87.5%). These pathogens were resistant to commonly recommended antibiotics for UTI. Only five cases of BU returned for follow-up at 3 months; no abnormalities were detected on repeat catheter urine samples, urinary tract ultrasonography, voiding cystourethrogram and DMSA studies in them. From these and other findings we conclude that BU is probably often present in young children with common diseases attending PHC centres in developing countries. Further studies are required to establish exactly the role these pathogens play in the pathogenesis of UTI.
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PMID:Bacteriuria in children attending a primary health care clinic: a prospective study of catheter stream urine samples. 898 26

A prospective cohort study was conducted to analyze factors associated with antibiotic noncompliance and waste among patients suffering acute respiratory infection (ARI) and acute diarrhea (AD). The study took place in four primary health care clinics in Mexico City, two belonging to the Ministry of Health (MoH) and two to the Mexican Social Security Institute (IMSS). Two hundred twenty-two patients with ARI and 155 with AD were included. Data about study variables and the assessment of compliance were obtained through patient interviews and direct observation. Factors associated with noncompliance were assessed through a multiple logistic regression procedure. Noncompliance was 60% for ARI and 55.5% for AD in both health care systems. Prescription of an antibiotic was justified only in 13.5% of cases. Associated factors were: increased duration of illness (OR 2.95; 95% CI, 1.17-7.41); complexity of the treatment: 3 or more doses per day (OR 2.47; 95% CI, 1.56-3.92), and treatment for more than 7 days (OR 1.94; 95% CI, 1.16-3.26); younger age of patient (OR 1.89; 95% CI, 1.18-3.02); and an inadequate physician-patient relationship (OR 1.87; 95% CI, 1.16-3.02). Antibiotic waste was higher in IMSS (ARI 39.3%, AD 32.6%), than in the MoH (ARI 21.2%, AD 16.4%). Educational strategies to modify physician prescribing practices and strengthen physician-patient relationships might improve compliance and decrease drug waste.
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PMID:Antibiotic noncompliance and waste in upper respiratory infections and acute diarrhea. 939 86

In children in developing countries, zinc deficiency may be common and associated with immune impairment and increased risk of serious infectious diseases such as diarrhea, pneumonia, and malaria. Studies have evaluated the therapeutic effects of zinc supplementation during acute or persistent diarrhea. In studies of acute diarrhea, the illness duration has been found to be 9-23% shorter in zinc-supplemented than in control children. Diarrhea was also less severe in zinc-supplemented children. In studies of persistent diarrhea, the effect sizes were similar but were often not statistically significant, perhaps because of the small number of children participating in these studies. Trials that provided continuous daily zinc supplementation for 5-15 mo evaluated effects on the incidence of diarrhea and in some studies acute lower respiratory infections and malaria. The reduction in the incidence of diarrhea in the zinc-supplemented group in these studies ranged from 8% to 45%. A study that gave 2 wk of zinc supplementation found preventive effects against diarrhea for the 3 mo of surveillance. More limited data also suggest that the incidence of acute lower respiratory infection and clinical attacks of malaria may also be reduced by zinc supplementation. If these results are confirmed by meta-analysis of the existing trials and additional research, improvement of zinc nutriture should become a priority intervention to reduce the high burden of serious infectious disease in children in developing countries.
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PMID:Therapeutic and preventive effects of zinc on serious childhood infectious diseases in developing countries. 970 Nov 63

Short stature, or stunting, is reportedly very common among infants aged 12-23 months in Africa, Asia, and Latin America. Linear growth retardation results from the populations' exposure to poor economic conditions, repeated infections, and chronic food deficits. The authors assessed whether the short stature of children under age 5 years is associated with an increased risk of acute or persistent diarrhea, acute respiratory infection, or any illness, adjusting for possible confounding factors such as whether the child was breast-fed, water quality, degree of household crowding, age, and gender. Following initial anthropometric assessment, the morbidity and diet of a cohort of 403 Somali children were recorded for 1 year at 2-week intervals. Short stature was associated with an increased incidence of acute diarrhea and with a risk of developing persistent diarrhea, but not with the incidence of acute respiratory infections. When adjusting for age only, short stature increased the risk of developing any illness, but that association was not shown when adjusting for other possible confounding factors. A dose-effect relationship was found between different degrees of short stature and acute diarrhea, with an increased incidence of acute diarrhea among the shortest children. Efforts were made to account for the possibility of reverse causality, which seemed not to change these main findings.
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PMID:The impact of short stature on child morbidity in a rural African community. 992 76


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