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Query: UMLS:C0740441 (acute diarrhea)
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A community survey of treatment regimens for acute diarrhoea in children was carried out in 10 villages in the Ona Ara Local Government Area of Oyo State, Nigeria, using a combination of qualitative (focus-group discussions) and quantitative (weekly surveillance of diarrhoea) methods. Focus-group discussions were conducted with parents of children aged less than 5 years, while a surveillance of diarrhoea among 550 children of same age was carried out during a 6-month period. The findings of the study showed that not all types of diarrhoea were recognized as illnesses, and only those considered to be illnesses were treated. Treatment often involved an adhoc group which comprised adults who were present at the time the illness occurred (including parents, neighbours, relatives, and elders). Certain beliefs and practices, such as associating types of diarrhoea with occupation or ethnic groups, categorizing the severity on perceived causes, and withholding certain foods during episodes of diarrhoea, were common factors in decision-making for seeking treatment. Antimicrobial agents were used in the case of 46.8% of 205 diarrhoeal episodes, and 28.5% were not at all treated. The usual practice of focusing on a target group, such as mothers, during educational interventions may need to be modified in communities where nearly every adult has a role in decision-making in relation to health. The need to adapt health policy and programmes to cultural norms should be addressed to improve the impact of programmes.
J Health Popul Nutr 2000 Dec
PMID:Treatment of childhood diarrhoea in Nigeria: need for adaptation of health policy and programmes to cultural norms. 1126 66

(1) Nifuroxazide, an intestinal antibacterial agent, is now available in France, without a prescription, for the treatment of acute diarrhoea in adults. (2) According to the only available comparative randomised trial, there is no effect on dehydration. Relative to a placebo, the mean number of stools is reduced by about one per day during the first two days of treatment, with no significant difference thereafter.
Prescrire Int 1999 Dec
PMID:Nifuroxazide in acute diarrhoea: OTC preparation. Irrational. 1150 13

Probiotics are living microorganisms that can affect the host in a beneficial manner. Prebiotics are nondigestible food ingredients that stimulate the growth and activity of probiotic bacteria already established in the colon. Efficacy of probiotic compounds has been shown in a wide range of gastrointestinal diseases. Lactobacillus GG alone, or the combination of Bifidobacterium bifidum and Streptococcus thermophilus, is effective in the treatment of Clostridium difficile, as well as in preventing the frequency and severity of infectious acute diarrhea in children. Prevention of antibiotic-induced diarrhea with the concomitant administration of either Lactobacillus GG or Saccharomyces boulardii has been demonstrated. The most successful studies involve the use of Lactobacillus GG at a dose of 1 x 1010 viable organisms per day and the yeast boulardii at a dose of 1 g/day. A probiotic preparation (VSL#3 - 6 g/day) that uses a combination of three species of Bifidobacterium, four strains of Lactobacillus and one strain of Streptocccus has shown promise in maintaining remission in ulcerative colitis and pouchitis, as well as in preventing the postoperative recurrence of Crohn's disease. The mechanism of action of probiotics may include receptor competition, effects on mucin secretion or probiotic immunomodulation of gut-associated lymphoid tissue. Oral administration of probiotic compounds has been demonstrated to be well tolerated and safe. However, while probiotics have the potential to improve human health and to prevent and treat some diseases, major improvements are needed in labelling and quality assurance procedures for probiotic compounds. In addition, well planned and controlled clinical studies are necessary to delineate fully the potential for probiotic compounds.
Can J Gastroenterol 2001 Dec
PMID:The use of probiotics in gastrointestinal disease. 1177 48

This report summarizes the current knowledge on the effects of zinc supplementation on the management of acute diarrhoea. All published and unpublished studies on this topic, conducted in hospitals and in the community, were reviewed. Based on the results of this review, it is concluded that there is now enough evidence demonstrating the efficacy of zinc supplementation on the clinical course of diarrhoea, with regard to the severity and duration of the episode. However, the meeting also concluded that effectiveness studies to assess the feasibility, sustainability, and cost-effectiveness of different strategies for delivering zinc supplementation should be undertaken.
J Health Popul Nutr 2001 Dec
PMID:Effect of zinc supplementation on clinical course of acute diarrhoea. 1185 58

A prospective observational study was conducted to determine the prevalence and the clinical impact of intestinal parasitic infections in diarrheal illness among HIV-infected and HIV-uninfected children hospitalized with diarrhea in Bangkok, Thailand. Stool samples were examined for intestinal parasites using a simple smear method, a formalin-ether concentration method, a modified acid-fast stain and a modified trichrome stain. Intestinal parasites (IP) were identified in the stool specimens of 27 of 82 (33%) HIV-infected and 12 of 80 (15%) HIV-uninfected children (p=0.01). Microsporidia and Cryptosporidium were the most common IP found. Eighty-two percent of HIV-infected and 97% of HIV-uninfected groups presented with acute diarrhea and 76% of each group had watery diarrhea. Pneumonia was the most common concurrent illness, found in 22%. Clinical findings were unable to differentiate children infected with IP. Sixty-three percent of HIV-infected and 83% of HIV-uninfected children who had IP made a satisfactory recovery without specific anti-parasitic therapy. However, 9 children (7 HIV-infected and 2 HIV-uninfected) with persistent diarrhea who also had cryptosporidiosis and/or microsporidiosis did not respond to azithromycin and/or albendazole respectively. HIV-infected children with cryptosporidiosis were older and had more advanced HIV infection than those with microsporidiosis. Routine stool examination for IP should be considered due to the absence of clinical markers. The lack of effective therapy for the major IP found underscores the importance of preventive measures.
Southeast Asian J Trop Med Public Health 2001 Dec
PMID:Intestinal parasitic infections among human immunodeficiency virus-infected and -uninfected children hospitalized with diarrhea in Bangkok, Thailand. 1204 52

Diarrhea involves a significant increase in excreted fluid volume, due either to a failure of the bowel to reabsorb or absorb fluid or to a great increase in fluid secreted into the bowel. To cause diarrhea, pathogenic organisms must be swallowed, survive the acid in the stomach, colonize the small bowel, and stick to the enterocytes. In secretory diarrhea, Vibrio cholerae bacteria and enterotoxigenic Escherichia coli enter the enterocytes, stimulate adenylatecyclase, and cause a chain of reactions that results in the secretion of sodium and chloride ions (electrolytes)--accompanied by water--into the lumen of the bowel. In invasive diarrhea, Shigella bacteria not only colonize the surface of the small bowel but they also penetrate and invade the mucous membrane. Many enterocytes are destroyed, blood vessels may rupture, and white cells are excreted as pus along with blood and tissue fluid. Rotaviruses, a common cause of acute diarrhea in small children, penetrate the bowel in patches, killing many enterocytes and thus reducing the surface for absorption. Replacement of lost water and electrolytes is the 1st priority in the treatment of diarrhea. Examination of the diarrhea stools for blood can help to identify invasive diarrhea. Children with Shigella dysentery who seems seriously ill require specific antibiotics in addition to rehydration.
Dialogue Diarrhoea 1988 Dec
PMID:Mechanisms of diarrhoea and why they matter. 1228 45

The Program of Information, Education, and Services for Basic Family Health Care in Magdalena Medio and Bajo was designed to increase knowledge and use of contraception and to improve basic health practices and nutrition in the region, which includes municipios belonging to 9 different departments and a total population of 1,720,000. Poverty levels in the area are high. During the 1st year of the project, which was underway from February 1988-May 1991, home visits were made to inform each family about basic family health, to weigh and measure children under 5 not receiving health care elsewhere, and to refer families to the nearest health services. Talks were presented to small groups on family planning, intestinal parasites, sexually transmitted diseases, nutrition, vaccination, cancer prevention, malaria, acute diarrhea, and acute respiratory infection. Community workshops were presented in the 2nd year. Community distribution posts were created for contraceptive and other health product distribution. Information and communication materials from PROFAMILIA were used, and other materials were specially designed for the project by the Foundation for Development of Health Education in Colombia. PROFAMILIA's system of service statistics was used for quantitative evaluation of the information and education activities and sales of contraceptives, antiparasitics, and oral rehydration packets of each instructor. In the 3 years of the program, 89.086 cycles of pills, 398,772 condoms, 29,080 vaginal tablets, 209.791 antiparasitics, and 49,305 oral rehydration packets were sold. 9295 talks were presented to 143,227 residents of the region. 22,000 children were enrolled in the growth monitoring program, and almost 40,000 women were referred for prenatal care and cytology. The instructors gave 900 talks to distributors of contraceptives, antiparasitics, and oral rehydration packets. Surveys of women aged 15-49 residing in the municipios covered by the project were conducted at the beginning and end of program activities in order to assess project impact. 1673 women were interviewed in the 1st survey in June-July 1988 and 1660 were interviewed in the 2nd survey in March-April 1991. In general terms, the region of Magdalena Medio and sand Bajo showed important changes in contraceptive prevalence, maternal-child health, knowledge of AIDS, and family violence over the 3 years of the project. Knowledge of contraception improved throughout the region, especially in rural areas. The proportion of women in union using a method increased from 56.7% to 58.0%. There were no overall changes in the proportions of children vaccinated.
Profamilia 1992 Dec
PMID:[Basic family health program in Magdalena Medio y Bajo]. 1228 83

This article describes the international training workshops conducted by the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B). During May 4-15, 1997, an international training course was conducted on the Laboratory Diagnosis of Common Diarrheal Disease Agents. The aim was to update the knowledge and skills of health professionals. 11 participants learned procedures for isolation and identification of pathogens, preparation of culture media, and laboratory safety. It is expected that those trained will spread their knowledge to others upon return to their home countries. A 4-week introductory course was conducted on Epidemiology and Biostatistics. The aim was to train persons from national institutions and nongovernmental organizations (NGOs) how to plan, design, analyze, and undertake epidemiological studies. A 2-week course was held on Emergency Response to Cholera and Shigella Epidemics. 12 participants from international NGOs that respond to disaster situations gained skills in managing epidemics and learning how to identify and apply measures to reduce morbidity and mortality from acute diarrhea in emergency and disaster situations. Participants learned how to recognize and manage patients with cholera and shigellosis and how to prepare an action plan for treatment and control purposes. This course consisted of theoretical lectures, hands-on training, and practical training. The Center's success in intervening in the Rwandan cholera epidemic justifies continued training for next year as well. 13 participants attended a 2-week course on Clinical Management of Diarrheal Diseases.
Glimpse 1997 Dec
PMID:Training activities at the Centre. 1229 23

The aim of this work was to study feasibility of diarrhoea control in children (6 months to 5 y of age) by feeding fermented milk preparations. The design used was a randomized controlled clinical trial and the study was carried out at the Delhi University College Hospital providing tertiary care, and a nearby community centre Nand Nagri, a resettlement colony in East Delhi. Children suffering from acute diarrhoea (75 patients from the hospital and 75 from the community) were allocated to three groups by double-blind technique. Group 1 was given a fermented milk, Actimel, containing 10(8) of each Lactobacillus casei DN-114001, Lactobacillus bulgaricus and Streptococcus thermophilus per gram. Group 2 was given Indian Dahi (Lf 40) containing 10(8) of each Lactococcus lactis, Lactococcus lactis cremoris and Leuconostac mesenteroides cremoris per gram. Group 3 was given ultra-heat-treated yoghurt preparation (no live bacteria). Actimel was also used as a starter to prepare the curd in order to study the preventive effect of diarrhoea in children in a community. In the hospital study Indian Dahi and Actimel administration reduced mean duration of diarrhoea by 0.3 and 0.6 day (P<0.001), respectively. The corresponding figures in the community study were 0.2 and 0.5 day (P<0.05), respectively. The families using Actimel as a starter showed a reduction in diarrhoeal morbidity episodes by 40% of the children tested in a 3 month follow-up. In conclusion, Actimel, fermented milk containing Lactobacillus casei DN-114001, and Indian Dahi can significantly reduce the duration of diarrhoea in children; the former preparation being superior.
Eur J Clin Nutr 2002 Dec
PMID:Feasibility studies to control acute diarrhoea in children by feeding fermented milk preparations Actimel and Indian Dahi. 1255 49

Shigella flexneri infections are one of the main causes of acute diarrhoea in Cuba. Twenty strains isolated from sporadic cases in nine different Cuban provinces were characterized. Serotyping, antibiotic-resistance typing, plasmid-typing and AFLP-typing were used to determine their suitability for use in epidemiological studies of S. flexneri. The predominant serotypes were serotype 6 (35%) and serotype 2 (35%). Eleven different plasmid profiles were detected (Diversity Index = 0.92). AFLP-typing discriminated 12 different patterns (DI = 0.95), these patterns were not coincident with plasmid-typing patterns. Both techniques combined distinguished 14 patterns among the 20 studied strains (DI = 0.99). There was no consistent relationship between plasmid-typing and AFLP-typing patterns or antibiotic-resistance typing patterns. Ninety-five percent of S. flexneri strains were multiresistant.
Epidemiol Infect 2002 Dec
PMID:Use of AFLP, plasmid typing and phenotyping in a comparative study to assess genetic diversity of Shigella flexneri strains. 1255 26


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