Behavior of urban based child caretakers in the home treatment of diarrheal diseases

Behaviors of low income urban mothers and child caretakers in the treatment of childhood less than 5 year diarrhea were analysed from a surveillance study conducted between August 1988 and July 1989. Help seeking behaviors of mothers and caretakers for 412 episodes of child diarrhea were as follows: investigators 37.1%, drug stores 18.2%, wait and see or self treatment 17.0%, private clinics 12.6%, near by hospital 10.2%, and local health center 4.9%. Major treatment practices included ORT alone (54%) and ORT plus antibiotics and/or antidiarrheal drug (22%). Overall ORT usage was 76%. Twelve percent of diarrheal episodes no treatment was given to the children. Antimicrobials were believed to be essential in addition to ORT especially when diarrhea was associated with fever, vomiting and bloody stools. Thirty-six percent of invasive diarrhea cases (Shigella, Salmonella, Campylobacter) were treated with antibiotics. Only 18.2% of noninvasive diarrhea received antibiotics, most of this antibiotic use being in rotavirus diarrhea where vomiting and some fever are prominent. Availability of oral rehydration salts (ORS) and good experience with ORT were the key to the extensive use or ORT in this study. A surprisingly small number of mothers and child caretakers (4.9%) sought help from the local health center when their children had diarrhea.     

Effect of low birth weight on severe childhood diarrhea.

A hospital-based case-control study was conducted at Phanat Nikhom District Hospital, Chon Buri Province, Thailand to determine the association between low birth weight and severe diarrhea and its magnitude of association among children under two years of age. Data were analyzed from 52 severe diarrheal cases and 121 mild diarrheal children attending the hospital during October 1988 to December 1989. Information regarding birth weight was obtained from hospital record or health care of each subject. Information on variables which may confound the association between low birth weight and severe diarrhea were also collected by interviewing all subjects' mothers with structured questionnaires. It was found that the crude Odds Ratio between low birth weight and severe diarrhea was 4.62. However after controlling for confounding variables: age, concurrent infection, duration of diarrheal attack prior attending hospital and ORT usage, the adjusted Odds Ratio was 3.92. The present study confirms that low birth weight is an important determinant of severe diarrhea and feasible intervention in the case of low birth weight needs to be explored.     

Assessment of the effectiveness of oral rehydration therapy against severe diarrheal dehydration.

A hospital based case-control study for assessing the effectiveness of oral rehydration therapy (ORT) preparation against severe dehydration due to diarrhea was conducted at the Infectious Diseases Hospital, Jakarta, Indonesia. A total of 202 children aged 24 months or less who attending the hospital were suffering from acute watery diarrhea were recruited in the study. Those who were severely dehydrated as assessed by WHO criteria were accounted as cases; those who were non-severely dehydrated were accounted as controls. There were 59 cases and 143 controls. A questionnaire was used to interview all study subjects' mothers about ORT usage and various risk factors. Mothers who used ORT were asked to show how they prepared either oral rehydration solution (ORS) or sugar salt solution (SSS). Effectiveness of ORT against severe diarrheal dehydration was based on the formula for assessment of vaccine efficacy by using the odds ratio (OR). With the use of the logistic regression method, an adjusted OR was obtained after controlling various confounders. The effectiveness of ORT against severe diarrheal dehydration was 72.1% for proper ORT preparation and was decreased to 63.2% when ORT was improperly prepared.     

Outcome of children rehydrated in a hospital ORT corner in Bangladesh: a follow-up study

This prospective follow-up study was carried out during 1996 to identify the outcome of children rehydrated in the ORT Corner of the Chittagong Medical College Hospital. In total, 269 children, aged less than five years, who attended the ORT Corner, accompanied by their mothers, for treatment of uncomplicated acute watery diarrhoea with 'no signs of dehydration' and 'some dehydration,' were selected for the study. Mothers of the children were interviewed at the ORT Corner, and children were followed-up at home on the 5th post-ORT Corner visit day. The follow-up was completed for 260 cases (96.7%). At follow-up, 227 cases (87.3%) were found to be cured, and 33 cases (12.7%) still had diarrhoea. Of the cured, the mean duration of the episode was 5.84 +/- 2.34 days (95% CI.5.55-6.13 days). All the cases received oral rehydration therapy (ORT) after attending the ORT Corner. Eighty-one cases (31.2%), however, reconsulted the private doctors. Of those who reconsulted, only 3 (3.7%) received WHO-recommended treatment of acute watery diarrhoea, and the rest 78 (96.3%) received medication. The medication prolonged the episode of diarrhoea significantly (6.22 days vs 5.48 days, p < 0.001). None of the cases, who reconsulted the private doctors, revisited the ORT Corner. Treatment by 'ORS only' was mentioned by 64% of the mothers as the reason for non-revisit of the ORT Corner, and 20% of the mothers denied the receipt of any advice about when to revisit the ORT Corner which calls for further strengthening of communication activities of the ORT Corner.     

Community case management of childhood diarrhea in a setting with declining use of oral rehydration therapy: findings from cross-sectional studies among primary household caregivers, Kenya, 2007

We sought to determine factors associated with appropriate diarrhea case management in Kenya. We conducted a cross-sectional survey of caregivers of children < 5 years of age with diarrhea in rural Asembo and urban Kibera. In Asembo, 61% of respondents provided oral rehydration therapy (ORT), 45% oral rehydration solution (ORS), and 64% continued feeding. In Kibera, 75% provided ORT, 43% ORS, and 46% continued feeding. Seeking care at a health facility, risk perception regarding death from diarrhea, and treating a child with oral medications were associated with ORT and ORS use. Availability of oral medication was negatively associated. A minority of caregivers reported that ORS is available in nearby shops. In Kenya, household case management of diarrhea remains inadequate for a substantial proportion of children. Health workers have a critical role in empowering caregivers regarding early treatment with ORT and continued feeding. Increasing community ORS availability is essential to improving diarrhea management.     

Private Sector Provision of Oral Rehydration Therapy for Child Diarrhea in Sub-Saharan Africa

Although diarrheal mortality is cheaply preventable with oral rehydration therapy (ORT), over 700,000 children die of diarrhea annually and many health providers fail to treat diarrheal cases with ORT. Provision of ORT may differ between for-profit and public providers. This study used Demographic and Health Survey data from 19,059 children across 29 countries in sub-Saharan Africa from 2003 to 2011 to measure differences in child diarrhea treatment between private for-profit and public health providers. Differences in treatment provision were estimated using probit regression models controlling for key confounders. For-profit providers were 15% points less likely to provide ORT (95% confidence interval [CI] 13–17) than public providers and 12% points more likely to provide other treatments (95% CI 10–15). These disparities in ORT provision were more pronounced for poorer children in rural areas. As private healthcare in sub-Saharan Africa continues to expand, interventions to increase private sector provision of ORT should be explored.     

Factors affecting utilization of health care services by mothers of children ill with diarrhea in rural Vietnam

To examine the use of health services for the treatment of childhood diarrhea in three southern provinces of Vietnam, and identified household, maternal, child and health service characteristics associated with this use, a cross-sectional household survey was conducted between November 1998 and January 1999. Women with a pre-school aged child living at home were the primary respondents for the survey questionnaires. Respondents were asked to recall diarrheal disease events experienced by their child during the two weeks prior to interview, and their responses to these events. Prevalence ratios (PR) were used to identify associations between maternal age, education, occupation, ethnicity, knowledge about diarrhea, feeding practises during diarrhea, household residence and economic status, disease severity, use of oral rehydration solution (ORS), time to nearest health care facility and overall satisfaction with local medical services, and the use of health care services for children ill with diarrhea. The two-week period prevalence of childhood diarrhea was 10% and varied by the province and ethnicity of the child's mother. Forty-three percent of mothers reported using ORS during diarrheal episodes. Seventy percent of mothers sought advice or treatment when their child became ill with diarrhea. After controlling for potential confounders in regression models, maternal ethnicity, maternal high school education (in comparison to no education or incomplete primary education), more severe disease and the use of ORS were factors associated with increased utilization of health care services. There was a low level of the utilization of ORS to treat children with diarrhea, especially by ethnic minority mothers. A high percentage of mothers reported low levels of satisfaction with medical services, especially those from ethnic minorities. Mothers from ethnic minorities and those with lower levels of education were less likely to seek advice or treatment. These findings suggest the need for programs to promote the use of ORS and use of appropriate services for the treatment of childhood diarrheal disease. Interventions are needed to improve the access of ethnic minority children to child health care services for the treatment of diarrhea.     

Microbiologic and clinical study of acute diarrhea in children in Aswan, Egypt

Children with diarrhea presenting to a Government Rehydration Center in Aswan, Egypt, were investigated to determine the etiology and clinical presentation of acute childhood diarrhea in southern Egypt. Among 126 outpatients and 25 inpatients with diarrhea (mean age 18 months), enterotoxigenic Escherichia coli (ETEC) (17% of cases), Cryptosporidium (9%), Salmonella spp. (7%), Campylobacter jejuni/coli (7%), and Shigella spp. (5%) were the most common enteropathogens identified during the high incidence season of July. Enteropathogens were isolated as often from inpatients as outpatients, except for Salmonella spp. and Cryptosporidium, which were recovered more often from inpatients. Salmonella-infected children, in particular, were more ill, feverish, and dehydrated on presentation than other children, resulting in more frequent hospitalization. Except for Salmonella-infected children, children with acute diarrhea usually presented without severe dehydration, which may have been due to frequent initiation of oral rehydration therapy (ORT) by mothers trained by local health care providers. A potential environmental source of ETEC was identified in clay water storage containers commonly used in this area.     

Dermatoglyphics of children with chronic constipation

BACKGROUND: The dermatoglyphics can be used to study the participation of genetic factors in many diseases. There is controversy concerning the association between the dermatoglyphic pattern of digital arches and constipation. AIM: To compare the dermatoglyphic patterns among children with and without chronic constipation in relation to the dermatoglyphic patterns and characteristics of stools of their mothers. METHODS: Three groups of children aged from 2 to 12 years and their mothers were studied: 35 patients with severe chronic constipation, 45 children with mild chronic constipation and 51 children without constipation. The fingerprints were taken and evaluated by a datiloscopy technicist and classified in arch, radial loop, ulnar loop, whorl and others. RESULTS: Digital arches were found in 25.7% of severe constipated patients, 28.9% of mild constipated children and in 23.5% of controls. There was not a statistical significant association. Constipation was found in 51,9% (68/131) of the mothers. Arches were found in 35.3% of the mother with constipation and in 42.9% of mothers without constipation. There was a slight association between constipation in children and in theirs mothers (Kappa coefficient = +0.16). CONCLUSION: The dermatoglyphics were not useful to identify the influence of genetic in constipation. There was not association between the dermatoglyphic pattern of digital arch and constipation both in children and in their mothers. Only a slight concordance was found between constipation in children and in their mothers.     

The treatment of acute diarrhea in the third millennium: a pediatrician's perspective

Diarrheal diseases continue to be a major cause of morbidity and mortality worldwide. Although new, potentially useful drugs such as acetorphan are appearing at the horizon, the cornerstone of treatment remains a proper oral rehydration (ORT). Yet, the rates at which ORT is used are still disappointingly low. Despite dramatic progresses in the understanding of the pathophysiology of diarrhea, the list of available drugs is indeed short. Recently however, several new options have appeared that may bear a great potential in the near future. The first is a potential improvement of ORS. It was recently shown that the addition of a resistant starch to oral rehydration solution reduces fecal fluid loss and shortens the duration of diarrhea in patients with cholera. Starches that are resistant to hydrolysis by amylase in fact generate in the colon short-chain fatty acids, which are known to enhance sodium absorption. The second development in treating diarrheal disease is acetorphan (racecadotril). This enkephalinase inhibitor has in fact been shown to be effective in reducing by almost half the stool output of 135 young children with acute diarrhea. Finally, probiotics. In the last few years, they have attracted a great deal of renewed interest, particularly focusing on their effects in treating and preventing diarrheal diseases. Lactobacillus GG proved effective in several clinical trials, mostly randomized and placebo-controlled, in the prevention and/or treatment of acute diarrheal disease in children. We have recently shown (6) the safety and efficacy in its administration in the ORS, especially in Rotavirus-induced diarrheas, in a large multicenter, randomized, double blind and placebo-controlled study conducted on behalf of the ESPGHAN Working Group on Acute Diarrhea.     

Maternal influence on the use of impregnated bednets in the protection of infantile malaria

A cross-sectional survey of 184 mothers or caretakers was undertaken to investigate the effect of socio-behavioral background on decision making in relation to the use of impregnated bednets to prevent malaria for their children in Ratchaburi Province, Thailand. It was found that most mothers had knowledge of the cause, transmission and prevention of malaria. They perceived susceptibility and severity of malaria as a risk to their children, which might even cause death. They also perceived and had positive attitudes toward impregnated bednets as a protection for their children. Three-quaters (76.4%) of them used impregnated bednets regularly to protect their children whereas one-quarter (23.6%) used infrequently and few never used. Bivariate analysis showed that the use of impregnated bednets was significantly related to the factors such as knowledge of malaria prevention, perception of benefits of the use, the receipt of information about the impregnated bednets from malaria workers.     

Maternal knowledge on risk behavioural practices and it's association with diarrhoea in a rural community of West Bengal, India

Knowledge of rural mothers related to five diarrhoeagenic risk behaviours, identified in an earlier study, was ascertained. A high proportion of mothers (67%-79%) had knowledge about risk of bottle feeding, non-use of soap for cleaning feeding containers, storage of drinking water in wide-mouthed vessels and indiscriminate disposal of children's faeces. However, only around 31% of mothers were aware about danger of using pond water for cleaning feeding containers. Risk behavioural practices were less amongst mothers who had knowledge about them. Risk of diarrhoea amongst children of mothers having risk practice without knowledge as compared to those who utilised their knowledge to avoid risk practice was found significantly higher (p < or = 0.005) except for bottle feeding (p = 0.330). The results of this study indicate that children can be protected significantly from diarrhoea if mothers' diarrhoeagenic behaviours can be altered through educational intervention.     

Salivary cotinine levels in children presenting with wheezing to an emergency department

We set out to evaluate salivary cotinine concentrations to judge tobacco smoke exposure among infants and children, and to examine the results in relation to age and wheezing. This was a case-control study of wheezing children (n = 165) and children without respiratory tract symptoms (n = 106) who were enrolled in the Pediatric Emergency Department at the University of Virginia. The age range of both wheezing and control patients was 2 months to 16 years. Questionnaires were combined with cotinine assays in saliva to evaluate exposure to environmental tobacco smoke (ETS) for each child. The prevalence of exposure to one or more smokers at home was high (68%); and 43% of the children enrolled were exposed to ETS from their mothers. According to the questionnaires, and after adjusting for age and race, a wheezing child in this study was more likely than a control to be exposed to at least one smoker at home (odds ratio = 1.9; 95% CI = 1.1-3.4). However, the odds of exposure to ETS from smoking mothers did not differ significantly between wheezing and control patients, and no significant association was found between the presence of wheezing and salivary cotinine levels. Among children exposed to ETS at home, cotinine levels were significantly higher in saliva from those under the age of two years, and from toddlers aged 2 and 3 years, compared to values from children over age 4 years. Moreover, the number of smokers in the home strongly influenced cotinine levels from children under age 4 years. In addition, higher cotinine levels were observed in saliva from children under age 2 years who were exposed to ETS from their mothers. Cotinine levels were similar and significantly correlated in paired samples of saliva and serum from children under 4 years of age (n = 54), (r = 0.92, P < 0.001). Based on information gathered from questionnaires, the results indicate that wheezing children were more likely than controls to be exposed to ETS at home. However, significant differences in ETS exposure between wheezing and control groups with respect to maternal smoke exposure or comparisons of salivary cotinine levels were not apparent. It was clear that determinations of salivary cotinine for monitoring the prevalence and intensity of household smoke exposure in this study were most valuable during the first 4 years of life.     

Diarrhoeal diseases amongst children under five. A study in rural Alwar.

A house to house survey was done in three villages of district Alwar covering 875 children under five years age. Two week incidence of diarrhoea morbidity was 2.27 episodes/child/year taking into consideration the seasonal correction factor. The incidence decreased with increase of age. Incidence was found significantly more in children of illiterate mother (p < 0.05). Children of poor socio-economic conditions as determined by occupational status (labourers) suffered significantly more often from diarrhoea as compared to children of higher socio-economic status (agriculturist and others). Fifty per cent episodes of diarrhoea were treated with antibiotics, and only one child was given ORS. It is a matter of concern. About 3.7 per cent mothers washed their hands before preparing meals while, 1.6 per cent washed their hands after toilet. Only 2 per cent mothers had the knowledge of preparing the home made salt sugar solution. An intensive health education campaign is therefore, necessary for health professionals as well as mothers.     

Migration and child health inequities in Nigeria: a multilevel analysis of contextual- and individual-level factors

Objective To assess the role of rural–urban migration in the risks of under‐five death; to identify possible mechanisms through which migration may influence mortality; and to determine individual‐ and community‐level relationships between migration status and under‐five death. Method Multilevel Cox regression analysis was used on a nationally representative sample of 6029 children from 2735 mothers aged 15–49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios with 95% confidence intervals were used to express the measures of association between the characteristics, and intra‐class coefficients were used to express the measures of variation. Results Children of rural non‐migrant mothers had significantly lower risks of under‐five death than children of rural–urban migrant mothers. The disruption of family and community ties, low socio‐economic position and vulnerability, and the difficulties migrants face in adapting into the new urban environment, may predispose the children of rural–urban migrants to higher mortality. Conclusion Our results stress the need for community‐level and socio‐economic interventions targeted at migrant groups within urban areas to improve their access to health care services, maternal education, as well as the general socio‐economic situation of women.     

Enteropathogens and other factors associated with severe disease in children with acute watery diarrhea in Lima, Peru

To evaluate enteropathogens and other factors associated with severe disease in children with diarrhea, 381 children <5 years of age with diarrhea and moderate to severe dehydration (in-patients) and 381 age-, sex-, and date-of-visit-matched children with mild diarrhea (out-patients) presenting to a hospital in Peru, were studied. Rotavirus was detected in 52% of the in-patients and 35% of the out-patients (odds ratio [OR]=2.3, 95% confidence interval [95% CI]= 1.6-3.2); 95% of the rotaviruses among in-patients were of serotypes G1-G4. The risk of severe diarrhea was particularly great in children who were not exclusively breast-fed in early infancy and who also lacked piped water in their homes (for children with both characteristics OR=6.8, 95% CI=3.6-12.8). The high prevalence of rotavirus and its association with severe diarrhea underscores the need for rotavirus vaccines. Interventions to educate mothers and improve access to safe water should augment the impact of rotavirus vaccines in preventing severe diarrhea.     

Malaria parasitemia and childhood diarrhea in a peri-urban area of Guinea-Bissau.

To examine the association between diarrhea in early childhood and malaria parasitemia, we conducted a nested case-control study in Guinea-Bissau of 297 children with diarrhea and a similar number of children without diarrhea matched for age, season, and residential area. There were no associations between diarrhea and parasite rate, parasite density, or clinical malaria. However, anti-malarials were easily available and frequently used, which was reflected by a 0.7% prevalence of children with a parasite density > 100/200 leukocytes. Thus, the findings do not preclude that diarrhea may be a sign of clinical malaria or high-parasite density in endemic areas with lower use of antimalarials.     

Risk Factors for Diarrhea in Children under Five Years of Age Residing in Peri-urban Communities in Cochabamba,Bolivia

This study examined the relationship between childhood diarrhea prevalence and caregiver knowledge of the causes and prevention of diarrhea in a prospective cohort of 952 children < 5 years of age in Cochabamba, Bolivia. The survey of caregiver knowledge found that more than 80% of caregivers were unaware that hand washing with soap could prevent childhood diarrhea. Furthermore, when asked how to keep food safe for children to eat only 17% of caregivers reported hand washing before cooking and feeding a child. Lack of caregiver awareness of the importance of practices related to hygiene and sanitation for diarrhea prevention were significant risk factors for diarrheal disease in this cohort. The knowledge findings from this study suggest that health promotion in these communities should put further emphasis on increasing knowledge of how water treatment, hand washing with soap, proper disposal of child feces, and food preparation relate to childhood diarrhea prevention.