Risk factors for deaths in under-age-five children attending a diarrhoea treatment centre

Few case-control studies have examined possible risk factors for diarrhoeal deaths in under-age-five children in the developing countries. We analysed data from the surveillance system of our diarrhoea treatment centre/hospital for the period 1990-94 on 928 children less than 5 years of age. In univariate analysis, 11 factors were significantly associated with death: lack of breastfeeding, severe malnutrition, complicated diarrhoea, pneumonia, xerophthalmia, duration of diarrhoea 7-14 days, moderate or severe dehydration, recent history of measles, Shigella flexneri infection, maternal illiteracy, and very low household income. Rotavirus diarrhoea was negatively associated with fatal outcome. In the assessment of severe malnutrition, weight-for-height measurement discriminated mortality risk better than weight-for-age or height-for-age indices. Only two factors retained their significance, severe malnutrition and non-breastfeeding in the multivariate analysis with adjusted odds ratio (95% confidence interval) of 84.2 (9.1, 775.9) and 4.2 (1.3, 13.2) respectively.     

EFFECT OF LIGHT EXPOSURE ON GUT TRANSIT TIME IN JAUNDICED NEWBORNS

In order to elucidate the mechanism by which phototherapy induces loose stools in newborns, studies were performed on the speed of gut transit by performing the Carmine Red test on normal newborn, on jaundiced newborns before and after phototherapy. A statistically accelerated intestinal transit was observed in jaundiced newborns treated with phototherapy. The increased rate of intestinal transit produced by phototherapy is probably due to the action of the photo-decomposition derivatives of bilirubin, which are excreted during phototherapy.     

Rehydration of moderately dehydrated children with transient glucose intolerance using rice oral rehydration solution

Following the successful rehydration of two moderately dehydrated patients with transient glucose intolerance (TGI) using rice-oral rehydration solution (R-ORS), R-ORS has been used in Hacettepe University Ihsan Dogramaci Children's Hospital Diarrhea Training and Treatment Unit (DTTU) to rehydrate moderately dehydrated children with TGI. The files of children with moderate dehydration and glucose intolerance admitted to the unit were reviewed retrospectively within two periods according to the availability of R-ORS. The clinical and laboratory findings were analysed where available. Before R-ORS became available (September 1993) 6 patients were admitted, all of whom deteriorated with glucose (G)-ORS treatment in 7.0 +/- 3.8 h and were hospitalized for i.v. fluid treatment. During the second period 22 moderately dehydrated children with TGI were admitted. The clinical and laboratory characteristics on admission of the children in the two periods were not statistically different (p > 0.05). Among the 22 patients admitted during the second period 10 were administered G-ORS in the unit and 12 had already received G-ORS at home. Clinical and laboratory deterioration was observed in these 10 patients while receiving G-ORS in the unit within 6.3 +/- 3.7 h and rehydration was continued with R-ORS. Clinical and laboratory improvement were demonstrated in 8 patients within 18.2 +/- 6.5 h. Overall, 17 patients were rehydrated successfully with R-ORS, with a mean time of 18.0 +/- 7.2 h. Five patients were hospitalized. The overall success rate of R-ORS was 77.3%. R-ORS may be considered as an alternative mode of therapy to i.v. treatment in the rehydration of moderately dehydrated children with TGI.     

Acute phase proteins as markers of systemic illness in acute diarrhoea

Fifty-seven Tanzanian children, 6-25 months, hospitalized with acute diarrhoea were grouped according to whether there was clinical evidence of systemic infection (SI) (n = 35) or not (n = 22). Serum acute phase proteins were measured in samples taken within 48 h of admission. Means for C-reactive protein (CRP) and serum amyloid A (SAA) were significantly higher in children with SI compared to those without (geometric means (95% CI); CRP, mg/l: 22.1 (13.6-35.5) vs. 7.4 (4.4-12.4); SAA, mg/l: 12.2 (6.8-22.1) vs. 4.9 (2.5-9.7)). Levels of alpha1-acid glycoprotein were similar in both groups (1.16 g/l (0.95-1.43) vs. 1.04 (0.83-1.29), respectively). CRP > or =30 mg/l had a positive predictive value of 95%, and specificity of 96% for correctly identifying SI, but a low sensitivity (51%) and negative predictive value (55%). Clinical outcome of diarrhoea was worse in children with SI: more needed intravenous fluids (23% vs. 5%), the duration of diarrhoea was longer (59.4 vs. 34.2 h) and mortality was higher (6% vs. 0%). APPs were not found to be useful markers of systemic illness in acute diarrhoea in this population.     

思密达治疗肝原性腹泻疗效观察：附57例临床报告

为探讨思密达治疗肝原性腹泻的疗效，我们设思密达治疗组（Ｎ＝５７）、多酶片为对照组（Ｎ＝２７）进行临床对比观察。思密达每次一包（３ｇ），每日早餐前及入睡前各服一次；多酶片每次１ｇ，每日三次口服，七天为一疗程，两组护肝治疗用药相同。结果示思密达治疗组总有效率（８２．３８％）较多酶片组（６３％）为高，差异有显著性（Ｐ＜０．０１）。在止泻时间和改善排便时伴排气多症状上思密达效果更优。     

Efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting

Objectives : To determine the efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting. Methods : In this double-blind field trial, 156 children aged 4 36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days. Results : In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post-enrolment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment ( p = 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them ( p = 0.05). The weight gains at days 7 and 14 were similar in the two groups. Conclusions : These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use.     

Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana

The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.     

Copper in drinking water: not a strong risk factor for diarrhoea among young children. A population-based study from Sweden

AIM: To assess whether mean daily intake of copper or maximal concentration of copper in drinking water is related to the incidence of diarrhoea and vomiting among young children. METHODS: Mean daily intake of copper from drinking water was estimated prior to episodes of diarrhoea among 430 children aged 9 to 21 mo. A total of 4703 samples of tap water were collected in the homes of the children. The mean daily intake of copper and the maximal concentration of copper in samples of consumed water were used as measures of exposure. The cumulative incidence of acute diarrhoea and vomiting was studied during 12 wk of follow-up. Cases of diarrhoea caused by viral and bacterial infections were identified. RESULTS: The median copper level of the mean value for each child was 0.61 mg/L with 10th and 90th percentiles of 0.04 and 1.57 mg/L. Among the 430 children, 43 had episodes of acute diarrhoea, of which 23 had no identified viral or bacterial origin, and vomiting was reported in 95 children. No significant associations were found between daily intake of copper or maximal concentration of copper in drinking water and the risk of diarrhoea or vomiting. CONCLUSION: There is unlikely to be a strong association between daily intake of copper or maximal concentration of copper in drinking water and the risk of diarrhoea or vomiting within the range of copper intakes/concentrations studied.     

Milk formulas in acute gastroenteritis and malnutrition: a randomized trial

Objective:   To compare three low-lactose milk formulas differing in osmolality and degree of protein hydrolysis in the treatment of diarrhoea and malnutrition in subjects with high rates of lactose intolerance, osmotic diarrhoea and a tropical/environmental enteropathy.
Methods:   A randomized double-blind trial of 180 Aboriginal children under 3 years of age admitted with acute diarrhoea and/or malnutrition was carried out. The intervention milk formulas were: (i) De-Lact, a low-osmolality lactose-free formula; (ii) O-Lac, a lactose-free formula; and (iii) Alfaré, a partially hydrolysed formula. Outcome measures were diarrhoeal severity, weight gain, formula palatability and changes in intestinal permeability (L/R ratios).
Results:   The duration of diarrhoea in days (mean; 95% confidence interval) was significantly longer on Alfaré (8.5; 7.0−10.0) compared to De-Lact (6.1; 5.0−7.2) and O-Lac (6.9; 5.6−8.1; P  = 0.04). There were no differences in mean intake between formulas, but palatability of Alfaré was significantly worse ( P  < 0.01) than the other formulas. Over the trial 5 days, improvement in L/R ratios was significantly greater ( P  = 0.05) for De-Lact (18.6; 10.6−26.6) than for Alfaré (8.5; 2.1−14.9). Weight gain was not significantly different between the three formulas, except in a malnourished subgroup who had better weight gain on De-Lact ( P  = 0.05).
Conclusions:   In these Aboriginal children with diarrhoea and growth failure, a low osmolality milk was associated with better outcomes and a partially hydrolysed formula with less improvement in mucosal recovery, suggesting that cow's milk protein intolerance is not contributing to greater diarrhoeal severity or enteropathy in Aboriginal children.     

Antisecretory factor counteracts secretory diarrhoea of endocrine origin

BACKGROUND: Dietary induction of antisecretory factor (AF) can reduce diarrhoea in patients with inflammatory bowel disease. Patients with neuroendocrine tumours may suffer from diarrhoea with a prominent secretory component. We studied if AF-therapy could affect this type of diarrhoea. METHODS: Six patients with the midgut carcinoid syndrome and two with metastasizing medullary thyroid carcinoma (MTC) participated. Effects of intake of AF, in the form of AF-rich egg powder (AF-egg), and induction of endogenous AF-activity by intake of specially processed cereals (SPCs) were studied.In an initial open part of the study all patients received AF-egg for 4 weeks, followed by a double-blind crossover period with SPC and control cereals (CCs) for 6 weeks each. Daily number of bowel movements at the end of each treatment period was registered. RESULTS: Treatment with AF-egg resulted in a decrease of bowel movements in seven patients (P<0.01). Registrations of bowel movements from both SPC and CC diet periods were obtained from five patients. The daily number of bowel movements was lower during the SPC-period compared to the period with CC (P<0.05).All patients had low levels of AF-activity in serum at baseline. During treatment with AF-egg, the mean level increased slightly. AF-activity was higher (P<0.05) after SPC compared to the CC diet. CONCLUSIONS: In a group of patients with endocrine diarrhoea, AF-activity could be induced, and AF-therapy reduced the number of bowel movements.