Probiotics and diarrhoea - what about amasi (traditional fermented milk)? : editorial

Abstract

Urbanisation has greatly influenced diets, but those of us who belong to the older generation of Africans grew up eating amasi. An excellent meal for hot summer days, grandmothers also considered it a useful intervention for childhood diarrhoea. Diarrhoeal disease is a major cause of mortality and morbidity in poor communities, and a burden significantly increased by the HIV/AIDS epidemic. Any intervention (in addition to the vitally important oral rehydration solution) that might help prevent or treat diarrhoea should therefore be investigated. The number of Medline articles on probiotics is significant, especially when one considers that they were not even mentioned in medical curricula until recently. Probiotics are defined as live micro-organisms that, when administered in adequate amounts, confer a beneficial effect on the health of the host. 1 Two often-studied roles for probiotics in children are in acute diarrhoeal illness and antibiotic-associated diarrhoea (AAD). For AAD a systematic review of 9/10 trials reporting on the incidence of diarrhoea ‘showed statistically significant results favouring probiotics over … controls (RR 0.49; 95% CI 0.32 to 0.74). However, intention to treat analysis showed nonsignificant results overall (RR 0.90; 95% CI 0.50 to 1.63).’ The intention to treat analysis as a more reliable measure of outcome therefore puts a damper on the former positive results. The authors conclude that ‘The current data are promising, but it is premature to routinely recommend probiotics for the prevention of pediatric AAD.’ 2