The Effective Case Management of Childhood Diarrhoea with Oral Rehydration Therapy in the Kingdom of Lesotho

Abstract

In Lesotho prior to 1986, diarrhoea was the leading cause of hospital mortality in children less than 5 years of age. At the Queen Elizabeth II Hospital, diarrhoea-related admissions as a proportion of all admissions in children less than 5 years of age declined from 23% in the year prior to the opening of the Oral Rehydration Therapy Unit (ORTU) to 13% in the first nine months of 1987 (p less than 0.05). In addition, the case-fatality ratio of children treated in the ORTU declined from 1.4% in the first quarter of 1986 to zero in the second and third quarters of 1987 (p less than 0.05). In a case-control study conducted to identify reasons for children failing ORTU treatment, factors associated with an increased risk of hospitalization included male gender (odds ratio [OR] = 4.9; 95% confidence limits [CL] = 2.0, 11.9), fever greater than or equal to 38.5 degrees C (OR = 2.0; CL = 1.2, 3.3), undernutrition (OR = 3.2; CL = 1.1, 9.4), and moderate dehydration (OR = 2.3; CL = 1.2, 4.4) or severe dehydration. (OR = 12.1; CL = 3.8, 38.5). Breastfed children less than 2 years of age were at decreased risk of hospitalization (OR = 0.4; CL = 0.2, 0.7). At this major hospital in Lesotho, the standardization of outpatient treatment for diarrhoea with oral rehydration salts (ORS) in the context of an ORTU resulted in a marked decrease in diarrhoea-associated hospitalization and deaths in children less than 5 years of age.