Acute Diarrheal Diseases Research Articles

Leveraging Pareto Analysis of Outpatient Morbidity for Strategic Drug Procurement and Health Promotion in Resource-Constrained Setting in Ghana

Background: Effective health management in resource-limited settings requires strategic resource allocation and intervention planning. Pareto analysis, based on the 80/20 rule, aids in identifying key health conditions impacting outpatient morbidity, guiding intervention prioritization and resource optimization. This study applied Pareto analysis on outpatient morbidity data from Goaso Government Hospital, Ghana, to identify common health conditions and improve drug procurement and health promotion strategies. The methodology also serves as a guide for applying Pareto chart analysis to enhance decision-making in healthcare delivery. Methods: A cross-sectional study was conducted analyzing outpatient department (OPD) data from January to December 2023. Data were extracted from the Ghana Health Service Monthly Outpatient Morbidity Reports via the District Health Information Management System 2 (DHIMS 2). Data analysis was conducted using SPSS version 20 to estimate the mean and standard deviation. Microsoft Excel 2016 was employed for Pareto analysis and the creation of column charts. Results: The analysis revealed that female patients had a higher average number of outpatient cases (M = 259, SD = 430.7) compared to male patients (M = 156, SD = 282.5). Key conditions contributing to 80% of the cases included Upper Respiratory Tract Infections (URTIs), Pneumonia, Malaria, Acute Urinary Tract Infections (UTIs), Diarrhoeal diseases, Typhoid Fever, Anaemia, Rheumatism/Arthritis, Skin Diseases, and Septicaemia. Notably, young adults (ages 20-34) and children (ages 1-4) were most affected. Conclusions: A strategic approach to drug procurement is essential due to high disease prevalence. Key actions include maintaining a three-month supply of ACTs for malaria, stocking essential antibiotics, and ensuring a two-month supply of ORS. Utilizing data-driven forecasting and establishing strong supplier partnerships are crucial for optimizing drug availability. Simultaneously, targeted health promotion efforts should focus on respiratory health, malaria prevention, UTIs, WASH practices, anaemia, rheumatism, and skin diseases through public education. Additionally, qualitative research, such as patient interviews and provider surveys, is recommended to understand high morbidity rates and evaluate existing interventions.

Diagnostic accuracy of Gorelick 10 point scale in comparison to IMCI scale in identifying significant dehydration in South Indian children? - A prospective observational study

ABSTRACT Background: Unavoidable cause of mortality among under 5 children in India is dehydration resulting from acute diarrhoeal diseases. In spite of various dehydration scales available across the world, the most commonly used dehydration scale in India is IMCI.Gorelick 10 point scale having more clinical indicators could also be considered using if the diagnostic accuracy of the scale in identifying the significant dehydration is in par with that of IMCI scale. Our Objective was to classify the 1month - 60 month aged children admitted with diarrhoeal disease based on dehydration assessment using Body weight, Gorelick 10 point scale, IMCI scale and to compare the diagnostic accuracy of Gorelick 10 point scale vs IMCI scale in identifying significant dehydration. Methods: The prospective observational study was done among 224 , 1 month to 60 month aged children admitted with acute watery diarrhea. The children were assessed for severity of dehydration using Body weight, Gorelick 10 point scale, IMCI scale. The diagnostic accuracy of Gorelick 10 point scale vs IMCI scale in identifying significant dehydration was assessed using statistical methods like, Sensitivity, Specificity, Positive Predictive Value PPV,NPV,LR+, LR-, Youden index and accuracy and Kappa statistic to detect inter-rater reliability. Results: The proportion of participants classified as to have no dehydration, some dehydration and severe dehydration according to Gorelick 10 point scale, IMCI and percentage of weight loss was 79.9%, 18.8%, 1.3% vs 77.7%,21%,1.3% vs 79.9%,18.8%,1.3% respectively The diagnostic accuracy of IMCI scale in identifying Significant dehydration was higher than Gorelick 10 point scale, as noted by having Sensitivity, Specificity,PPV,NPV,LR+,LR-,Youden index and accuracy as 100%,97.2%,0%,100%35.8,0,0.97,97.7% vs 88.9%,97.2%,88.2%,97.2%,31.8,0.11,0.85,95.5% respectively and k value was 0.9. Conclusion: Though the diagnostic accuracy of IMCI was little higher than Gorelick 10 point scale in identifying significant dehydration, having obtained k value of 0.9, indicates posing an excellent agreement Gorelick 10 point scale can be used in place of IMCI to identify Significant dehydration.

Determinants of recovery time from severe acute malnutrition among cholera-exposed and unexposed children in Ethiopia: a prospective cohort study.

There is a vicious interplay between severe acute malnutrition (SAM) and diarrheal diseases including cholera. The lack of sufficient evidence on the time to recovery and its determinants among children with cholera prompted this investigation. The study aimed to evaluate the time to recovery and determinants among children with severe acute malnutrition, comparing cholera-exposed and unexposed children. A prospective cohort study was carried out from September 10, 2022, to February 21, 2023, among 224 children below 15 years. The study was conducted at cholera treatment centers and nearby communities in the Bale and Guji Zones of Oromia Regional state in Ethiopia. A structured questionnaire was used to obtain information and anthropometric measurements were conducted weekly. After checking all assumptions, a multivariable Cox Proportional Hazards model was used to identify independent determinants of time to recovery using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). Statistical significance was declared at p < 0.05. Nearly 80% of participants recovered from SAM with a recovery rate of 40/1000 person-week observation and a median time to recovery of 21 days [Inter Quartile Range14-28]. The recovery time from SAM for cholera-exposed children was delayed by 54% [ARR: 0.46, 95% CI: 0.30-0.69] compared to unexposed children. Similarly, the recovery time from SAM for food-insecured families was delayed by 39% [ARR: 0.61, 95% CI: 0.38-0.96] compared to food-secured families. Moreover, children with more than three meal frequencies per day had 1.61 times [ARR: 1.61, 95% CI: 1.04-2.50] higher probability of fast recovery from SAM, compared to children with less than three meals. Children from families with good attitudes toward nutrition had more than two times [ARR: 2.23, 95% CI: 1.45-3.41] higher probability of faster recovery from SAM than families with poor attitudes. The study revealed that cholera exposure is one of the main determinants of prolonged recovery time for children with SAM. Food insecurity, meal frequency, and the attitude of parents toward children's dietary habits were determinants for the recovery of children from SAM. The findings imply the need for designing interventions to enhance child feeding during cholera illness, focusing on key determinants.

An outbreak of acute diarrhoeal disease caused by Shigella sonnei in a village in Dibrugarh district, Assam.

Background & objectives Food and waterborne illnesses remain a neglected public health issue in India. Events with large gatherings frequently witness outbreaks of acute diarrheal diseases due to consumption of contaminated food or water or poor food handling practices. In the present study, an outbreak of acute diarrhoeal disease (ADD) occurring among the attendees of a birthday party in rural Dibrugarh district in the northeastern Indian State of Assam was investigated. Methods Sociodemographic information along with details of ADD outbreak that included information about source of foods, food handlers, illness details, etc., were collected using an outbreak investigation form for descriptive and analytical epidemiology. Rectal swabs from affected individuals and food handlers were collected along with bore-well water samples and tested in the laboratory by performing bacterial culture, biochemical analysis and polymerase chain reaction. Due to the delayed report on the outbreak, collecting leftover food for laboratory testing and analysis was impossible. Results A total of 25 cases of ADD had similar signs and symptoms. The mean incubation period for developing acute diarrhoea was 26.36±8.76 (± standard deviation) hours from food consumption. The overall attack rate was 60.04 per cent (25/41); 20 per cent (5/25) required hospitalization. Thirteen rectal swab samples were tested for pathogens and found positive for Shigella sonnei. Antibiotic susceptibility test of isolated S. sonnei showed resistance to nalidixic acid, ciprofloxacin and cefotaxime. Consumption of one of the food items - chicken curry was significantly associated with illness (Odds Ratio=14.8; 95% Confidence Interval: 2.75-85.11); P value<0.05 and Population Attributable Fraction (PAF) was 70.18 per cent. The water samples were found satisfactory for human consumption. Interpretation & conclusions The findings suggested that S. sonnei infection could be implicated in the investigated food-borne diarrhoeal disease outbreak and that there was a potential for human-poultry cross-infection. Additionally, the study revealed concerning levels of S. sonnei resistance to recommended antibiotics and drew attention to their public health relevance.

Human norovirus in Brazil: an update of reports in different settings.

Norovirus is an important etiologic agent of acute gastroenteritis and has become even more relevant in Brazil after the implementation of the monovalent rotavirus vaccine in 2006 through the public health system, now representing a significant portion of the etiology of acute diarrheal diseases. Although diagnosing acute gastroenteritis caused by norovirus is a relatively simple process, and the infection tends to be self-limited, the virus can be considerably harmful to vulnerable populations, such as children, the elderly, and immunocompromised individuals. The spread of norovirus is also particularly favorable among such groups due to its mode of transmission, favored by cluttered environments such as in hospitals and densely populated regions. Additionally, norovirus' ability to spread through water and food creates the need for measures to ensure adequate sanitation and the development of effective measures to prevent outbreaks and severe manifestations of the disease. This review aims to address the main reports of human norovirus detected in Brazil over the years, focusing on clinical-hospital, food-related, and urban conglomerate contexts, including the circulating strains.

Improved water supply infrastructure to reduce acute diarrhoeal diseases and cholera in Uvira, Democratic Republic of the Congo: Results and lessons learned from a pragmatic trial.

Safely managed drinking water is critical to prevent diarrhoeal diseases, including cholera, but evidence on the effectiveness of piped water supply in reducing these diseases in low-income and complex emergency settings remains scarce. We conducted a trial of water supply infrastructure improvements in Uvira (DRC). Our primary objective was to estimate the relationship between a composite index of water service quality and the monthly number of suspected cholera cases admitted to treatment facilities and, as a secondary analysis, the number of cases confirmed by rapid diagnostic tests. Other exposures included the quantity of supplied water and service continuity. We used Poisson generalised linear models with generalised estimating equations to estimate incidence rate ratios. Associations between suspected cholera incidence and water service quality (RR 0·86, 95% CI 0·73-1·01), quantity (RR 0·80, 95% CI 0·62-1·02) and continuity (RR 0·81, 95% CI 0·77-0·86) were estimated. The magnitudes of the associations were similar between confirmed cholera incidence and water service quality (RR 0·84, 95% CI 0·73-0·97), quantity (RR 0·76, 95% CI 0·61-0·94) and continuity (RR 0·75, 95% CI 0·69-0·81). These results suggest that an additional 5 L/user/day or 1.2 hour per day of water production could reduce confirmed cholera by 24% (95% CI 6-39%) and 25% (95% CI 19-31%), respectively. Ensuring a sufficient and continuous piped water supply may substantially reduce the burden of endemic cholera and diarrhoeal diseases but evaluating this rigorously is challenging. Pragmatic strategies are needed for public health research on complex interventions in protracted emergency settings. The trial is registered in ClinicalTrials.gov ID NCT02928341. https://classic.clinicaltrials.gov/ct2/show/NCT02928341.

A Longitudinal Study of Acute Diarrhoeal Diseases Among Children Under Five Years in an Urban Area of Goa.

Acute diarrhoeal diseases (ADD) account for a large number of preventable deaths in India, especially in children less than five years who are more at risk than adults with respect to the degree of dehydration and complications. (1) To measure the incidence of ADD among children under 5 years; (2) Determine risk factors associated among children; (3) Study treatment-seeking behaviour of their mothers. Community-based, prospective, longitudinal study conducted in an urban area of Goa. 250 children enrolled in the study with their mothers by stratified random sampling technique, conducted house-to-house visits every three months and mothers were interviewed with pre-tested semi-structured questionnaire. The duration of study was one year from January to December 2018. Data entered using EpiData Entry Client®, Analysed using SPSS® software version 22. Student's t-tests and Chi-square tests were used. The incidence of ADD was 0.124 episodes/child/year. Significant association was noted between ADD in children and certain socio-demographic factors like child's sex, birth order, birth weight, immunization status, malnutrition, mother's age group, mother's education, and mothers' hygiene practices. Efforts should be made to educate all mothers about the seeking timely treatment, awareness about home-based management and their types, awareness of ORS, zinc, importance of hygienic practices like hand washing for mother and child.

Driving forces of continuing evolution of rotaviruses.

Rotaviruses are non-enveloped double-stranded RNA virus that causes acute diarrheal diseases in children (< 5 years). More than 90% of the global rotavirus infection in humans was caused by Rotavirus group A. Rotavirus infection has caused more than 200000 deaths annually and predominantly occurs in the low-income countries. Rotavirus evolution is indicated by the strain dynamics or the emergence of the unprecedented strain. The major factors that drive the rotavirus evolution include the genetic shift that is caused by the reassortment mechanism, either in the intra- or the inter-genogroup. However, other factors are also known to have an impact on rotavirus evolution. This review discusses the structure and types, epidemiology, and evolution of rotaviruses. This article also reviews other supplemental factors of rotavirus evolution, such as genetic reassortment, mutation rate, glycan specificity, vaccine introduction, the host immune responses, and antiviral drugs.

Exclusive breastfeeding in Colombia: analysis of data on respiratory infections and acute diarrhoeal diseases

Introduction: Despite the fact that Colombia is the fourth country in the world with the highest concession of maternity leave days, it still does not cover what is defined as essential to reduce Respiratory Tract Infection (RTI) and Acute Diarrhoeal Disease (ADD) in infants. Objective: The objective of this research was to analyze indicators of respiratory infections and acute diarrheal diseases during exclusive breastfeeding (EBF) in Colombia. Methodology: The management of solid research data at the institutional level used as instrument the LERU roadmap for health indicators in institutions attached to the Secretariat of Health of Bogota, based on the case study and matched controls 1: 2, from publications of the SaluData observatory, the Ten-Year Breastfeeding and Complementary Feeding Plan- PDLMAC 2021-2030, as well as the registry book of infants between 0 to 5 months of age, taking as a focused sample the Hospital San Juan de Dios in Colombia, the detection of the occurrence of events that allow formulating a hypothesis in accordance with the variables: breastfeeding and maternity leave; respiratory infections and acute diarrheal diseases. Results: The findings show that there is an association between exclusive breastfeeding during maternity leave to reduce respiratory infections and acute diarrheal diseases in the hospitals attached to the Health Secretariat of Bogota. One in six children does not receive exclusive breastfeeding during maternity leave in Colombia. Conclusion: As implications, the public health strategies must be reconsidered to favor EBF and extend maternity leave times, complying with the 6-month goal defined by the World Health Organization.

Post-Diarrheal Acute Kidney Injury During an Epidemic in Monsoon - A Retrospective Study from a Tertiary Care Hospital.

Acute kidney injury (AKI) is a severe complication of acute diarrheal diseases; however, there is limited data on post-diarrheal AKI (PD-AKI) epidemiology and outcomes. This study aimed to investigate the clinicodemographic profile and outcomes of PD-AKI in our hospital. We retrospectively analyzed data from 93 patients admitted with PD-AKI during a diarrheal illness epidemic. Patients were stratified based on the Kidney Disease: Improving Global Outcomes (KDIGO) AKI stage and quick Sequential Organ Failure Assessment (qSOFA) score. Clinicodemographic data and outcomes were recorded and analyzed. The mean age of the patients was 45.7 ± 11.9 years, with a majority being men (n = 55, 59%). All patients presented with watery diarrhea, 85% (n = 79) had vomiting, and 66% (n = 61) presented in shock. At presentation, 59% were oliguric, while 32% were anuric. KDIGO stage 3 AKI was observed in 71% (n = 66) of patients. Dialytic support was required in 29% (n = 27) of cases. The mortality rate was 6.5% (n = 6), mostly due to refractory shock, while the remaining patients recovered. Risk factor analysis demonstrated a higher qSOFA score, and peak serum creatinine levels were associated with an increased likelihood of requiring renal replacement therapy and delayed renal recovery. This study provides valuable insights into the clinicodemographic characteristics and outcomes of PD-AKI. The high prevalence of severe AKI emphasizes the importance of early recognition and appropriate management strategies for these patients.

Cholera rages in Africa and the Middle East: A narrative review on challenges and solutions.

Cholera is a life-threatening infectious disease that is still one of the most common acute watery diarrheal diseases in the world today. Acute diarrhea and severe dehydration brought on by cholera can cause hypovolemic shock, which can be fatal in minutes. Without competent clinical therapy, the rate of case fatality surpasses 50%. The purpose of this review was to highlight cholera challenges in Africa and the Middle East and explain the reasons for why this region is currently a fertile environment for cholera. We investigated cholera serology, epidemiology, and the geographical distribution of cholera in Africa and the Middle East in 2022 and 2023. We reviewed detection methods, such as rapid diagnostic tests (RDTs), and treatments, such as antibiotics and phage therapy. Finally, this review explored oral cholera vaccines (OCVs), and the vaccine shortage crisis. We carried out a systematic search in multiple databases, including PubMed, Web of Science, Google Scholar, Scopus, MEDLINE, and Embase, for studies on cholera using the following keywords: ((Cholera) OR (Vibrio cholera) and (Coronavirus) OR (COVID-19) OR (SARS-CoV2) OR (The Middle East) OR (Africa)). Cholera outbreaks have increased dramatically, mainly in Africa and many Middle Eastern countries. The COVID-19 pandemic has reduced the attention devoted to cholera and disrupted diagnosis and treatment services, as well as vaccination initiatives. Most of the cholera cases in Africa and the Middle East were reported in Malawi and Syria, respectively, in 2022. RDTs are effective in the early detection of cholera epidemics, especially with limited advanced resources, which is the case in much of Africa. By offering both direct and indirect protection, expanding the use of OCV will significantly reduce the burden of current cholera outbreaks in Africa and the Middle East.

Antidiarrheal effect of Psidium guajava L. extract in acute diarrhea: a systematic review.

Acute diarrheal diseases are a leading cause of childhood mortality and morbidity worldwide. Psidium guajava has been globally used for its antidiarrheal potential. We conducted a systematic review of scientific articles published up to the year 2021, which included in vivo pre-clinical tests and clinical trials involving patients with acute infectious diarrhea to verify the antidiarrheal, antibacterial and antispasmodic effects of galenic preparations or phytopharmaceuticals from P. guajava. PRISMA and Rayyan were used as tools for the selection of studies collected in four databases (Pubmed, Scopus, Web of Science and Science Direct). The keywords used to carry out the search were: 'Psidium guajava', 'guava', 'antidiarrhe*' and 'diarrhe*', joined by Boolean operators 'OR' or 'AND'. The characteristics of studies in animal models of acute diarrhea induction, as well as in vivo and in vitro motility and microbiological tests linked with its main pathophysiological mechanisms, were collected. Twenty-three articles were included. Twenty (87%) of these reported heterogenic preclinical studies, predominating pharmacological studies of efficacy against conventional antidiarrheal agents, which utilized relevant outcomes and models of infectious diarrhea from the top pathogens in the clinic along with classical castor oil-induced diarrhea associated with motility tests. Only three articles (13%) corresponded to clinical trials investigating the efficacy, dose and safety of these preparations. Most studies reported positive results and significant mechanistic evidence from antibacterial, anti-motility, anti-secretory and protective/anti-inflammatory perspectives. However, further studies are needed to define the clinical significance and safety treatment with P. guajava extracts. © 2024 Society of Chemical Industry.

Impact of COVID-19-related nonpharmaceutical interventions on diarrheal diseases and zoonotic Salmonella

Non-pharmaceutical interventions (NPIs) have been proven effective in reducing the spread of the coronavirus disease 2019 (COVID-19), but their broader impact on gastrointestinal disorders remains poorly studied. Here, we report an observational analysis and retrospective study that compares the incidence of acute diarrheal diseases in Hangzhou, Zhejiang, China, between 2019 and 2020, with an examination of the antimicrobial resistance and genetic spectrum of non-typhoidal Salmonella (NTS) from 2015 to 2022, before and during the COVID-19 pandemic. Our findings underscore that NPIs related to COVID-19 effectively reduced the incidence of acute diarrhea, with a substantial decrease in most enteric pathogens. Notably, NTS exhibited an unexpected surge. Further genomic investigations of NTS isolates revealed an overall reduction in antimicrobial-resistant (AMR), disinfection-tolerant, and virulent capabilities, but with marked variations detected between human and animal isolates. Additional genome-based analysis confirmed a decrease in the scale of zoonotic transmission in response to NPIs, suggesting particular NTS types may contribute to human infections via alternative pathways. The collective findings manifested that COVID-19-related NPIs had a mixed impact on NTS infections, which may inform AMR NTS mitigation policy.

Effect of the Built Environment on the Cumulative Incidence of Acute Diarrheal Diseases: A Community-Based Cohort Study From Underprivileged Areas of Bhopal, India.

Background Diarrhea is a major public health problem in under-five children worldwide. Various sociodemographic, environmental, and behavioral factors play a role in the occurrence of diarrheal disease in children under the age of five. This study aims to estimate the cumulative incidence of acute diarrheal diseases during a one-year study period and examine its association with the built environment factors among children under the age of five in selected underprivileged areas of Bhopal. Methodology We conducted this study in Bhopal, a city in central India. We surveyed the underprivileged dwellers of Vajpayee Nagar, Sanjay Nagar, and Mother India Colony of Bhopal city. This is a prospective cohort study with a one-year follow-up period to examine the cumulative incidence of acute diarrheal diseases among under-five-year-old children in the study area. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Data were collected from February 2021 to February 2022. A total of 658 families of eligible children were contacted to participate in the study. After excluding 38 participants for various reasons (denied consent: 3; lost to follow-up: 32; moved out of the study area: 3), data were finally analyzed for 620 participants. In the study among the under-five-year-old children, the cumulative incidence of acute diarrheal diseases was 23.8% (148 out of 620). In our study, lower age (adjusted odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.99, p = 0.041) and non-availability of flush latrine in the house (adjusted OR = 4.95, 95% CI = 1.80-13.59, p = 0.002) were statistically associated with a higher incidence of acute diarrheal disease among the study population. Conclusions In our investigation, we observed a cumulative incidence of diarrhea at 23.8% (148 out of 620) among the underprivileged under-five population residing in Bhopal, India. This incidence exhibited significant associations with younger age and the absence of in-house flush latrines.

Water as a social determinant of health: bringing policies into action

Water is one of the social determinants of health and a key factor towards improving health outcomes and inequalities. Access to safe and adequate water has been identified as an essential component for protecting, maintaining and promoting public health and reducing the total burden of diseases. Though India has made substantial progress in increasing access to safe drinking water in rural areas through household tap connections, there is a lack of contemporary evidence reflecting the progress achieved so far. A desk review of India’s schemes, programmes, and policies on access to drinking water was undertaken for review. Programme and policy documents from various central government websites such as the Ministry of Jal Shakti, Department of Drinking Water and Sanitation, Jal Jeevan Mission, and Central Water Commission websites were reviewed. The paper focuses on the recently launched Jal Jeevan Mission (JJM) in addressing the identified gaps of the former initiatives in rural areas. The broad vision of JJM also aims to reduce the incidence of acute diarrhoeal diseases. It was found that with the launch of JJM in 2019, tap water connections in rural households have increased from 16.69% (2019) to 62.79% (2023). The Government of India (GoI)’s commitment and citizen-centric approach to decentralised governance in providing safe drinking water to all is reflected in the financial allocations made under the JJM to states and fifteen finance commission (FC-XV) grants. The review highlights the need for intersectoral coordination across the levels to realise better results and health outcomes.

Antibiotic resistance of conditionally pathogenic Enterobacteriaceae strains causing acute diarrhoea diseases

Acute diarrheal disease presents a major public health problem, and the identification of pathogens serves both to identify the sources of spread of infections and to establish the correct treatment. In this context, the aim of this research was to detect the conditionally pathogenic agents from the Enterobacteriaceae family, which cause more frequently acute diarrheal diseases, and to test their sensitivity to antibiotics. The research was carried out during 2019–2022 within the Public Health Medical Institution TMA Buiucani, mun. Chișinău. 537 strains were isolated and eight conditionally pathogenic agents from the Enterobacteriaceae family were identified. During the study period, a slow decrease in the values of the quantitative indices of the conditional pathogenic agents was observed, the etiological spectrum was dominated by Klebsiella spp. (43,58 %). Conditionally pathogenic agents have registered a different degree of resistance to antibiotics, which underlines the importance of an antibiogram for the effectiveness of the therapy. A very high resistance was recorded to the penicillin. The results obtained during the study period reveal the importance of monitoring the antibiotic resistance, which is very significant in the treatment of acute diarrheal diseases.

Assessment, diagnosis and planning of the ECP of AEDs in children from two to five years of age at the Fundación Hombro a Hombro, Santo Domingo, 2022

The research addresses the assessment, diagnosis and planning of the Nursing Care Process (PAE) in children from two to five years of age with acute diarrheal diseases (ADD) at the Fundación Hombro a Hombro, Santo Domingo, Ecuador. A qualitative and descriptive approach was used, analyzing data from 70 patients and their mothers. The findings reveal that male children have a higher prevalence of ADE (65.7%), influenced by sociodemographic factors such as the mothers' youth (18-27 years) and the need to work, resulting in inadequate care by other family members (71.4%). The main causes identified were poor hygiene practices, poverty and inadequate sanitation. NANDA, NIC and NOC taxonomies were used to identify diagnoses such as diarrhea (72.9%) and nutritional imbalance (15.7%). Although 84.3% of the mothers had knowledge of EDA, its application was deficient. Applied studies on preventive practices, health fairs, and educational sessions were recommended to improve the prevention and management of EDA. In addition, a nursing action plan based on Virginia Henderson's theory was developed to address these needs.

Role of nursing in the management of acute diarrheal diseases. Decalogue

Acute diarrheal diseases (ADEs) are a major cause of morbidity and mortality, especially in children under five years of age and the elderly, aggravated by limited access to safe water and sanitation in developing countries. This paper highlights the crucial role of nursing in the management of ADEs, focusing on oral rehydration, health education and infection control. Nurses not only administer treatments, but also educate communities on hygiene and nutritional practices. Implementation of effective nursing strategies can significantly reduce the incidence and severity of ADEs, improving the quality of life of affected patients. Ten key recommendations for the management of these diseases are presented, emphasizing the importance of prevention, early diagnosis and continuous follow-up.

Initial response to SARS-CoV-2 (COVID-19) outbreak in Sri Lanka; views of public health specialists through an International Health Regulations lens.

The COVID-19 pandemic affected Sri Lanka despite having developed an International Health Regulations (IHR) steering committee in 2016 and a national action plan for health security following the Joint External Evaluation in 2018. Many steps were taken to improve the disaster management skills of healthcare workers even before the COVID-19 outbreak. We interviewed seven public health specialists to obtain their views on the country's response to the pandemic. A thematic analysis was conducted, leading to the emergence of three major themes and seven subthemes. The major themes included health security preparedness; COVID-19 management; and effects of COVID-19. The subthemes were; preparedness prior to pandemic and gaps in the preparedness (under health security preparedness); dual burden for the curative sector, strategies to reduce transmission and barriers to managing COVID-19 (under COVID-19 management) and negative and positive effects of COVID-19 (under effects of COVID-19). When COVID-19 reached Sri Lanka, healthcare workers, border control authorities and those involved with infectious disease control were overwhelmed by the magnitude of the pandemic. Healthcare workers' hesitation to work amidst the pandemic due to fear of infection and possible transmission of infection to their families was a major issue; the demand for personal protective equipment by health workers when stocks were low was also a contributory factor. Lockdowns with curfew and quarantine at government regulated centers were implemented as necessary. Perceptions of the public including permitting healthcare workers to perform field public health services, logistical barriers and lack of human resources were a few of the barriers that were expressed. Some persons did not declare their symptoms, fearing that they would have to be quarantined. The pandemic severely affected the economy and Sri Lanka relied on donations and loans to overcome the situation. Pandemic also brought about innovative methods to maintain and upgrade health service provision. Individuals with non-communicable diseases received their regular medications through the post which reduced their risk of being infected by visiting hospitals. Improvement of laboratory services and quarantine services, a reduction of acute respiratory infections and diarrhoeal diseases, improved intersectoral coordination and public philanthropic response were other positive effects.

Nutritional status of under-5 Rohingya Children admitted for Diarrheal Diseases at Primary Health Centers in Cox’s Bazar District of Bangladesh

Background: One of the leading causes of mortality and morbidity in under-5 children is Diarrhea. Malnutrition, in association with the diarrheal disease, affect children negatively. On 2018, Bangladesh saw massive influx Rohingya people with almost 29% under-5 children. Objective: The purpose of the present study was to determine the prevalence of malnutrition among children admitted with acute diarrheal diseases at the Primary health Centers at Cox’s Bazar. Methodology: This cross-sectional study was conducted among the diarrhea affected under-5 Rohingya children who reported to primary health centers at cox’s bazar. The study was conducted from January to December 2018. Primary caregiver of 276 respondents were interviewed, their hospital records were reviewed. Data were collected by face-toface interview using a semi-structured questionnaire. Results: The majority (60.1%) of the participants were male. Only 2.9% of the participants reported passing of macroscopic blood in stool. Oral Rehydration Solution (ORS) was not taken by most of the participants (50.7%), prior to visit to the hospital. The mean (±SD) age was 18.54 (±12.44) months. Among the participants, 14.1% had severe underweight (&lt;-3 WAZ score) and 27.2% had moderate underweight (-3 to &lt;-2 WAZ score). No death was reported, and 97.1% were discharged with advice from the hospital. Statistically significant relationship was found between age of the participants and underweight (p&lt;0.05) with a Moderate effect size (Φ=.21). Conclusion: The study findings would be helpful to identify the need for raising awareness among Rohingya caregiver and help healthcare providers to become more cautious in treating diarrheal patients. Bangladesh Journal of Infectious Diseases, June 2023;10(1):31-37