Diarrhea Status Research Articles

Skin rash and good performance status predict improved survival with gefitinib in patients with advanced non-small cell lung cancer

Gefitinib (Iressa) is active as a single agent in the treatment of select patients with recurrent non-small cell lung cancer (NSCLC). The clinical characteristics of patients treated with gefitinib on an Expanded Access Program (EAP) at our institution identified predictive variables associated with better outcome. Patients (n=199) with advanced NSCLC were treated with gefitinib (250 mg) upon progression with chemotherapy. Baseline patient characteristics were: median age, 69 years; males, 57%; adenocarcinoma, 56%. Partial responses were noted in two patients (1%) and disease stabilization in 66 (35%) patients. The median survival (MS) was 5.9 months [95% confidence interval (CI) 4.1-7.1] and median time to progression was 3 months (95% CI 2.0-3.0). The predictive factors analyzed were gender, skin rash, diarrhea, tumor histology and performance status (PS). Patients who developed skin rash (any grade) had MS of 10.8 months versus 4.0 months for those without rash (P <0.0001, log rank test). Patients with PS 0, 1 and 2 had MS of 8.4, 6.2 and 2.8 months, respectively (P <0.0002). The other factors did not impact survival. Occurrence of skin rash and baseline PS of 0/1 were associated with improved survival with gefitinib for recurrent NSCLC patients at our institution.

Lactose intolerance associated with adjuvant 5-fluorouracil-based chemotherapy for colorectal cancer

Background & Aims: Bowel mucosal injury associated with 5-fluorouracil (5-FU) treatment might result in secondary lactose intolerance. The frequency and clinical significance of 5-FU-related hypolactasia are unknown. Methods: One hundred fifty patients randomly assigned to receive 1 of 2 adjuvant 5-FU-based chemotherapy regimens, the Mayo regimen or the simplified de Gramont regimen, were studied for lactose tolerance by using an oral lactose absorption test, a symptom questionnaire, treatment-related toxicity, and Subjective Global Assessment of Nutritional Status questionnaire before, during, and 2 and 6 months after chemotherapy for colorectal cancer. Results: The frequency of hypolactasia increased from 24% before treatment to 35% during treatment ( P < 0.0001). Therapy-related hypolactasia was reversible on discontinuation of chemotherapy. Symptoms compatible with lactose intolerance occurred in 94% of patients with an abnormal lactose absorption test result during chemotherapy. The frequency of hypolactasia increased during chemotherapy in both treatment groups, but was detected more commonly in those for whom therapy included continuous 5-FU infusions (the de Gramont regimen; 45% vs. 25%; P = 0.006). The presence of hypolactasia during chemotherapy was associated with flatulence, diarrhea, and poor nutritional status. Conclusions: Reversible chemotherapy-related hypolactasia and lactose intolerance are not infrequent in patients treated with 5-FU-based adjuvant chemotherapy for colorectal cancer. Avoidance of lactose during chemotherapy may improve treatment tolerability in these patients.

Results of 2 phase I studies of intravenous (iv) pelitrexol (AG2037), a glycinamide ribonucleotide formyltransferase (GARFT) inhibitor, in patients (pts) with solid tumors

3075 Background: AG2037 is a rationally designed, novel inhibitor of GARFT, which is an essential enzyme in the de novo synthesis of purines, a critical process for cell growth. Methods: The primary objectives of these studies were to determine the maximum-tolerated dose (MTD) and recommended safe dose of AG2037 for Phase II studies (RP2D). AG2037 was given by bolus or slow iv push (every 3 weeks in Study-002 and weekly for 3 consecutive weeks every 4 weeks in Study-003) to pts with advanced solid tumors in cohorts of at least 3 patients at each dose level. The dose for the next cohort was increased by 100% if no drug related Grade 3 or worse toxicity was encountered, and by ∼50% if Grade 2 toxicity was observed. Results: 45 pts in Study-002 were treated at doses ranging from 1 to 576 mg/m2 and 49 were treated in Study-003 at doses ranging from 1 to 760 mg/m2. Study-002 was terminated before MTD was determined since mechanism-based toxicities appeared to correlate to drug exposure and not to peak concentration. For Study-003, at the highest dose (720 mg/m2), Grade 3 anemia, thrombocytopenia, diarrhea, fatigue, mucosal inflammation, dehydration, hyponatremia, confusion, or mental status changes were observed in 1 or 2 of 6 pts. There were no grade 4 toxicities. The MTD was 540 mg/m2/infusion. Grade 3 nausea was the only Grade 3 or 4 related adverse events in the 7 patients treated at MTD. The pharmacokinetics of AG2037 were linear over the studied dose range; plasma concentrations declined in a triexponential manner with a terminal half-life of 85 hours and were inversely proportional to creatinine clearance. RBC polyglutamate increased with dose to a maximum concentration and showed minimal decline between doses. One pt with colorectal cancer had a partial response by RECIST at 6 mg/m2 (Study-003). Conclusions: The RP2D for AG2037 is 540 mg/m2/week for 3 consecutive weeks, every 4 weeks. Expected adverse events on this schedule include mild to moderate myelosuppression, mucositis, diarrhea, anorexia, fatigue, and peripheral neuropathy. Further study in colorectal and other solid tumors is warranted. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Pfizer, Inc. Pfizer, Inc. Pfizer, Inc. Pfizer, Inc.

Saúde e nutrição de crianças de áreas urbanas da Zona da Mata Meridional de Pernambuco: resultados preliminares de um estudo de coorte

OBJETIVOS: apresentar as características socioeconômicas e demográficas, o perfil nutricional de crianças ao nascer e aos 12 meses de vida, além dos dados longitudinais sobre aleitamento, diarréia e situação vacinal durante o primeiro ano de vida. MÉTODOS: uma amostra de 652 recém-nascidos foi recrutada de setembro de 1997 a agosto de 1998 e acompanhada durante os primeiros 18 meses de vida. Essas crianças residiam nas áreas urbanas de quatro municípios da zona da mata meridional de Pernambuco. A coleta de dados foi realizada através de visitas domiciliares. RESULTADOS: cerca de 60% das famílias tinham uma renda per capita £ ½ salário mínimo e 41% das mães referiam menos de quatro anos de escolaridade. A mediana do aleitamento materno exclusivo e total foi de 0 dias e 94 dias, respectivamente. A incidência da diarréia foi de dois episódios/criança/ano nos primeiros 12 meses de vida e a prevalência de déficit peso/idade e comprimento/idade (&lt;-2 escores z) aos 12 meses foram de 6,8% e 11%, respectivamente. Apenas 66% das crianças aos 12 meses tinham completado o esquema vacinal. CONCLUSÕES: o desenvolvimento desta pesquisa prospectiva contribuirá para uma maior compreensão dos problemas de saúde e nutrição da população infantil e para o adequado planejamento de intervenções na área.

Esofagectomia trans-hiatal no tratamento do megaesôfago chagásico avançado

OBJETIVO: Avaliar os resultados da esofagectomia trans-hiatal no tratamento do megaesôfago chagásico avançado. MÉTODO: Foram estudados retrospectivamente 28 pacientes portadores de megaesôfago chagásico avançado (MCA), graus III e IV, segundo a classificação radiológica de Rezende (adotada pela Organização Mundial de Saúde), e que foram submetidos à esofagectomia subtotal trans-hiatal no Serviço de Clínica Cirúrgica do Hospital Universitário Prof. Alberto Antunes (HUPAA) da Universidade Federal de Alagoas, entre 1982 e 2000. Foram analisadas, as seguintes variáveis: A) Queixas clínicas pré-operatórias versus as pós-operatórias (disfagia, regurgitação, pirose, diarréia, dumping, plenitude pós-prandial, pneumonia e o estado ponderal). B) avaliação radiológica pós-operatória da boca anastomótica esofagogástrica cervical e do estômago transposto. C) avaliação endoscópica pós-operatória do coto esofágico e da boca anastomótica. RESULTADOS: O seguimento variou de 4 a 192 meses, média de 58,18 meses. Dezesseis pacientes eram do sexo feminino e 12 masculinos. Idade mínima de 16 e máxima de 67 anos, média de 36,5 anos. Não houve mortalidade nesta série. Houve resolução plena da disfagia na maioria dos pacientes (20/28 - 71,4%), um (3,6%) referiu disfagia leve que não necessitou tratamento e 7/28 (25%) necessitaram de uma ou mais sessões de dilatação. Nenhum necessitou de dilatação permanente. A pirose foi o sintoma mais importante no seguimento tardio (35,7%), seguida da regurgitação (25%), diarréia (14,3%), plenitude pós-prandial (10,7%) e dumping (3,6%). Houve ganho ponderal em 87,5% dos pacientes avaliados. A esofagite no coto esofágico foi o achado endoscópico mais significativo (46,4%). O esôfago de Barrett no coto remanescente foi encontrada em 10,7% dos casos. A maioria dos achados radiológicos foi normal, embora três doentes (10,7%) tenham apresentado estase gástrica. CONCLUSÃO: A esofagectomia trans-hiatal mostrou-se eficaz para o tratamento da disfagia no megaesôfago chagásico avançado, embora com morbidade elevada, porém com mortalidade nula.

Prevalence of intestinal parasites in HIV-infected adult patients in Southwestern Ethiopia

Background: Parasitic infection of the intestinal tract is a major source of disease in patients with HIV particularly in the tropics, where diarrhea is a common complaint with variable severity and specific pathogens are be identified in more than half of the HIV/AIDS patients with persistent diarrhea. Objective: The objective of this study was to determine the prevalence of intestinal parasites and their association with diarrhea of HIV infected patients. Methods: A cross-sectional study was conducted on 372 consecutive patients from Feb.-July, 2001, on HIV infected and non-infected patients which were confirmed by Wellcozyme ELISA(Murex, UK). Chronic diarrhea was defined as three or more lose stool passed daily for more than two weeks. Parasite infections were diagnosed by examination of single stool specimen which were examined as fresh wet mounts, formol-ether concentration technique and Modified acid fast stain. Result: Diarrhea was more prevalent in HIV infected 99(51.1%) than in HIV non infected patients 53(29.5%). Regardless of their diarrhea status, the general prevalence of intestinal parasites in HIV infected and HIV non-infected were 44.8% and 34.4% respectively. Among the 192 HIV infected patients 54 (28.1%) and 45(23.4%) of them had chronic and acute diarrhea respectively. The prevalence of intestinal parasites were 28(51.9%)in patients with chronic and 17(37.8%) in those acute with diarrhea. C. parvum, I. belli, and C. catyenesis oocyst were detected only in HIV infected patients with chronic diarrhea (P

Availability of irrigation water for domestic use in Pakistan: its impact on prevalence of diarrhoea and nutritional status of children.

This study assessed whether availability of water for domestic use had any impact on nutritional status of children in an area where people depend on irrigation water for all their domestic water needs. During May 1998-April 1999, data on the occurrence of diarrhoea among 167 children aged less than five years were collected from 10 villages in the command area of the Hakra 6R canal in southern Punjab, Pakistan. Anthropometric measurements were taken at the end of the study period. Additional surveys were conducted to collect information on the availability of water, sanitary facilities, hygiene, and socioeconomic status. Height-for-age and longitudinal prevalence of diarrhoea were used as outcome measures. Quantity of water available in households was a strong predictor of height-for-age and prevalence of diarrhoea. Children from households with a large storage capacity for water in the house had a much lower prevalence of diarrhoea and stunting than children from families without this facility. Having a toilet was protective for diarrhoea and stunting. Increased quantity of water for domestic use and provision of toilet facilities were the most important interventions to reduce burden of diarrhoea and malnutrition in this area. An integrated approach to water management is needed in irrigation schemes, so that supply of domestic water is given priority when allocating water in time and space within the systems.

Effects of nutritional status on diarrhea in Peruvian children

Objectives: We conducted a 4-year (1995-1998) field study in a Peruvian peri-urban community (pueblo joven) to examine the relation between diarrhea and nutritional status in 230 children <3 years of age. Methods: We followed the birth cohort daily for diarrhea and monthly for anthropometry. We modeled diarrheal incidence with a multivariate time-to-event regression model to account for multiple episodes per child and irregular follow-up periods and diarrheal duration with a mixed-effects gamma regression model to account for disease heterogeneity across children. Results: During 159,551 child-days of follow-up, we identified 1387 diarrheal episodes, which yielded an average incidence of 3.2 episodes per child-year. Diarrhea was seasonal, for example, infants had up to 8 diarrheal episodes during the summer; however, these variations decreased noticeably with age. Nutritional status was significantly associated with diarrheal incidence. The frequency of diarrhea increased by 15% per standard deviation decrease in height-for-age z score. Diarrheal episodes in children <6 months of age lasted significantly longer than episodes among older children. Conclusions: These results identify infants and children of poor nutritional status as priority risk groups for prevention efforts aimed at reducing the burden of acute childhood diarrhea. (J Pediatr 2002;140:210-8)

Radiotherapy for cancer patients aged 80 and older: A study of effectiveness and side effects

To profile cancer patients aged 80 and older undergoing radiotherapy and to study the tumor response and side effects of therapy. We retrospectively analyzed the records of patients aged 80 and older who received radiation therapy at James A. Haley Veterans Hospital and H. Lee Moffitt Cancer Center between 1988 and 1995. A total of 203 patients aged 80-94 received radiotherapy during this period. Treatment sites included head and neck [50], breast [16], chest [37], pelvis [53], and miscellaneous [39]. Age, treatment site, field size, total dose, response to treatment, treatment interruptions, incidence and severity of weight loss, myelosuppression, diarrhea, mucositis, dermatitis, and follow-up status are assessed using our departmental records and hospital tumor registry. Of 191 patients evaluated, 179 (94%) completed the treatment without serious complications. A total of 195 sites were irradiated. Twelve patients (6%) required interruption of the treatment. Therapeutic responses were seen in 86 out of 112 patients (77%) treated with curative intent (with 67% complete response) and in 67 out of 83 patients (81%) treated with palliative intent. The causes of treatment interruptions included weight loss from diarrhea, dysphagia, and progressive disease. Treatment interruptions were more likely in patients treated with large treatment fields. In patients treated for upper aero-digestive tract cancer, Grade 3 and 4 mucositis was noted in 20 and 2% of patients, respectively. Grade 1 and 2 enteritis was noted in 43% of patients treated for pelvic malignancies. Grade 3 dermatitis was noted only in 2% of patients. Radiotherapy is highly effective and well tolerated by the oldest old. Age is not a contraindication to aggressive radiotherapy.

THERAPEUTIC AND NUTRITIONAL EFFECT OF AN ORAL REHYDRATION SOLUTION (ORS) CONTAINING GLUTAMINE. A DOUBLE BLIND RANDOMISED STUDY IN 44 DIARRHEIC INFANTS.

The ORS as recommended by the World Health Organisation (WHO) has been a major advance in the treatment of acute diarrhea in children. The ideal composition of the ORS is still controversial, as regards sodium levels, as well as, other proposed components ie. amino-acids or cereals. It has been demonstrated that amino-acid glutamine has an effect on sodium absorption, enterocyte metabolism, immunity and nutritional status. We compared 2 ORS containing 50 mmol/L sodium with the same osmolarity and energy content. The control (C) solution contained only carbohydrates while the tested (G) solution contained 60 mmol/L glutamine. We included 44 infants aged 1 to 9 months with acute diarrhea and more than 5% dehydration. They received 200ml/kg of either C or G solution by continuous intra-gastric tube-feeding during a 24 hour period. Casein hydrolysate (Pregestimil®) was then introduced in increasing amounts over a 96h period, and adding the same ORS up to 150ml/kg/day as total intake. The efficacy as regards rehydration, recovery of diarrhea and nutritional status was studied. Serum glutamine, ammonia and urea levels were measured, as well as, urine nitrogen output. Our results showed that in group G not only did the watery stools end earlier (12,3±3,28h vs 39,2±8,2 p = 0.007), but the first normal stool occurred also earlier (33,2±4,6 vs 52,9±8,6 p = 0.04). The presence of glucose in the stools was rarely observed after 48h in group G (p = 0.04) as compared to group C. In group C the insulin growth factor 1 (IGF1), a marker of nutritional status, fell but it remained stable in group G (p = 0.004). Both ORS had the same efficacy on rehydration and normalisation of blood sodium, potassium and proteins. The glutamine blood level was increased by 60% in group G, the urea level fell more slowly in group G (p <0.0001) while the ammonia level was higher but remained in the normal range in group G (p=0.01). This study suggests that the new ORS containing glutamine is effective in the recovery and nutritional status of diarrheic infants. The low osmolarity in the 2 solutions and the low amount of sodium chloride may explain the results of our study as compared to the single, non conclusive study, promoted by the WHO and published in 1994. This new solution could be of clinical interest when treating children with acute diarrhea, especially in developing countries or in children suffering from malnutrition.

Impact of Breast Feeding on the Number of Diarrheal Episodes and Nutritional Status in Children Less Than Six Months Old

OBJECTIVE: To evaluate the impact of breast feeding on the number of episodes of diarrhea and nutritional status in infants. MATERIALS AND METHODS: From January to April 1993, we enrolled in a case-control study 102 children with acute diarrheal disease (ADD) and 37 healthy children who were <6 months of age, at the Oral Rehydration Unit (ORU) of Children's Health Institute (CHI) in Lima, Peru. We assessed duration of breast feeding, number of episodes of diarrhea, nutritional status, socio-economic status, hygienic behaviour, and maternal age. We used linear regression analysis to determine whether duration of breastfeeding correlated with episodes of diarrhea. RESULTS: 44% of patients with ADD, were breastfed until 1 month of age, 29% until 3 months, and only 27% until 6 months. In contrast, 95% of the healthy controls were breastfed for 6 months. Among infants with ADD, 20% showed mild, 19% moderate, and 40% showed severe malnutrition. Children with shorter breastfeeding had more episodes of diarrhea and were more likely to be malnourished (p=0.01). There was an inverse correlation between the number of episodes of diarrhea and duration of breast-feeding (r=0.46). CONCLUSION: Exclusive breast-feeding for a minimum of four months significantly reduces the number of episodes of diarrhea and malnutrition in children less than 6 months of age.

Water, waste, and well-being: a multicountry study.

Data collected in the late 1980s from eight countries in Sub-Saharan Africa (Burundi, Ghana, Togo, and Uganda), Asia/North Africa (Sri Lanka and Morocco), and the Americas (Bolivia and Guatemala) were combined and analyzed to test whether incremental health effects regarding diarrhea and nutritional status result from incremental improvements in water and sanitation conditions. Rural (n = 11,992) and urban (n = 4,888) samples were analyzed separately. Optimal (i.e., on the premises) and intermediate (improved public water) water supplies were compared with unimproved water conditions. Optimal (flush toilets or water-seal-latrines) and intermediate (latrines) sanitation levels were compared with unimproved sanitation. Nationally representative (random) samples of ever-married women age 15-49 years, with or without children, were interviewed in all countries, and children aged 3-36 months with available weight and height data were included in the analyses. Multiple linear regression controlled for household, maternal, and child-level variables; in addition, dummy variables were included for each country. Improvements in sanitation resulted in less diarrhea and in taller and heavier children with each of the three levels of water supply. Incremental benefits in sanitation were associated with less diarrhea and with additional increases in the weights and heights of children. The effects of improved sanitation were greater among urban dwellers than among rural dwellers. Health benefits from improved water were less pronounced than those for sanitation. Benefits from improved water occurred only when sanitation was improved and only when optimal water was present. These findings suggest that public health intervention should balance epidemiologic data with the cost of services and the demand for water. There should be efforts to develop compatible technologies so that incremental improvements in service can be made.

Frequent diarrhoeas in early childhood have sustained effects on the height, weight and head circumference of children in East Bhutan.

Episodes of diarrhoea and nutritional status of 113 children in East Bhutan were recorded monthly from 7 to 36 months of age. A re-examination was carried out 20 months later. The load of diarrhoeal diseases in early childhood was negatively associated with the parameters of children's long-term nutritional status 20 months later. Also, when early nutritional status and socioeconomic factors are included in the model, the diarrhoea variable explains a significant part of the variation in height for age (p = 0.04, delta R2 = 0.035), weight for age (p = 0.03, delta R2 = 0.030) and head circumference (p = 0.0007, delta R2 = 0.077). This is not so for the variation in weight for height or mid-upper arm circumference (p > 0.1, delta R2 < 0.005). Stunting is widespread in the area, and the effects of diarrhoea on nutritional status are more likely to be sustained in settings where dietary intake is marginal.

Patterns of methane production in a Burmese (Myanmar) population

While up to 50% of Western populations produce methane, this is less than that of rural black Africans and there is no information on methane production in populations from Asian developing countries. Females consistently produce methane more commonly than males, and methane production in children under the age of five years, except in Nigeria, is unusual. Breath methane was sampled in 1426 subjects from Myanmar ranging in age from 1 month to 88 years, with a mean age of 26.2 years. Half (49.8%) of the Myanmar population produced methane, this figure comprising 53% of females and 46% of males sampled. Methane production increases with age and reaches adult levels after 10 years of age. A high prevalence of methane production was found in children under 3 years of age (15.8%). Methane production was absent in 13 solely breast-fed children and increased as other food was introduced into the diet. There was an association of methane production within families and with smoking. The prevalence of methane production increased in male and female smokers, with 75% of smokers producing methane. Methane production was not associated with occupation, education, income, water source, latrine type, previous diarrhoea, antibiotic usage or socio-economic status.

Persistent diarrhoea: factors affecting absorption and clinical prognosis during management with a rice-based diet.

Twenty-six persistent diarrhoea patients aged 4 to 18 months were treated with a diet prepared with rice powder, soya oil, glucose, egg white and water. Absorption of macronutrients was estimated in a 72 h balance study and clinical response was examined during one week of dietary treatment. Nutrient absorption was compared with that of 25 healthy age-matched controls treated with the same diet. Twenty-one patients (81%) recovered from diarrhoea within seven days. Absorption of nutrients was significantly reduced among the persistent diarrhoea patients. More malnourished patients had a significantly reduced absorption of nutrients except carbohydrate and an increased severity and longer duration of diarrhoea. Total gut transit time had significant association with nutrient absorption in the persistent diarrhoea patients. The period of recovery negatively correlated with coefficient of absorption and positively with initial stool weight. Failure to recover was associated with severity of diarrhoea and systemic infection. The study indicates that nutrient absorption is significantly reduced in patients with persistent diarrhoea and nutritional status, and that initial purging rate and intestinal hurry are significantly related to the prognosis and nutrient absorption.

The Imo State (Nigeria) Drinking Water Supply and Sanitation Project, 2. Impact on dracunculiasis, diarrhoea and nutritional status

Morbidity due to dracunculiasis (guinea worm disease) and diarrhoea in persons of all ages, and nutritional status of young children, were used as health impact indicators in the evaluation of the Imo State Drinking Water Supply and Sanitation Project in south-eastern Nigeria. Data were collected using repeated cross-sectional surveys and longitudinal follow-up. The study area was found to have a low level of endemicity of dracunculiasis. While no impact could be demonstrated on overall period or point prevalence rates in the cross-sectional surveys, a prospective longitudinal survey showed a significant reduction in the percentage of person-fortnights positive for dracunculiasis in areas served by the project, while the control areas showed no such change. In the cross-sectional surveys it was found that, in the project villages, those persons drinking only borehole water had significantly lower period prevalence rates one year later than others. Moreover, those living further from the nearest borehole had higher rates of dracunculiasis. An impact of the project on diarrhoea morbidity was found only in limited sub-groups of the population. A greater association with water availability rather than quality was suggested for rates in young children. The prevalence of wasting (< 80% weight-for-height) among children aged less than 3 years decreased significantly over time in all 3 intervention villages; there was no such decline in the control villages.

The use of nutritional status as a second outcome measure in case-control studies of environmental risk factors for diarrhoeal diseases.

Case-control studies are typically used to study the effect of several factors on the risk/incidence rate of a single disease. This paper describes a particular situation in which it is of interest to study the effect of a factor--improved sanitation facilities--on the risk/incidence rate of two 'diseases'--the incidence rate of diarrhoea and the risk of undernutrition. The conditions under which it is valid to perform an analysis of the association between the risk factor (unimproved sanitation) and a second outcome variable (undernutrition) are examined. If the effect of exposure status (improved/unimproved sanitation facilities) on the propensity to report an episode of diarrhoea is independent of the effect of nutritional status it appears that such an analysis may be valid. There must also be no interaction between the risk factor (unimproved sanitation) and the second outcome (undernutrition) with respect to their effects as risk factors for the first outcome variable (diarrhoea incidence rate).

Diarrhoea and nutritional status as risk factors of child mortality in a Dakar hospital (Senegal).

Various factors affecting the survival of children were studied on a sample of 571 children under 5 years admitted to the infectious diseases unit of a hospital in Dakar. Results indicate that the nutritional status at admission is a major determinant of the prognosis. The mortality of children beneath the 80% level of weight/height was 2.64 times greater than the mortality of children above 80% and that of those presenting with edema 6.21 times greater. Presenting with diarrhea was also a significant factor in child mortality. The risk of dying for a child admitted with diarrhea was 1.97 times greater than for children without diarrhea and 3.73 times greater if the child was dehydrated at the time of admission. Controlling for the nutritional status and for the presence of diarrhea as well as for all other given factors 1 pathological group emerged viz. children affected by meningitis and meningitic syndromes. The season of the year also played an important role and weaning also appeared as a risk factor for children. For policy implications quick and standardized care of children with diarrhea and malnutrition seems to be a priority measure in order to lower the high rates of mortality observed. (authors modified)

EFFECTS OF THE ADDITION OF ENZYMES AND CARBOXYMETHYLCELLULOSE TO PEA FLOUR USED FOR CALF MILK REPLACERS

In experiment 1, milk replacers comprising 45% field peas with high or low levels of supplemental proteolytic and amylolytic enzymes were fed to 4 to 17-day-old Holstein-Friesian calves. Each replacer was also fed with 3% additional carboxymethylcellulose. Gross energy digestibility and crude protein digestibility were both higher for the control replacer than the enzyme-treated rations. Digestibilities increased with age but there were no significant differences due to enzyme level or carboxymethylcellulose. In experiment 2, pea flour was treated with commercial proteolytic, starch-thinning and amylolytic enzymes. From 3 days of age, calves were fed milk replacers where treated pea flour supplied 0, 25, 50 or 75% of the dietary protein. There were no differences (P &lt;.05) between ration groups in diarrhea status. Across regimens, gross energy digestibility and crude protein digestibility did not increase with age to 10 days. Nor were any differences in digestibility caused by starting to feed pea products at 4 rather than 10 days. Gross energy digestibilities in 15-day-old calves were 90, 87, 87 and 73%, respectively; protein digestibilities were 78, 68, 68 and 39%, respectively, as the proportion of pea protein increased from 0 to 75% of the diet. The enzymatic treatment of pea flour was not effective in making the product a suitable dietary ingredient for calves under 21 days of age.