Diarrheal Disease In Children Research Articles

Country characteristics and acute diarrhea in children from developing nations: a multilevel study.

BackgroundEach year 2.5 billion cases of diarrheal disease are reported in children under five years, and over 1,000 die. Country characteristics could play a role on this situation. We explored associations between country characteristics and diarrheal disease in children under 5 years of age, adjusting by child, mother and household attributes in developing countries.MethodsThis study included 348,706 children from 40 nations. We conducted a multilevel analysis of data from the Demographic and Health Surveys and the World Bank.ResultsThe prevalence of acute diarrhea was 14 %. Country inequalities (OR = 1.335; 95 % CI 1.117–1.663) and country’s low income (OR = 1.488; 95 % CI 1.024–2.163) were associated with diarrhea, and these country characteristics changed the associations of well-known determinants of diarrhea. Specifically, living in poor countries strengthens the association of poor household wealth and mother’s lack of education with the disease. Other factors associated with diarrhea were female sex of the child (OR = 0.922; 95 % CI 0.900–0.944), age of the child (OR = 0.978; 95 % CI 0.978–0.979), immunization status (OR = 0.821; 95 % CI 0.799–0.843), normal birthweight (OR = 0.879; 95 % CI 0.834–0.926), maternal age (OR = 0.987; 95 % CI 0.985–0.989), lack of maternal education (OR = 1.416; 95 % CI 1.283–1.564), working status of the mother (OR = 1.136; 95 % CI 1.106–1.167), planned pregnancy (OR = 0.774; 95 % CI 0.753–0.795), a nuclear family structure (OR = 0.949; 95 % CI 0.923–0.975), and household wealth (OR = 0.948; 95 % CI 0.921–0.977).ConclusionsInequalities and lack of resources at the country level in developing countries -but not health expenditure- were associated with acute diarrhea, independently of child, family and household features. The broad environment considerably modifies well-known social determinants of acute diarrhea and public health campaigns designed to target diarrhea should consider macro characteristics of the country.

Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review.

BackgroundHarmful practices in the management of childhood diarrhea are associated with negative health outcomes, and conflict with WHO treatment guidelines. These practices include restriction of fluids, breast milk and/or food intake during diarrhea episodes, and incorrect use of modern medicines. We conducted a systematic review of English-language literature published since 1990 to assess the documented prevalence of these four harmful practices, and beliefs, motivations, and contextual factors associated with harmful practices in low- and middle-income countries.MethodsWe electronically searched PubMed, Embase, Ovid Global Health, and the WHO Global Health Library. Publications reporting the prevalence or substantive findings on beliefs, motivations, or context related to at least one of the four harmful practices were included, regardless of study design or representativeness of the sample population.ResultsOf the 114 articles included in the review, 79 reported the prevalence of at least one harmful practice and 35 studies reported on beliefs, motivations, or context for harmful practices. Most studies relied on sub-national population samples and many were limited to small sample sizes. Study design, study population, and definition of harmful practices varied across studies. Reported prevalence of harmful practices varied greatly across study populations, and we were unable to identify clearly defined patterns across regions, countries, or time periods. Caregivers reported that diarrhea management practices were based on the advice of others (health workers, relatives, community members), as well as their own observations or understanding of the efficacy of certain treatments for diarrhea. Others reported following traditionally held beliefs on the causes and cures for specific diarrheal diseases.ConclusionsAvailable evidence suggests that harmful practices in diarrhea treatment are common in some countries with a high burden of diarrhea-related mortality. These practices can reduce correct management of diarrheal disease in children and result in treatment failure, sustained nutritional deficits, and increased diarrhea mortality. The lack of consistency in sampling, measurement, and reporting identified in this literature review highlights the need to document harmful practices using standard methods of measurement and reporting for the continued reduction of diarrhea mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2127-1) contains supplementary material, which is available to authorized users.

Community-acquired diarrhoea in a world with rotavirus vaccine: a glimpse into the future.

Community-acquired diarrhoea in a world with rotavirus vaccine: a glimpse into the future.

Examination of the Enterotoxigenic Escherichia coli Population Structure during Human Infection.

ABSTRACTEnterotoxigenic E. coli (ETEC) can cause severe diarrhea and death in children in developing countries; however, bacterial diversity in natural infection is uncharacterized. In this study, we explored the natural population variation of ETEC from individuals with cholera-like diarrhea. Genomic sequencing and comparative analysis of multiple ETEC isolates from twelve cases of severe diarrhea demonstrated clonal populations in the majority of subjects (10/12). In contrast, a minority of individuals (2/12) yielded phylogenomically divergent ETEC isolates. Detailed examination revealed that isolates also differed in virulence factor content. These genomic data suggest that severe, cholera-like ETEC infections are largely caused by a clonal population of organisms within individual patients. Additionally, the isolation of similar clones from geographically and temporally dispersed cases with similar clinical presentations suggests that some isolates are particularly suited for virulence. The identification of multiple genomically diverse isolates with variable virulence factor profiles from a single subject highlights the dynamic nature of ETEC, as well as a potential weakness in the examination of cultures obtained from a single colony in clinical settings. These findings have implications for vaccine design and provide a framework for the study of population variation in other human pathogens.

Non Medical Interventions for Childhood Diarrhoea Control:Way Forward in Nepal

Diarrhoeal diseases remain a major cause of mortality of children aged under-five years in the developing countries including Nepal. The transmission of diarrhoea mostly caused by biological agents and is facilitated by the behavioural, social and environmental factors. More recently, the concept of prevention altering these factors is getting momentum. To recommend the most effective non medical intervention that can prevent and control childhood diarrhoeal disease in Nepal. Literature review was conducted to analyse the successful interventions in developing countries. Peer review articles were accessed from "Science Direct", "Google Scholar", and "PubMed". Interventions focussing on social and environmental determinants of diarrhoea were included. Four interventions (with primary focus in social and environmental determinants of diarrhoeal disease) were purposively selected, summarized and discussed. Saniya programme (Burkina Faso 1995 to 1998) is considered successful in modifying the risk behaviours. Intensive hand washing programme (Pakistan 2002 to 2003), a cluster randomized controlled trail, was not sustainable as the results did not last long once the free supply of soap was stopped. School Led Total Sanitation (Nepal 2006) is a participatory, community centred program whose focus is on local ownership. This program approach is effective and feasible for scaling up in Nepal. Global Public Private Partnership for Hand washing with Soap (Ghana 2002) was based on the marketing researches and hence yielded effective results. Combination of School Led Total Sanitation and Global Public Private Partnership for hand washing with soap suits Nepal. These interventions focus on creating demand, changing behaviour and thereby, improving the sanitation status.

Adherence and virulence genes of Escherichia coli from children diarrhoea in the Brazilian Amazon.

The bacterial pathogen most commonly associated with endemic forms of childhood diarrhoea is Escherichia coli . Studies of epidemiological characteristics of HEp-2 cell-adherent E. coli in diarrhoeal disease are required, particularly in developing countries. The aim of this study was evaluate the presence and significance of adherent Escherichia coli from diarrhoeal disease in children. The prevalence of LA, AA, and DA adherence patterns were determined in HEp-2 cells, the presence of virulence genes and the presence of the O serogroups in samples obtained from 470 children with acute diarrhoea and 407 controls in Porto Velho, Rondônia, Brazil. E. coli isolates were identified by PCR specific for groups of adherent E. coli . Out of 1,156 isolates obtained, 128 (11.0%) were positive for eae genes corresponding to EPEC, however only 38 (29.6%) of these amplified bfpA gene . EAEC were isolated from 164 (14.1%) samples; of those 41(25%), 32 (19%) and 16 (9.7%) amplified eagg , aggA or aafA genes, respectively and aggA was significantly associated with diarrhoea ( P = 0.00006). DAEC identified by their adhesion pattern and there were few isolates. In conclusion, EAEC was the main cause of diarrhoea in children, especially when the aggA gene was present, followed by EPEC and with a negligible presence of DAEC.

Solar and temperature treatments affect the ability of human rotavirus wa to bind to host cells and synthesize viral RNA.

Rotavirus, the leading cause of diarrheal diseases in children under the age of five, is often resistant to conventional wastewater treatment and thus can remain infectious once released into the aquatic environment. Solar and heat treatments can inactivate rotavirus, but it is unknown how these treatments inactivate the virus on a molecular level. To answer this question, our approach was to correlate rotavirus inactivation with the inhibition of portions of the virus life cycle as a means to identify the mechanisms of solar or heat inactivation. Specifically, the integrity of the rotavirus NSP3 gene, virus-host cell interaction, and viral RNA synthesis were examined after heat (57°C) or solar treatment of rotavirus. Only the inhibition of viral RNA synthesis positively correlated with a loss of rotavirus infectivity; 57°C treatment of rotavirus resulted in a decrease of rotavirus RNA synthesis at the same rate as rotavirus infectivity. These data suggest that heat treatment neutralized rotaviruses primarily by targeting viral transcription functions. In contrast, when using solar disinfection, the decrease in RNA synthesis was responsible for approximately one-half of the decrease in infectivity, suggesting that other mechanisms, including posttranslational, contribute to inactivation. Nevertheless, both solar and heat inactivation of rotaviruses disrupted viral RNA synthesis as a mechanism for inactivation.

CLINICAL STUDY TO ASSESS THE EFFECT OF AMALAKI SYRUP AS IMMUNOMODULATER FOR LOWERING DOWN THE MORBIDITY RATE

It h as been estimated that about 6 lak h s infant and young children die from RS V annually, and if bacterial co - infections are included then this number may approach 10 lak h s deaths annually. More than 2 million deaths are estimated to r esult each year in the world as a consequence of diarrheal disease in children of under five years. This statistic shows that children are more vulnerable to infection because their im mune system is less or under developed. Therefore, considering these pro spects a clinical trial was carried with 156 children (1 - 7 years of age group) suffering from recurrent diseases like cough, running nose, diarrhoea, fever etc. in three groups. These groups were assigned as Group A with A malaki syrup, group B with placebo syrup and group C with only observation. This clinical study prove s that a simple and cost effective formulation of A malaki is capable to bring down the morbidity status of children by the mechanism of immune modulation.

Changing patterns of rotavirus strains circulating in Ireland: re-emergence of G2P[4] and identification of novel genotypes in Ireland.

Worldwide, Group A Rotavirus (RVA) is recognized as the most common aetiological agent of acute diarrheal disease in children. One hundred and ninety seven positive faecal samples were obtained from patients between 2006 and 2008. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to amplify the VP7 and VP4 gene segments of these samples, and G and P typing was carried out subsequently. The most common strain type was G1P[8], and the emergent global G9-type was identified in both years. RVA strain type G2P[4], previously reported in Ireland in 1999, was also detected. Genotypes G2 and G3 in combination with P[4] were detected in 2006-2007 only. There was also an emergence of strain types including G3P[4], G9P[4], G2P[4 + 8] and G2G4P[8] in this study. Molecular analysis of the VP7 genes revealed G1 strains circulating within lineage Ic as previously reported in Ireland. In addition, new sublineage within lineage I of G1 strains was also identified. Analysis of G4 strain NRVL-Hum-49 revealed similarity with other human G4 viruses in lineage Ib. G9 strain NRVL-Hum-74 clustered with a unique G9 strain, CIT-254, in lineage IIIc. This data supports the observations made that the profile of RVA strains in Ireland appears to be dynamic. This study demonstrates that the circulation of human rotavirus is changing continuously in Ireland, and continued surveillance of the circulating strains is needed to detect the appearance of new strains, or new variants which may lead to vaccine breakthrough.

Diarrheagenic Escherichia coli pathotypes isolated from children with diarrhea in the Federal Capital Territory Abuja, Nigeria.

Escherichia coli are frequently isolated from diarrheic children in the Federal Capital Territory Abuja, Nigeria, but their virulent properties are not routinely evaluated. Therefore, the etiology of childhood diarrheal disease attributable to diarrheagenic Escherichia coli (DEC) in Abuja, Nigeria remains unknown. Stool specimens from 400 acute diarrheic children between 0 and 60 months of age were studied. E. coli strains isolated were evaluated by polymerase chain reaction (PCR) for nine virulence genes and HEp-2 cell adherence to detect and identify five distinct diarrheagenic E. coli categories. Diarrheagenic E.coli was detected in 51 (12.8%) of the diarrheic children. The observed DEC pathotypes were enteropathogenic E. coli (EPEC) in 18 (4.5%) children, enterotoxigenic E. coli (ETEC) in 16 (4.0%), enteroaggrative E. coli (EAEC) in 8 (2.0%), enterohaemorrhagic E. coli (EHEC) in 6 (1.5%), and enteroinvasive E. coli (EIEC) in 3 (0.8%). Four (1.0 %) EPEC strains with only the eae+ gene that adhered diffusely to HEp-2 cell were identified as atypical EPEC. All the DEC categories except atypical EPEC were identified in children between 6 and 12 months of age. This study underscores the need for routine evaluation of diarrheic children for virulence properties of infectious DEC. Atypical EPEC are emerging among the DEC pathotypes isolated from childhood acute gastroenteritis in Abuja, Nigeria.

The Prevalence of Diarrheal Disease in under Five Children and associated Risk Factors in Wolitta Soddo Town, Southern, Ethiopia

Though the relationship between environmental risk factors and the occurrence of diarrhea in children have been documented elsewhere, there are limited studies in Ethiopia in general and in Soddo Town in particular. The present study assessed the prevalence and associated risk factors of under-five children diarrheal disease Community-based cross-sectional study was conducted in Soddo town, Southern Ethiopia. Nine hundred seventy (970) mothers/ care takers of index under-five children living in the households selected by systematic random sampling from Kebeles in the town constituted the study population. Data were collected using structured and pre-tested questionnaire, entered into a computer, edited and cleaned by using Epi info version 3.5.4 and analyzed using SPSS for windows version 16.0. Binary logistic regression model was used to calculate the Odds ratios and 95% confidence interval for the different risk factors and the level of significance was set at P < 0.05. Out of 970 sampled mother/caretaker-child pairs, 954 participated in the study and giving a response rate of 98.4%. The mean ages of the respondents and the index children were 27.62 (+5.03SD) years and 26.41(+15.89 SD) months, respectively. Prevalence of diarrheal disease over a period of two weeks preceding the study was about 11%. In the Bivariate analysis, a number of risk factors including monthly income less than five hundred birr and age of the child (P<0.05) appeared to be significantly associated with under-five childhood diarrheal disease and number of siblings under 5 years in a household, monthly income less than 500Birr and the age 12-23 months of the child were the only significant variables on multivariate analyses (P< 0.05). As diarrheal disease was major problem among under-five children in Soddo town. Appropriate intervention programs targeting Child birth spacing and improving the monthly income of households should be designed.

Disease caused by rotavirus infection.

Although rotavirus vaccines are available, rotaviruses remain the major cause of childhood diarrheal disease worldwide. The Rotarix (GlaxoSmithKline Biologicals Rixensart, Belgium) and RotaTeq (Merck and Co., Inc. Whitehouse Station, New Jersey, USA) vaccines are effective for reducing the morbidity and mortality of rotavirus infection. This article aims to assess the epidemiology of rotaviral gastroenteritis and the efficacy and effectiveness of licensed rotavirus vaccines. This review concludes by presenting challenges in the field that require further exploration by and perspectives from basic and translational research in the future.

Molecular surveillance of rotavirus strains circulating in Yaoundé, Cameroon, September 2007–December 2012

Rotavirus is the most common cause of severe diarrheal disease in children under 5years of age worldwide. The World Health Organization (WHO) estimated that 453,000 rotavirus-attributable deaths occur annually. Through the WHO, the Rotavirus Sentinel Surveillance Program was established in Cameroon in September 2007 with the Mother and Child Center (MCC) in Yaoundé playing the role of sentinel site and national laboratory for this program. The objectives of this surveillance were to assess the rotavirus disease burden and collect baseline information on rotavirus strains circulating in Cameroon. Diarrheal stool samples were collected in a pediatric hospital from children under 5, using the WHO case definition for rotavirus diarrhea. Antigen detection of rotavirus was performed by using an enzyme immunoassay (EIA). The genotypic characterization was performed using multiplexed semi-nested reverse transcription-polymerase chain reaction (RT-PCR) assays. Between September 2007 and December 2012, 2444 stool samples were received at the MCC laboratory for rotavirus antigen detection, of which 999 (41%) were EIA positive. Among EIA positive samples 898 were genotyped. Genotype prevalence varied each year. Genotype G9P[8] was the dominant type during 2007 (32%) and 2008 (24%), genotype G3P[6] predominated in 2010 (36%) and 2011 (25%), and G1P[8] was predominant in 2012 (44%). The findings showed that the rotavirus disease burden is high and there is a broad range of rotavirus strains circulating in Yaoundé. These data will help measure the impact of vaccination in the future.

Early childhood diarrhoeal diseases and cognition: are we missing the rest of the iceberg?

Risk factors which interfere with cognitive function are especially important during the first 2 years of life – a period referred to as early child development and a time during which rapid growth and essential development occur. Malnutrition, a condition whose effect on cognitive function is well known, has been shown to be part of a vicious cycle with diarrhoeal diseases, and the two pathologies together continue to be the leading cause of illness and death in young children in developing countries. This paper reviews the burden of early childhood diarrhoeal diseases globally and the emerging evidence of their relationship with global disparities in neurocognitive development. The strength of evidence which indicates that the severe childhood diarrhoeal burden may be implicated in cognitive impairment of children from low- and middle-income counties is discussed. Findings suggest that greater investment in multi-site, longitudinal enteric infection studies that assess long-term repercussions are warranted. Furthermore, economic analyses using the concept of human capital should play a key role in advancing our understanding of the breadth and complexities of the health, social and economic ramifications of early childhood diarrhoeal diseases and enteric infections. This broadened awareness can serve to help advocate for more effective interventions, particularly in developing economies.

Novel Microbes Associated With Diarrheal Disease in Poor Countries

Insights into the mechanisms of intestinal microbiota underlying diarrheal disease in children in developing countries are emerging from a genomic analysis of microbial flora (Pop M et al. Genome Biol. 2014;15[6]:R76).

Mothers' Roles in Prevention and Care of Diarrhea in Children of Aran and Bidgol, Iran

Dear Editor, Diarrhea is the second leading cause of death in children under five in developing countries and one of the nine causes of death in children worldwide (1, 2). Diarrheal diseases are major causes of malnutrition, delayed physical development, and early childhood mortality in in developing countries and poor communities (3, 4). The major cause of death in children with diarrhea is loss of water and essential minerals. We can use the oral rehydration solution (ORS) to replace the lost minerals and water and prevent the progression of dehydration (1). Three main factors that can prevent children from death include educating the communities on the adequate fluid and nutrition intakes, continuing breastfeeding, and child care during diarrhea. Lack of knowledge in this area may lead to poor practices (4). According to various statistics about knowledge and practice of mothers in prevention and care of diarrheal diseases in children (4), this study was performed to assess this issue. This cross-sectional study was performed in fall 2013 on 81 mothers with children under five years having a history of diarrhea. They were selected from 117 mothers who had referred to health centers and rural health houses in Aran and Bidgol city, Iran, using convenience sampling. Data were collected with questionnaires which were completed by the interviewed mothers. The questionnaire consisted of five questions considering the demographic data, 26 questions related to the mothers' knowledge, and 14 questions related to the mothers' practices regarding prevention and care of children with diarrheal disease. Total score of knowledge was 26; 26-19 presented high, 18-10 average, and 9-0 low knowledge. Total score of practice was 14; 0-8 presented bad practice and 9-14 good practice. Data was analyzed by descriptive statistics, and chi-square test. Results showed that the mean age of mothers was 31.6 ± 2.7 years; 33.3% of mothers were graduated from high school; 37% were primipara and 63% were multipara. The knowledge level was moderate in 71.6% of mothers. Only 13.5% of the mothers had good knowledge. The mean score of mothers' knowledge about diarrhea and its causes was 13.9 ± 4.02. The mean score of mothers' practices was 8.5±1.8. Only about half of the mothers (53.1%) were aware of the role of ORS in dehydration treatment; 46.9% prepared ORS correctly and 34.6% were awarded for holding the period of ORS and acting accordingly. Of the mothers, 50.6% got good scores in practice and the rest got bad scores. None of the mothers got perfect knowledge and practice scores. However, with increased knowledge level, practice was better; but chi-square test did not show any significant relationship between the mothers´ knowledge (high, average, low) and practice (good, bad) regarding prevention and care of diarrheal diseases in children (P = 0.072). The results showed that the majority of mothers in the study had average levels of knowledge and practice. Due to serious complications of diarrhea, it is necessary to educate women about prevention and care of children with diarrhea.

A cluster randomized controlled trial to reduce childhood diarrhea using hollow fiber water filter and/or hygiene-sanitation educational interventions.

Safe domestic potable water supplies are urgently needed to reduce childhood diarrheal disease. In periurban neighborhoods in Cochabamba, Bolivia, we conducted a cluster randomized controlled trial to evaluate the efficacy of a household-level hollow fiber filter and/or behavior change communication (BCC) on water, sanitation, and hygiene (WASH) to reduce the diarrheal disease in children less than 5 years of age. In total, 952 households were followed for a period of 12 weeks post-distribution of the study interventions. Households using Sawyer PointONE filters had significantly less diarrheal disease compared with the control arm during the intervention period, which was shown by diarrheal prevalence ratios of 0.21 (95% confidence interval [95% CI] = 0.15–0.30) for the filter arm and 0.27 (95% CI = 0.22–0.34) for the filter and WASH BCC arm. A non-significant reduction in diarrhea prevalence was reported in the WASH BCC study arm households (0.71, 95% CI = 0.59–0.86).

Nibbled to death

Trogocytosis, a process in which one cell 'takes a bite' out of another, had previously been seen only in immune cells. But the phenomenon has now been found in Entamoeba histolytica, as a way for this parasite to kill host cells. See Letter p.526 Entamoeba histolytica, the causative agent of fatal diarrhoeal disease in children in the developing world, was so named for its ability to destroy host tissues, although the mechanism underlying this effect was unclear. Here Katherine Ralston et al. describe how these amoeba kill intestinal epithelial cells by biting off and ingesting pieces of cell, in a process reminiscent of the trogocytosis seen between immune cells. Ingestion of the bites is required for killing, and the mechanism operates both in tissue culture and during invasion of intestinal explants. The authors suggest that intercellular exchange via trogocytosis may be more evolutionarily ancient and widespread than was assumed. This work also highlights amoebic trogocytosis as a potential target for new drugs to treat amoebiasis — a major neglected disease.

Health Utilization for Childhood Gastroenteritis in Southern India

To the Editor: Diarrheal disease causes 334,000 deaths in under-five children in India annually [1]. Although the use of oral and intravenous rehydration have substantially decreased diarrheal mortality [2], the fact that children still die of diarrhea indicate the need to understand the beliefs and practices of households regarding its cause and management. We conducted a 30-cluster survey [3], involving 210 households with under-five children in Vellore, Tamil Nadu, India, to document healthcare utilization for acute childhood diarrhea, using a protocol developed and field-tested by the World Health Organization (WHO) [4]. The study was approved by the Institutional Review Board, and verbal consent obtained from all respondents. Knowledge about symptoms (90.9 %) and transmission (88.6 %) of diarrhea was high, although nearly all respondents still continued to hold traditional beliefs regarding its causation. Over 80 % were aware of oral rehydration solution (ORS), but despite the high awareness, only 16.7 % reported ORS use for diarrheal management, similar to the usage rates reported elsewhere in India [5]. Alarmingly, the majority of respondents (68.1 %) felt that antibiotics should be given during a diarrheal episode, with one-third expressing disappointment if no medications were prescribed. Most respondents (71.4 %) preferred private practitioners for management of childhood diarrhea; only 9.5 % preferred using government facilities. Perceived quality of care (99.5 %), friendly staff (91.4 %) and less waiting time (67.1 %) were considered important factors for utilization of a healthcare facility. Of the 210 households, 8.1 % had children with a diarrheal episode during the 2-wk recall period. A third of the children with diarrhea were taken to private practitioners, all of whom received antibiotics. This study highlights lacunae in knowledge and practices about childhood diarrhea in southern India. The challenge of reducing excessive antibiotic usage in an era of increasing resistance needs to be addressed, despite the expected difficulties of countering both demand from patients and promotion of use by doctors, pharmacists and manufacturers. A multi-pronged approach using appropriate communication tools for education of the community and local private practitioners regarding prevention and management of diarrheal diseases in children will be needed to reduce the disease burden and the inappropriate use of antibiotics.

Community health workers: to train or to restrain? A longitudinal survey to assess the impact of training community health workers in the Bolama Region, Guinea-Bissau

BackgroundThe shortage in human resources for health affects most dramatically developing countries which frequently use community health workers (CHW) as the basis for health programmes and services. The traditional definition refers CHWs as members of the community who are recruited and trained in health prevention and promotion to provide services within their community. In Guinea-Bissau, CHWs play a fundamental role in the diagnosis and treatment of childhood diarrheal diseases - one of the main health problems in the country.MethodsThis study is based on 22 CHW, 79% of the total number of CHW in the Sanitary Region of Bolama. The main goal was to assess how training CHW on diarrheal diseases impacted the accuracy of the diagnosis and treatment of these diseases in children under the age of 5 years. Three evaluations were made throughout time - one evaluation before the training and two follow-up evaluations.An observation grid was developed to evaluate the identified signs, symptoms, diagnosis and treatments prescribed by the CHW in consultations to children with a suspicion of diarrhoeal disease. A similar grid was filled by a medical doctor who took the role of the external validation standard.Friedman’s variance analysis and Cochran’s Q test were performed to compare the accuracy depicted by CHWs in identifying items throughout time. A logistic regression model was also used to check the possible influence of socio-demographic characteristics of CHWs on the accuracy of the diagnosis and treatment prescribed by the CHW.ResultsThe results show that CHWs improve significantly their performance in identifying the correct diagnosis in the first follow-up moment after the training (P = 0.001, n = 22) but, 3 months later, the effectiveness decreases. No statistical evidence was found for the logistic regression models applied.This progressive loss of performance after training may occur because CHWs fail to apply treatment algorithms and guidelines over time.A limited set of socio-demographic characteristics of the CHWs can influence their performance and should not be disregarded when selecting CHW candidates.ConclusionThe selection, supervision, support and continuous training of CHW are as important as the training provided.