Management Of Diarrhea Research Articles

Clinical interventions of community pharmacies for diarrhea management: Evidences from developing countries

Clinical interventions of community pharmacies for diarrhea management: Evidences from developing countries

Effects of opium tincture on gastrointestinal function and motility in healthy volunteers: A magnetic resonance imaging study.

Opioids inhibit motility and secretion of the gut and have been used for antidiarrheal treatment for centuries. However, the underlying mechanisms of opium tincture are not evident. To investigate the effects of opium tincture on gastrointestinal motility, intestinal volumes, and water content of different gut segments assessed by magnetic resonance imaging (MRI). Twenty healthy volunteers were included in a randomized, placebo-controlled, crossover study of 9 days of treatment with 30 drops of opium tincture per day. MRI was performed on day 1 (before treatment) and day 9 (during treatment). Measurements included assessments of gastric volume, gastric emptying, gastric motility, small bowel volume, small bowel water content, small bowel motility, colon volume, colon water content, and whole gut transit. Opium tincture delayed gastric emptying by a mean difference of 5.6 min [95% CI: 1.8-9.4], p = 0.004, and increased postprandial gastric meal volume (17-21%, p = 0.02). Small bowel endpoints did not change. Opium tincture delayed whole gut transit time (p = 0.027) and increased ascending colon volume by 59 mL [95% CI: 15-103], p = 0.004, and transverse colon volume by 48 mL [95% CI: 4-92], p = 0.027. T1-relaxation time of the descending colon chyme was decreased during opium treatment, indicating dryer feces (difference: -173 ms [95% CI: -336 -11], p = 0.03). Opium tincture induced changes in the stomach and colon in healthy volunteers. An improved understanding of how opioids affect gut functions may lead to a better understanding and optimized management of diarrhea.

Postbiotics: A new member in the biotics family.

Postbiotics were defined in 2021 by the International Scientific Association for Probiotics and Prebiotics (ISAPP) as a "preparation of inanimate microorganisms and/or their cellular components that confers a health benefit to the host." The field of postbiotics is a new area within the biotics family; numerous products have already been developed for clinical applications, such as immune stimulation, the management of diarrhea in children and adults, the management of irritable bowel syndrome, and 3 infant formulas. In particular, infant formulas with postbiotics obtained from milk fermented with Bifidobacteriumbreve C50 and Streptococcusthermophilus O65 -and their metabolites-, including the oligosaccharide 3'-GL, have demonstrated to be safe and to contribute to the development of the gut microbiota and the gutassociated immune system. These modifications help to prevent and manage functional gastrointestinal disorders in infants.

The role of pharmaceutical care in the use of rifaximin for the treatment of diarrhea

the management of diarrhea represents a prevalent issue within the realm of healthcare. Rifaximin is recommended to treat traveler's diarrhea and irritable bowel syndrome. At the same time, it is important to rationally use an antimicrobial drug to prevent the development of antimicrobial resistance. Aim: to evaluate the role of pharmaceutical care in using rifaximin to treat diarrhea, based on a questionnaire. A questionnaire survey was done among 55 pharmacy professionals and 42 pharmacy visitors regarding the dispensing and use of rifaximin for diarrhea treatment. The survey of pharmacy visitors revealed that rifaximin was used for the treatment of small intestinal bacterial overgrowth syndrome (32 cases), traveler's diarrhea (7 cases), and irritable bowel syndrome with diarrhea (3 cases). Patients did not undergo stool culture before rifaximin prescription, which could have prevented antimicrobial resistance and ruled out other causes of diarrhea. It was found that 14% of respondents reported improvement the next day, while 83.3% reported improvement within three days. Pharmacists can educate visitors about the importance of completing the treatment course. Five percent of respondents reported nausea as an adverse reaction. Pharmacists dispensed rifaximin for the treatment of diarrhea in adults almost three times more often than in children. The tablet form of the drug was used in 94.5% of cases, while the oral suspension was used in 5.5% of cases. The majority of pharmacy visitors (89.0%) received rifaximin with a doctor's prescription, and 10.9% without a prescription, which emphasizes the importance of pharmaceutical care to prevent irrational use of the drug. The results of the study show that 92.7% of pharmacists provide recommendations on the safety of rifaximin use, and 78.2% recommend abstaining from alcohol during treatment. Only 21.8% of pharmacists warn about the possible staining of urine, which can cause concern for patients. The majority of pharmacists (89.1%) systematically ask women about possible pregnancy, which indicates their awareness of safe pharmacotherapy. Pharmacists also clarify the simultaneous use of rifaximin with other drugs: 32.7% ask about taking oral contraceptives, 7.3% – antiarrhythmic drugs, and 3.6% – warfarin. mailto:https://meshb.nlm.nih.gov/record/ui?ui=D002648Pharmacists can enhance the effectiveness of rifaximin treatment by preventing its uncontrolled use, emphasizing the importance of completing the treatment course and informing about possible adverse reactions. When providing pharmaceutical care to visitors taking rifaximin, pharmacists should educate them about potential changes in urine color. Additionally, pharmaceutical workers advise women taking oral contraceptives to use additional contraceptive methods while taking rifaximin.

Evaluation of the determinants of uptake of oral rehydration salts with zinc in the management of childhood diarrhea in Kakamega County

Background: Diarrhea remains a significant public health concern, contributing to high child mortality, particularly in Sub-Saharan Africa and South Asia. Approximately 1.5 million cases of childhood diarrhea are reported annually in Kenya, with a prevalence of 16%. Despite the availability of affordable interventions like oral rehydration salts (ORS) and zinc supplementation, their utilization remains suboptimal in Kakamega County, where child mortality is 45 per 1,000. The combined impact of ORS and zinc in reducing childhood diarrhea and its consequences has not been adequately studied in Kakamega County. This study aims to assess the utilization of ORS and zinc in diarrhea management in Kakamega County. Methods: We utilized a cross-sectional design to evaluate current practices and outcomes in managing diarrhea among children under five years old. A random sampling approach was applied to ensure a representative sample. Key variables assessed included the frequency of diarrhea episodes, the use of ORS and zinc, and nutritional status. Statistical analyses, including Chi-square tests and descriptive methods, were used to examine the relationships between the variables in SPSS version 26. Results: Of the 246 children surveyed, 47.4% were under 10 months old. The study found that 26.8% of children had not received rotavirus vaccinations, and diarrhea was significantly (p<0.05) associated with poor nutritional outcomes. ORS had strong support (69.4%), but zinc supplementation showed moderate support (54.3%). Conclusions: The study highlights the need for increased uptake of ORS and zinc supplementation, as well as enhanced vaccination coverage to prevent diarrhea-related deaths and malnutrition in Kakamega County.

Prevalence of Anemia and its associated factors among 6–59 months age children visiting public hospitals at Afar Region, Northeast Ethiopia: a hospital-based cross-sectional study

BackgroundAnemia is a significant global public health issue among children aged 6 to 59 months, particularly in low-income countries like Ethiopia. Studies focusing on pastoral communities, especially in the Afar Region, often underestimate the prevalence of anemia in these children. To address this information gap, this study aimed to determine the prevalence of anemia and its associated factors among children aged 6 to 59 months in public hospitals in the Afar Region of northeastern Ethiopia.MethodA hospital-based cross-sectional study was conducted among children aged 6 to 59 months, using systematic random sampling, at public hospitals in the Afar Region from February 28 to April 30, 2023.The data collection tool was adapted from the Ethiopian National Food Consumption Survey and the World Health Organization Infant and Young Child Feeding guidelines. Data entry was performed using EpiData version 4.2 and Anthroplus software for anthropometric measurements. Data analysis was conducted using SPSS version 26. Binary logistic regression models were applied to identify predictors of anemia, with a p-value of ≤ 0.05 considered statistically significant.ResultAmong the 306 children aged 6 to 59 months, the overall prevalence of anemia was 46.41 (95 CI: 43.8–48.9 ). Of the 142 anemic children aged 6 to 59 months, 62 (43.66 ) had mild anemia, 60 (42.25 ) had moderate anemia, and 20 (14.08 ) had severe anemia. Key factors associated with anemia included mothers with no formal education, the lowest family monthly income, a family size greater than five, and rural residence. Additionally, a previous diagnosis of parasitic infection, children aged 24–35 months, early weaning, a malaria diagnosis within the past three months, and diarrhea in the last two weeks were significant predictors of anemia in children aged 6 to 59 months.ConclusionIn the current study, anemia in children aged 6 to 59 months was classified as severe and is regarded as a critical public health issue. This suggests that more efforts should be made to significantly decrease anemia by actively involving rural mothers with no formal education and low income who have children aged 6–59 months, focusing on the prevention and management of malaria, diarrhea, and parasitic infections.

Adherence to Clinical Practice Guidelines on the Management of Acute Infectious Gastroenteritis in Children as a Measure of Quality of Care Delivered by a Primary Care Facility in Rural Philippines: A Descriptive Retrospective Study.

This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH). A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low. There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%. Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.

Mothers' Knowledge, Attitudes, and Practices Regarding the Prevention and Management of Diarrhea among Children in Pakistan: A Cross-Sectional Study.

Diarrheal disease is the second leading cause of death worldwide in children under 5 years old, after pneumonia. Fortunately, diarrhea is a preventable disease that can be avoided by implementing basic home management strategies. Mothers are essential to its management and prevention; therefore, this study assessed the knowledge, attitudes, and practices of mothers in Pakistan related to diarrheal disease prevention and management. The study was conducted using a cross-sectional design in three cities of Pakistan from September 2022 to December 2022. A questionnaire was used to collect data on mothers' sociodemographic characteristics and their knowledge, attitudes, and practices related to the prevention and management of diarrheal diseases. A total of 356 mothers (81.7% of them were housewives, and 58.4% were 25-34 years old) participated in the study. Data were analyzed using descriptive statistics and tests of association. Significant associations were found between mothers' income, education, and ethnicity and their knowledge, attitudes, and practices regarding the prevention and management of diarrheal diseases (P <0.05). However, no significant association was found between the other variables. The knowledge and attitudes of the mothers regarding the prevention and management of diarrhea were satisfactory; however, their prevention-related practices and home-based management were unsatisfactory. Therefore, community education, formation of health and hygiene committees, and dissemination of user-friendly information are crucial for creating awareness about the prevention and management of diarrheal diseases. These measures can help improve the practices of mothers and reduce the incidence of diarrheal diseases in Pakistan.

Perspectives of Nursing Mothers in Ibadan Markets Regarding Management of Childhood Diarrhoea: A Qualitative Study

Introduction: Diarrhoea is a gastrointestinal disorder characterised by the passage of three or more loose or liquid stools per day or more frequently than a normal individual should have. It can be short-term (acute) or long-term (chronic), varying from mild to severe. Aim: The study aimed to explore the perspectives of nursing mothers in Ibadan North East local government markets regarding childhood diarrhoea management. Method: A qualitative study was conducted among mothers of children between 0-59 months at Ibadan, precisely Ibadan Northeast Local Government. The study was conducted in selected Ibadan North East Local Government markets. The selection of these markets for the study was based on their high population of women with children and the moderate commercial activities. A purposive sampling technique was used to select 29 nursing mothers who were interviewed until data saturation was reached. Data was analysed using the QSR NVIVO 12 software program. Verbatim transcription was conducted while listening to the recording. The thematic analysis method was used for data analysis. Results: This study revealed that a significant diarrhoea management pattern is using herbal mixtures and several concoctions. The primary determinant factor for this management is the strong cultural belief of the Yoruba in this herbal mixture, and Yorubas were the most populous in this research setting. Subthemes that emerged include management options and the mother's level of knowledge, traditional management of different types of childhood diarrhoea and actions taken during managing childhood diarrhoea. Conclusion: This study shows that the majority of nursing mothers in Ibadan markets have a wrong perspective of childhood diarrhoea management, and this could be linked to their age, culture, education, and financial capability. Hence there need for further research on Intervention studies to identify bad behavioral practices performed by those Nursing motherand in the market and to render proper health Education on those practices.

Effectivity of Earthworm (Lumbricus rubellus) Extract as Antidiarrhea Caused by Enteropathogenic Escherichia Coli

Background: Diarrhea still becomes a health problem in Indonesia with a high mortality rate among children under five years old. Antibiotics are used in the management of diarrhea caused by Enteropathogenic Escherichia coli, but it can change the intestinal microbiota in children and can cause resistance. Therefore, raw material is needed as an antibacterial.Methods: The sources of the narrative review come from Google Scholar, PubMed, and ResearchGate with keywords such as earthworm, Lumbricus rubellus, earthworm extract, antidiarrhea, and Escherichia coliResult: Earthworms (Lumbricus rubellus) have some active compounds that are useful for fibrinolytic, thrombolytic, antithrombotic, anti-inflammatory, antioxidant, and broad-spectrum antimicrobial properties. The antimicrobial activity of earthworms is due to the presence of Lumbricin-1 content where its activity against Escherichia coli has been proven by various studies.Conclusion : Earthworm (Lumbricus rubellus) extract can inhibit the growth of Escherichia coli bacteria so it has the potential to become an antidiarrheaKeywords: antidiarrheal; earthworm; Lumbricus rubellus; Lumbricin-1; Enteropathogenic Escherichia coli

Rifaximin and Metronidazole Fixed Dose Combination: New Treatment Option in the Management of Diarrhea

Background: Endemic infectious diarrhea is a widespread problem around the world, caused by a combination of viruses, bacteria, and parasites. While commonly used fluoroquinolone antibiotics are effective for specific types of acute diarrhea, they carry potential side effects. Aim: To assess the effectiveness and tolerability of a fixed-dose combination of rifaximin and metronidazole as an alternative treatment approach for the management of acute diarrhea. Study Design: A multicentre, open-label, non-comparative and non-randomized trial was conducted in 370 patients suffering from acute diarrhea due to various factors. Methodology: Patients were given a tablet containing fixed-dose combination of 200 mg of rifaximin and 400 mg of metronidazole twice daily for 5 days. The primary outcomes evaluated were changes in the number of loose/watery stools, the presence of fever, nausea, vomiting, abdominal pain and gas/flatulence from baseline to day 5. A global assessment using a 3-point scale (Excellent/Good/Poor) was done by the investigators for efficacy and tolerability evaluation. Adverse drug reactions were monitored throughout the study period. Results: After 5-day therapy, the average number of watery stools per day decreased significantly from 7.853 ± 3.773 to 0.766 ± 0.949 (P &lt; .001). None of the patients experienced fever and vomiting, while few patients experienced nausea (0.31%), abdominal pain (0.31%), and gas/flatulence (0.93%) at the end of the study. According to the evaluation by the investigators, all patients reported good to excellent efficacy and tolerability. Conclusions: The combination therapy of rifaximin and metronidazole is clinically effective and safe to treat acute diarrhea caused by different factors and can serve as a new treatment option for managing acute diarrhea.

A Multidisciplinary Approach in the Management of Infectious Diarrhea in the Emergency Department.

Background Globally, infectious diarrhea poses a serious threat to public health, especially in emergency department (ED) settings where timely and efficient treatment is essential. The primary objective of this study was to explore and evaluate the efficacy of a multidisciplinary approach (MDA) in the management of infectious diarrhea within the ED setting. Methodology This prospective cohort study was conducted from January to December 2023 at the Lady Reading Hospital ED in Peshawar, Pakistan. Individuals 18 years of age or older with a confirmed diagnosis of infectious diarrhea were included in the study. Those who refused to participate or had non-infectious reasons were excluded from the study. Through successive sampling, 650 patients comprised the study sample. Using a standardized form, demographic information, clinical presentations, test results, treatment methods, and patient outcomes were collected. Descriptive statistics and logistic regression were used in statistical studies to assess treatment outcomes and complications. Results Of the 650 patients, the majority (203 patients, 31.23%) were between the ages of 30 and 39 years. The gender distribution was about equal (332 men, 51.08%; 318 females, 48.92%). Abdominal pain (383 patients, 58.92%) was the most common presenting complaint. In 310 instances, bacterial pathogens were found, 160 had viral infections, and 110 had parasitic infections. There were notable complications, such as sepsis (37 patients, 5.69%), although the response to treatment effectiveness was notably high (593 patients, 91.08%). Upon follow-up, 590 (90.77%) patients had symptom and sign resolution, while 80 (12.31%) patients had a low recurrence rate. Longer symptom duration (odds ratio (OR) = 1.45, 95% confidence interval (CI) 1.12-1.88, p = 0.005) and specific antibiotics (OR = 1.68, 95% CI = 1.25-2.25, p = 0.001) were found to improve treatment success using logistic regression, whereas the risks of complications increased with age (OR = 1.05, 95% CI = 1.01-1.09, p = 0.012) and severe dehydration (OR = 1.75, 95% CI = 1.32-2.31, p < 0.001). Conclusions The MDA to manage infectious diarrhea in the ED significantly improved patient outcomes and reduced complications.

Determining lactate concentrations in Korean indigenous calves and evaluating its role as a predictor for acidemia in calf diarrhea

BackgroundCalf diarrhea leads to high mortality rates and decreases in growth and productivity, causing negative effects on the livestock industry. Lactate is closely associated with metabolic acidosis in diarrheic calves. However, there have been no reports on lactate concentrations in Korean indigenous (Hanwoo) calves, especially those with diarrhea. This study aimed to determine the reference range of L-lactate and D-lactate concentrations in Hanwoo calves and to better understand the utility of lactate as predictive factors for acidemia in diarrheic calves.ResultsL-lactate and D-lactate concentrations were measured in healthy (n = 44) and diarrheic (n = 93) calves, and blood gas analysis was performed on diarrheic calves. The reference range in healthy calves was 0.2–2.25 mmol/L for L-lactate and 0.42–1.38 mmol/L for D-lactate. Diarrheic calves had higher concentrations of L-lactate and D-lactate than healthy calves. In diarrheic calves, L-lactate and D-lactate each had weak negative correlation with pH (r = − 0.31 and r = − 0.35). In diarrheic calves with hyper-L-lactatemia, the combined concentrations of L-lactate and D-lactate had moderate correlation with pH (r = − 0.51) and anion gap (r = 0.55). Receiver operating characteristic analysis showed D-lactate had fair predictive performance (AUC = 0.74) for severe acidemia, with an optimal cut-off value of > 1.43 mmol/L. The combined concentrations of L-lactate and D-lactate showed fair predictive performance for predicting acidemia (AUC = 0.74) and severe acidemia (AUC = 0.72), with cut-off values of > 6.05 mmol/L and > 5.95 mmol/L.ConclusionsThe determined reference ranges for L-lactate and D-lactate in Hanwoo calves enable the identification of hyper-L-lactatemia and hyper-D-lactatemia. Diarrheic calves exhibited increased lactate concentrations correlated with acid-base parameters. While the concentrations of L-lactate and D-lactate have limitations as single diagnostic biomarkers for predicting acidemia or severe acidemia, their measurement remains important, and L-lactate has the advantage of being measurable at the point-of-care. Assessing lactate concentrations should be considered by clinicians, especially when used alongside other clinical indicators and diagnostic tests. This approach can improve calf diarrhea management, contributing positively to animal welfare and providing economic benefits to farms.

Landscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children

ObjectiveDiarrhoea remains a leading cause of morbidity and death among under-5 children in Kenya, despite multipronged policy and programme initiatives to increase access to treatment. This study interrogates the comprehensiveness...

Viral diarrheas - newer advances in diagnosis and management.

Viruses are the most common etiological agents of diarrhea in children. Despite rotavirus vaccine introduction, rotavirus remains as the leading cause of death globally, followed by norovirus, which represents a diagnostic challenge. Here, we describe new advances in the diagnosis and management of viral diarrheas. Although immunoassays are widely used for their fast turnaround time and low cost, molecular techniques have become the most reliable diagnostic method due to their high sensitivity and capacity to analyze multiple pathogens in gastrointestinal panels. Isothermal nucleic acid amplification assays (LAMP and RPA) are promising techniques since they do not require sophisticated equipment and can be used as point-of-care testing. CRISPR/Cas nucleic acid detection systems are new diagnostic methods with great potential. Several recent published articles describe the role of human intestinal enteroids to characterize norovirus infection, to test new drugs, and for vaccine development. The interaction between the human gut microbiota and gastrointestinal viral infections has been extensively reviewed and offers some innovative mechanisms for therapeutic and preventive measures. Although important advances have been made, more research is needed to address remaining challenges and further improve diagnostic capabilities and better management strategies for this critical infectious disease.

Prevention and home‐based management of childhood diarrhoea in an urban informal settlement in Northern Ghana; a cross‐sectional study of maternal knowledge, attitude and practices

AbstractBackgroundThe burden of diarrhoea morbidity and mortality among children under 5 years is higher in developing countries than in developed regions. Residents of informal settlements in many developing lower‐and‐middle‐income countries (LMICs) have a relatively high prevalence of diarrhoea and diarrhoea‐related diseases. Mothers are the burden bearers during children's diarrhoea episodes. Therefore, maternal knowledge and management skills are important to minimise the effects of morbidity and mortality associated with diarrhoeal diseases.MethodsThis cross‐sectional study was conducted among mothers residing in an informal settlement to assess their knowledge of diarrhoea prevention and home‐based management practices. An interviewer‐based questionnaire was used to gather information, imported into Microsoft Excel (Microsoft) and exported to STATA software version 13.1 (Stata) for data analysis. We performed descriptive multivariable analysis to find out participants knowledge of diarrhoea prevention and home‐based management practices and associated factors.ResultsA total of 428 participants participated in this study, with the majority, 6 64.5% (276/428) having good knowledge of prevention and home‐based management of diarrhoea among children under 5 years. Multivariable logistic regression analysis, participants who were multiparous and completed tertiary were 4.01 [confidence interval (CI) = 3.23–7.15; p = &lt;0.0001] and 2.02 (CI = 2.16–4.91; p = 0.005) times likely to have good knowledge. Participants who had attained tertiary education and earned monthly income above Gh¢ 4000 were 7.21 (CI = 5.24–16.5; p &lt; 0.0001) and 12.4 (CI = 4.80–33.3; p &lt; 0.0001) likely to have good practice of prevention and home‐based management of diarrhoea among children under 5 years.ConclusionThese findings may serve as a basis for developing specific interventions to enhance good knowledge and good practice regarding home‐based management of diarrhoea among children under five. Practitioners can provide targeted education, empower mothers to implement proper preventive measures and timely interventions thereby reducing the impact and severity of diarrhoeal episodes in children under 5 years in urban informal settlements.

Analysis of the severity of symptoms of acute diarrhoea caused by rotaviruses in children and the level of parental knowledge about the prevention of this condition

Introduction. Gastrointestinal infections in young children in the form of acute diarrhoea of viral aetiology constitute a serious epidemiological and therapeutic problem. Aim. The aim of the study is to determine the severity of symptoms of acute rotavirus diarrhoea in children and to evaluate the level of parental knowledge about the factors predisposing to this condition and the preventive measures. Material and methods. A group of 100 individuals aged 18 to 40, parents of children under the age of 4 who were hospitalised due to acute diarrhoea, was surveyed. The questions concerned determining the severity of symptoms of acute diarrhoea in children of rotavirus aetiology and assess the level of parental knowledge about the factors predisposing to this condition and preventive measures. The study utilised the diagnostic survey method with a self-designed questionnaire, as well as a standardised questionnaire for assessing the child's condition on admission and the CDS scale. Results. The analysis of the results showed that parental knowledge about the course, management, and prevention of infectious diarrhoea in children is low. Parents tend to avoid seeking information from nurses and physicians, instead relying on media and Internet sources, which they consider as credible. The study identified sociodemographic factors that influence parental knowledge. Conclusions. Age, education, and place of residence significantly influence parental knowledge about the course, management, and prevention of infectious diarrhea in children. It was found that the gender of the parents does not have a significant impact on the level of knowledge regarding the disease in question.

Understanding pre-hospital disease management of fever and diarrhoea in children-Care pathways in rural Tanzania.

Many children in sub-Saharan Africa die from infectious diseases like malaria, pneumonia, and diarrhoea that can be prevented by early diagnosis, effective and targeted treatment. This study aimed to gain insights into case management practices by parents before they present their children to hospital. We conducted a cross-sectional study among 332 parents attending a district hospital with their under-fives symptomatic with fever and/or diarrhoea between November 2019 and July 2020 in rural Tanzania. Timely and targeted treatment was defined as seeking health care within 24 h of fever onset, and continued fluid intake in case of diarrhoea. The main admission diagnoses were acute respiratory infections (61.8%), malaria (25.3%), diarrhoea (18.4%) and suspected sepsis (8.1%). The majority of children (91%) received treatment prior to admission, mostly antipyretics (75.6%), local herbal medicines (26.8%), and antibiotics (17.8%)-half of them without prescription from a clinician. For diarrhoea, the use of oral rehydration solution was rare (9.0%), although perceived as easily accessible and affordable. 49.4% of the parents presented their children directly to the hospital, 23.2% went to a pharmacy/drug shop and 19.3% to a primary health facility first. Malaria symptoms began mostly 3 days before the hospital visit; only 25.4% of febrile children visited any health facility within 24 h of disease onset. Prior use of local herbal medicine (AOR = 3.2; 95% CI 1.4-7.3), visiting the pharmacy (adjusted Odds Ratio [AOR] = 3.1; 95% confidence interval [CI]: 1.0-9.8), the dispensary being the nearest health facility (AOR = 3.0; 95% CI: 1.5-6.2), and financial difficulties (AOR = 2.2; 95% CI 1.1-4.5) were associated with delayed treatment. This study suggests that antipyretics and antibiotics dispensed at pharmacies/drug shops, as well as use of local herbal medicines, delay early diagnosis and treatment, which can be life-threatening. Pharmacies/drug shops could be integrated as key focal points for sensitising community members on how to respond to paediatric illnesses and encourage the use of oral rehydration solutions.

Phase II study to evaluate safety and efficacy of neratinib, an irreversible pan-HER tyrosine kinase inhibitor, and trastuzumab biosimilar in patients with HER2 mutated advanced solid tumors (KCSG AL20-17).

3134 Background: Neratinib, an irreversible pan-HER tyrosine kinase inhibitor, has single agent clinical activity in HER2 mutated cancer. This open-label single arm phase 2 trial investigated the efficacy and safety of the dual anti-HER2 therapy, neratinib plus trastuzumab in heavily pretreated patients with HER2 mutated solid tumors excluding HER2 amplifications. Methods: Neratinib was administered 240mg p.o. daily with trastuzumab biosimilar (Herzuma) every 3 weeks. The primary endpoint was objective response rate (ORR) by RECIST v1.1. Secondary endpoints were duration of response (DoR), progression free survival (PFS), and safety. An exploratory biomarker study was also conducted. Results: Forty patients were enrolled with a median follow-up of 11.08 months (range, 0.39-21.63 months) and a median of 3 (range 1-9) lines of prior systemic therapy. Tumor types included lung (42.5%), colorectal (20%) biliary (12.5%), and breast (7.5%). Sixty percent (60%) of patients (n=24) had HER2 mutation in the kinase domain. Among evaluable patients (n=39), the ORR was 23.1% (CR=0, PR=9) with a median DoR of 11.18 months (95% CI 0-22.63). Median PFS was 3.42 months (95% CI 1.57-5.27) and median overall survival was 9.47 months (95% CI 2.93-16.01). Grade ≥3 adverse events (AEs) occurred in 47.5% of patients (n=19) and diarrhea was the most frequently reported AE (n=10; 25%) followed by bilirubin elevation (n=2; 5%), and anemia (n=2; 5%). Conclusions: In heavily pretreated patients with HER2 mutated solid tumors, neratinib plus trastuzumab showed a moderate response rate, with a durable duration of response. Most AEs were manageable, highlighting the need for prophylactic diarrhea management. Exploratory biomarker results will be presented at the upcoming meeting. Clinical trial information: NCT06083662 .

Relationship between caregivers’ individual factors and home management of diarrhea among caregivers of children below five years in Ngandu location in Nyeri County.

Background: To prevent dehydration and malnutrition in children with diarrhea, it is important they get good management at home. The caregivers should commence home remedies immediately before they seek medical advice. This study assessed the level of knowledge on home management of diarrhea among caregivers of children below five years. Methods: This research applied descriptive cross sectional study design. The current study was a household survey targeting caregivers of children below five years with diarrhea. The Cochran's Sample Size Formula was used to calculate a sample size of 345 respondents. Purposive sampling was used to recruit respondents in the study. The study employed a researcher- administered semi-structured questionnaire. Descriptive statistics and chi-square tests were used in the analysis. Results: The study found that that slightly above half 52.2% (n=180) of the respondents had low knowledge on management of diarrhea. There was a significant relationship (χ2 =4.044, df = 1, p&lt;0.044) between respondent’s’ level of education and knowledge of home management of diarrhea. Cross tabulation showed that 60.2% of those who had low education also had low knowledge. Conclusion: The study concluded that the level of knowledge on home management of diarrhea among caregivers of children below five years with diarrhea was low. Level of education was a significant predictor of knowledge whereby low knowledge was associated with low education. The study recommends enhanced training of mothers on home management of diarrhea by nurses.