Management Of Diarrhea In Children Research Articles

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.

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.

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.

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 = <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 < 0.0001) and 12.4 (CI = 4.80–33.3; p < 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.

The Enterics for Global Health (EFGH) Shigella Surveillance Study in Malawi.

Malawi is among 7 countries participating in the Enterics for Global Health (EFGH) Shigella surveillance study, which aims to determine the incidence of medically attended diarrhea attributed to Shigella, a leading bacterial cause of diarrhea in children in low-resource settings. We describe the EFGH study site in the densely populated informal settlement of Ndirande Township, Blantyre, Malawi. We explore the site's geographical location, demographic characteristics, and the healthcare-seeking behavior of its population, particularly for childhood diarrhea. We also describe the management of childhood diarrhea at the health facility, and the associated challenges to attaining optimum adherence to local and national guidelines at the site. Our overarching aim is to improve global health through understanding and mitigating the impact of diarrhea attributed to Shigella.

Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR.

Diarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care. Simulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists' practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists' practice was categorized into adequate, less adequate, and poor. 182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription. A high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists' practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.

Oral rehydration therapy and Zinc treatment among diarrhoeal children in India: Exploration from latest cross-sectional National Family Health Survey.

Diarrhoea is one of the deadliest diseases and causing death among children in India, but no systematic attempt is made to understand it especially its control using oral rehydration salts (ORS). It is well known that use of ORS and Zinc have been effective in containing diarrhoea among children. An attempt is made using large scale national data set in India to understand use of ORS and Zinc to control diarrhoea and their associated factors among diarrhoeal children under five in India. Publicly available most recent cross-sectional National Family Health Survey data in India was used for the study. The multi-stage cluster sampling design was used with 2011 Census of India as a sampling frame. Households were selected using a Systematic Random Sampling design from selected primary sampling units in rural and urban clusters. From the selected households, the eligible children were those who suffered from diarrhoea in the two weeks preceding the survey and were less than 5 years old. Using this criterion, out of 232,920 children in the survey of less than five years, 16,213 sample diarrheal children found to be available for the study. Both descriptive and inferential statistical techniques were used to analyse the data. Across India, 61% and 31% of the children were given ORS and Zinc respectively. However, combined ORS + Zinc treatment was only around 24%. The treatment of ORS, Zinc, and combined ORS + Zinc supplementations were significantly higher among younger children, children of 24-35 age group mothers, children from rich wealth index groups, belong to Hindu religion and general caste compared to their counterparts. The logistic regression results showed that consumption of ORS among diarrhoeal children under five years of age depends upon size of a child at birth. For instance, diarrheal children who were very small size at birth compared to very large at birth, had 39% lower odds of consuming ORS (AOR = 0.61; CI 0.48, 0.78; p<0.001). Another important variable is place of first treatment sought for diarrheal children. That is children who first sought treatment in private hospital compared to government hospital had 52% lower odds of ORS consumption. The logistic regression adjusted AORs are similar with Zinc and ORS + Zinc supplementations. To improve the coverage and management of childhood diarrhoea in India, planning activities should focus not only on distribution, and increasing knowledge of ORS preparation especially for urban slum residents and rural disadvantaged groups through demonstration. There should be also proper focus on providing ongoing pathways to ensure proper supply chains.

A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria.

We assess progress towards improved case management of childhood diarrhea in Nigeria over a period of targeted health systems reform from 2013 to 2018. Individual and community data from three Demographic and Health Survey rounds are leveraged in a geospatial model designed for stratified estimation by venue of treatment seeking and State. Our analysis reveals a highly regionalised health system undergoing rapid change. Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44-0.69; 95% CI] in 2008; 0.70 [0.54-0.83] in 2018) or chemist/pharmacy (0.28 [0.17-0.42] in 2008; 0.48 [0.31-0.64] in 2018). Yet State-level variations in venue attendance and performance by venue have conspired to hold the overall proportion receiving this potentially life-saving therapy (0.45 [0.35-0.55] in 2018) to well-below ideal coverage levels. High performing states that have demonstrated significant improvements include Kano, Jigawa and Borno, while under-performing states that have suffered declines in coverage include Kaduna and Taraba. The use of antibiotics is not recommended for mild cases of childhood diarrhea yet remains concerningly high nationally (0.27 [0.19-0.36] in 2018) with negligible variation between venues. Antibiotic use rates are particularly high in Enugu, Kaduna, Taraba, Kano, Niger and Kebbi, yet welcome reductions were identified in Jigawa, Adamawa and Osun. These results support the conclusions of previous studies and build the strength of evidence that urgent action is needed throughout the multi-tiered health system to improve the quality and equity of care for common childhood illnesses in Nigeria.

Descriptive Epidemiology of Home-Based Management of Diarrhea in Children Under Five Years: The Case of Northern Ghana

Descriptive Epidemiology of Home-Based Management of Diarrhea in Children Under Five Years: The Case of Northern Ghana

Application of Honey Therapy to Decrease Stool Frequency in Children with Diarrhea: A Case Study

Diarrhea is characterized by the presence of watery bowel motions that occur three or more times within 24 hours. Inadequate management of diarrhea in children might lead to fatality. One method involves administering honey treatment to decrease the frequency of bowel movements. The objective was to elucidate the implementation of a way to reduce bowel movement frequency. The design involved a case study conducted on two toddlers suffering from diarrhea. The solution involved administering honey therapy three times daily for five days. Data analysis and presentation in case studies were conveyed through written text, which presented the facts in a narrative format. The use of honey therapy resulted in a reduction in the frequency of bowel movements in subjects 1 and 2. The post-intervention frequency of bowel movement in subject 1 was three times per day, with a mushy consistency. In subject 2, it was four times per day, again with a mushy consistency. Nurses at the Community Health Center (Puskesmas) can offer guidance on using honey therapy to parents whose children are suffering from diarrhea.

Knowledge, Attitude and Practice of Mothers regarding Oral Rehydration Solution in Acute Diarrhoea at Monno Medical College Hospital

Background: Diarrhoea is one of the major causes of morbidity and mortality among the under-five age group in Bangladesh. Effective by ORS treatment can reduce diarrhoea-related mortality and unnecessary hospitalization, for which role of mothers is important. The use of oral rehydration saline (ORS) is greatly affected by mothers’ knowledge and attitude towards using it in treating their children. Objectives: Assessment of the knowledge, attitude and practice of the mothers about ORS for better management of diarrhoea in children. Methodology: A cross-sectional descriptive study was carried out in the department of Paediatrics of Monno Medical College Hospital, Manikganj, during the period from January to December, 2022. Data were collected from 300 mothers by face-to-face interview by a questionnaire. Finally, collected data were analyzed, using SPSS software version 20. Results: Majority (195, 65.0%) of the children’s age were in between 6 month to 2 years. Most (143, 47.7%) of the mothers completed primary education. About two-thirds of the mothers (193, 64.3%) resided in rural areas. In this study, most (213, 71.0%) of the mothers always used ORS during the attack of diarrhoea, 281(93.7%) mothers had adequate knowledge about ORS, 253(84.3%) had knowledge about preparetion of ORS, 235(78.3%) informed to know when to administer ORS and 170 (56.7%) knew the exact amount of ORS to administer. Conclusion: Positive attitude was seen among the participant mothers regarding the use of ORS. But mothers’ knowledge and practices regarding its administration was insufficient. Journal of Monno Medical College, June 2023; 9 (1): 03-06

Using the Simulated Patient Method to Evaluate the Community Pharmacy Management of Childhood Diarrhoea: A Systematic Review

The simulated patient method has been widely used to assess community pharmacy practice in the management of childhood diarrhoea. In such a process, a community pharmacist is required to explore a patient’s history, choose the right medication and provide drug-related information. The aim of this review was to evaluate the aforementioned practice. A comprehensive literature search was carried out over Sage Journal, PubMed, ScienceDirect and Google Scholar, and the analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible articles were those published from 2011 to 2021 and original studies that used the simulated patient method to examine the pharmaceutical services provided by pharmacists in relation to childhood diarrhoea. The eight studies that satisfied the eligibility criteria were reviewed. These investigations were undertaken in Brazil, Nigeria, Turkey, Ethiopia and Pakistan. Five of the studies focused on history taking with regard to the characteristics of diarrhoea and revealed that the evaluated pharmacists asked about patient histories. In terms of therapy, three studies indicated that the evaluated pharmacists recommended the administration of oral rehydration salts. Pharmacies should improve their history-taking process, provide drug related information and recommend therapies to increase the knowledge of simulated patients about diarrhoea treatment in children.

Assessment of knowledge and practice of zinc sulphate supplementation in the treatment of diarrhoea among under-five children in Primary Health Care centres in Keffi, Nigeria

Zinc supplementation reduces the severity, duration and recurrence of diarrhoea in children. This study assessed the level of knowledge and practice of zinc supplementation in the management of diarrhoea in children in primary health care facilities in Keffi, Nigeria. Retrospective and qualitative studies were conducted in nine facilities. Validated data collection form and questionnaire were used to collect medications prescribed for diarrhoea in children less than five years old. Descriptive statistics was done, and associate variables were tested using Chi-square Tests. The study assessed 380 case files and 19 health care workers in nine facilities. The finding revealed that 21.1% and 10.5% of the prescribers were aware of and had formal training on the use of zinc in the management of diarrhoea respectively. Oral rehydration salt with zinc and antibiotics were prescribed in 10.5% and 57.9% cases respectively. Only 13.2%, 8.2% and 8.5% of children managed for diarrhoea had correct doses, frequencies and durations of zinc respectively. Only 44.4% facilities had zinc tablet in stock. The study revealed low knowledge and practice among primary health care workers about treatment guidelines on zinc supplementation in the management of diarrhoea in children less than five years.

Know-do gap for sick child care and drivers of knowledge and practice among health extension workers in four regions of Ethiopia: a cross-sectional study

ObjectiveThough efforts were made to expand community-based sick child healthcare in Ethiopia, the quality of care provided remained low. Improving quality of care requires understanding providers’ knowledge of appropriate care...

Diet and Management of Diarrhea.

Diet plays an important role in human health and disease. Of all human diseases, diarrheal illnesses bring diet into sharp focus as it has a direct causal and therapeutic relationship. With the advent and widespread use of next generation sequencing, significant advances have been made in unraveling the etiologies of congenital diarrheas and enteropathies, some of which are eminently treatable with dietary modification. Early institution of appropriate dietary therapy is lifesaving in congenital osmotic diarrheas. Chronic diarrhea in older children and adolescents often have an underlying dietary basis, depending on the etiology. Identification and exclusion of the offending food in the diet results in dramatic improvement in symptoms. It is equally important to be prudent and cautious in the use of exclusion diets in management of chronic diarrhea as it is associated with micronutrient deficiencies, needless escalation of cost and enable maladaptive food intake behaviors. In this review, authors discuss etiology specific dietary management of diarrhea in children with emphasis on congenital diarrheas and enteropathies.

Spatial variations and determinants of childhood diarrhea management in Uganda

ABSTRACT The study examines the variability of community-based and determinants of childhood diarrhea management including rehydration and feeding therapies using the 2016 Uganda Demographic and Health Survey, UDHS (N = 2,923). The study utilized the Bayesian model and geo-statistical techniques with location (district) and nonlinear metrical attributes (mother’s and child’s age) to gain a better understanding of childhood diarrhea management. The results show that 45% and 58% of under-5 children received less than the usual amount of fluid and food, respectively, during diarrheal episodes. However, the findings indicate that the prevalence of diarrhea among under-5 children does vary spatially within and between subregions and districts of Uganda. The fixed effects show that the covariates have no significant influence on rehydration therapy. However, the wealth index, family size, and number of under-5 children in a household have a significant impact on feeding therapy for children with diarrhea. In general, the results indicate that geography has a significant effect on the rehydration therapy, while both geography and socioeconomic variables have a significant influence on feeding therapy on under-5 children with diarrhea. These findings can support policymakers to identify subregions and districts with ineffective practices and policy strategies to better address the spatial variations and determinants of diarrhea management in Uganda.

Antibiotic-Prescribing Practices for Management of Childhood Diarrhea in 3 Sub-Saharan African Countries: Findings From the Vaccine Impact on Diarrhea in Africa (VIDA) Study, 2015–2018

Despite antibiotic prescription being recommended for dysentery and suspected cholera only, diarrhea still triggers unwarranted antibiotic prescription. We evaluated antibiotic-prescribing practices and their predictors among children aged 2-59 months in the Vaccine Impact on Diarrhea in Africa (VIDA) Study performed in The Gambia, Mali, and Kenya. VIDA was a prospective case-control study (May 2015-July 2018) among children presenting for care with moderate-to-severe diarrhea (MSD). We defined inappropriate antibiotic use as prescription or use of antibiotics when not indicated by World Health Organization (WHO) guidelines. We used logistic regression to assess factors associated with antibiotic prescription for MSD cases who had no indication for an antibiotic, at each site. VIDA enrolled 4840 cases. Among 1757 (36.3%) who had no apparent indication for antibiotic treatment, 1358 (77.3%) were prescribed antibiotics. In The Gambia, children who presented with a cough (adjusted odds ratio [aOR]: 2.05; 95% confidence interval [95% CI]: 1.21-3.48) were more likely to be prescribed an antibiotic. In Mali, those who presented with dry mouth (aOR: 3.16; 95% CI: 1.02-9.73) were more likely to be prescribed antibiotics. In Kenya, those who presented with a cough (aOR: 2.18; 95% CI: 1.01-4.70), decreased skin turgor (aOR: 2.06; 95% CI: 1.02-4.16), and were very thirsty (aOR: 4.15; 95% CI: 1.78-9.68) were more likely to be prescribed antibiotics. Antibiotic prescription was associated with signs and symptoms inconsistent with WHO guidelines, suggesting the need for antibiotic stewardship and clinician awareness of diarrhea case-management recommendations in these settings.

Evaluation of Care-Takers Awareness, Training and Approaches in the Management of Diarrhea in Children in Nawampiti Paris

Evaluation of Care-Takers Awareness, Training and Approaches in the Management of Diarrhea in Children in Nawampiti Paris

Evaluation of Care-Takers Awareness, Training and Approaches in the Management of Diarrhea in Children in Nawampiti Parish

Evaluation of Care-Takers Awareness, Training and Approaches in the Management of Diarrhea in Children in Nawampiti Parish

Knowledge, attitude and practices of community health workers on managing and preventing childhood malaria and diarrhea in Fako Division, South West Region, Cameroon; A mixed method study.

In developing countries, childhood malaria and diarrhea are among the 5 leading causes of death among children under five years; the use of community health workers (CHWs) to manage these diseases has shown some degree of success. A descriptive cross-sectional study was conducted to assess knowledge, attitude and practices (KAP) of CHWs on the management and prevention of childhood malaria and diarrhea in Fako Division, South-West Region, Cameroon. A pretested questionnaire was administered to eighty CHWs in Fako Division. Three focus group discussions (FGDs) were conducted with 29 CHWs. The Chi-Square and Spearman Correlation tests were used to investigate the association between socio-demographic characteristics with CHWs' KAP on childhood malaria and diarrhea management and prevention. A total of 52.5% of the participants had good knowledge, negative attitudes (65.0%), and carried out poor practices (60.0%) on the management and prevention of childhood malaria. Up to 8.75% CHWs did not know the first-line antimalarial drug used in Cameroon. More than half (57.5%) of participants had poor knowledge, 70.0% had a negative attitude and 82.25% carried out good practices on the management and prevention of childhood diarrhea. 47.6% of CHWs used a mixture of guava leaves and 'masepo' (Ocimum gratissimum) as treatment for childhood diarrhea. Level of education (p = 0.028) and Health District (p = 0.026) were significantly associated with practices on management and prevention of childhood diarrhea. CHWs had inadequate knowledge, poor attitude, and practices on childhood malaria management. Even though a majority of CHWs carried out good practices for diarrhea management, their knowledge and attitude were poor. Therefore, there is a need for training to improve CHWs' knowledge, attitude and practices on childhood malaria and diarrhea management.