Oral Rehydration Fluids Research Articles

Are young and older children with diarrhea presenting in the same way?

Diarrhoea is a global health problem. More than a quarter of diarrhoeal deaths occur among children less than five years. Different literatures analyzed presentation and outcomes of less than five diarrhoeal children. The world has made remarkable progress in reducing child mortality. So, older children are growing in number. Our aim was to identify clinical differentials and variations of pathogens among younger (less than five) and older (five to nine years) diarrhoeal children. Data were extracted from the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital (urban site) and Matlab Hospital (rural site) of the International Centre for Diarrhoeal Disease Research, Bangladesh for the period of January 2012 to December 2021. Out of 28,781 and 12,499 surveillance patients in Dhaka and Matlab Hospital, 614 (2.13%) and 278 (2.22%) children were five to nine-years of age, respectively. Among under five children, 2456 from Dhaka hospital and 1112 from Matlab hospital were selected randomly for analysis (four times of five to nine years age children, 1:4). Vomiting, abdominal pain, and dehydrating diarrhoea were significantly higher in older children in comparison to children of less than five years age (p-value <0.05) after adjusting study site, gender, antibiotic use before hospitalization, diarrhoeal duration < 24 hours, intake of oral rehydration fluid at home, parental education, WASH practice and history of cough. Vibrio. cholerae, Salmonella, and Shigella were the common fecal pathogen observed among older children compared to under five after adjusting for age, gender and study site. Although percentage of admitted diarrhoeal children with five to nine years is less than under five years children but they presented with critical illness with different diarrhoeal pathogens. These observations may help clinicians to formulate better case management strategies for children of five to nine years that may reduce morbidity.

A systematic review on oral rehydration beverages for treating exerciseassociated dehydrationPart II. The effectiveness of alternatives to carbohydrate-electrolyte drinks.

Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this back-to-back review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated persons. This systematic review was undertaken to compare alternative liquids, such as milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise. Cochrane Library, PubMed, and Embase were searched for relevant literature in June 2022. Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available. The study design, study population, intervention, outcome measures, and study limitations were extracted from each included article. Out of 3485 records, 11 studies were included comparing skim or low-fat milk, coconut water, and beer (0-5% alcohol) with water. Four studies showed that drinking skim or low-fat milk, without additional food intake, led to a statistically significant improved volume/hydration status when compared with drinking water. In three trials, no significant differences were shown at multiple timepoints for outcomes related to volume and hydration status following rehydration with fresh coconut water compared with water. Lastly, there is insufficient evidence to recommend beer for rehydration (0-5% alcohol). Consuming skim or low-fat cow's milk without additional food as compared with water appears to improve volume/hydration status in persons with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.

The Effect of Exclusive Breastfeeding on Mother's Weight Retention in Postpartum Period

Exclusive breastfeeding is giving only breast milk to babies, without other drinks food, or water, except for oral rehydration fluids, drops, or syrup containing vitamins, mineral supplements, or drugs recommended by health workers for medical reasons. Breast milk contains complete nutrition which is very good for growth and development and is easily digested by babies. Mothers who exclusively breastfeed find it easier and faster to lose weight to their pre-pregnancy state. As the gestational age increases, there is a progressive accumulation of maternal body fat. These fat reserves are a source of energy that will be used in the process of producing breast milk. By breastfeeding, the body will produce more breast milk so that fat deposits that function as energy reserves will be used. Thus shrinking fat deposits, the mother's weight will quickly return to its pre-pregnancy state. At present, postpartum weight gain is a separate problem for mothers because of frequent postpartum weight retention. The purpose of this study was to determine the effect of exclusive breastfeeding on maternal weight in the postpartum period. A research design used in this study is the pretest-posttest control group design. This study used a group of mothers who exclusively breastfed and a group of mothers who did not exclusively breastfeed as a control group. Data on exclusive and non-exclusive breastfeeding were taken using a questionnaire, while the mother's weight immediately after delivery was taken from the mother's KMS or health worker documents. Calorie intake data was taken using the semi-SSQ questionnaire. While data on body weight in the range of 0-6 months, was taken by way of the researcher weighing directly using the same scales for each respondent. research results obtained Exclusive breastfeeding on mothers causing maternal weight loss in the first 6 months postpartum. Weight retention did not occur as in the non-exclusive breastfeeding group.

Role of oral fluid, electrolytes and energy in various pediatric illnesses beyond diarrhea: an Indian expert panel consensus recommendation

Dehydration in non-diarrheal illnesses often goes unnoticed and there are no consensus treatment recommendations for management of dehydration in non-diarrheal illnesses. A multi-disciplinary committee of 10 experts from India gathered on virtual platform in September 2020 to develop consensus recommendation on current treatment strategies for managing oral fluid electrolyte and energy in pediatric patients during non-diarrheal illnesses and to identify unmet needs and gaps. A pre-meeting questionnaire-based voting system was adopted to reach consensus followed by a discussion between panel members. In absence of consensus, the topic was opened for debate to arrive at an aligned recommendation. Key clinical challenges include identifying dehydration in acute illnesses and recommending appropriate quantity and type of oral fluids based on symptom severity. This consensus statement provides guidance on management of dehydration in non-diarrheal illnesses including recommendation on oral fluid, electrolytes, and appropriate energy management in pediatric population. Oral fluid, electrolyte and energy supplementation were recommended based on symptoms in acute non-diarrheal illness increased insensible losses and/or decreased intake. Oral rehydration fluids should be prescribed accurately and at the right-time for countering dehydration, ideally early in the course of illness. Prescribing pattern should be precise and like intravenous fluids. Carbonated drinks and canned juices should not be recommended. Plain water may not be optimal in replacing electrolytes especially for anorexic patients who can only tolerate fluids. These clinical practice statements provide guidance for oral fluid, electrolytes, and energy recommendations for pediatric patients with various acute illnesses beyond diarrhea.

Role of Racecadotril in Children with Acute Diarrhea

Background: Diarrhea is a leading cause of illness and death among children in developing countries. Racecadotril (acetorphan), an enkephalinase inhibitor with antisecretory and anti-diarrheal actions, is an effective and safe treatment for acute diarrhea in adults and children.&#x0D; Objectives: The objective of this study is to evaluate the efficacy and tolerability of racecadotril as a treatment of acute diarrhea in children.&#x0D; Methods: This double-blind, randomized controlled clinical trial was conducted in Dr. MR Khan Children Hospital &amp; Institute of Child Health over 1 year (June 2017- May 2018). The study was approved by the ethical committee of the institute. The efficacy and tolerability of racecadotril (1.5 mg/kg) administered orally 3 times daily) as adjuvant therapy to oral rehydration or intravenous fluid were compared with those of placebo in 40 children aged 3 months to 60 months of children who had acute diarrhea.&#x0D; Results: During the first 72 hours of treatment, patients receiving racecadotril had a significantly lower stool output (grams per hour) than those receiving placebo. The mean (±SE) 72-hours stool output was 54.75± 12.92 g per kilogram in the racecadotril group and 152.50±37.64 g per kilogram in the placebo group (p&lt;0.001). The number of purging is significantly reduced in the racecadotril group than the placebo group (11.95±2.41 Vs 14.85±1.95, p= 0.000) on third day of admission. The duration of hospital stay is significantly lower in the racecadotril group than the placebo group (73.30±23.44 vs. 177.30±25.8. p= 0.000) group. Racecadotril was well tolerated; only 3 patients taking racecadotril had adverse effects like vomiting and 2 patients had hypokalaemia and 3 patients in the placebo group developed vomiting and 1patient developed hypokalaemia which all are mild and transient.&#x0D; Conclusion: In young children with acute watery diarrhea, racecadotril is an effective and safe treatment along with rehydration therapy.&#x0D; DS (Child) H J 2020; 36(1) : 8-13

Utility of early nutritional support by a registered dietitian in pneumonia patients: a trial of withdrawal of peripheral parenteral nutrition using thickened oral rehydration fluids

Utility of early nutritional support by a registered dietitian in pneumonia patients: a trial of withdrawal of peripheral parenteral nutrition using thickened oral rehydration fluids

Does giving dairy calves with diarrhoea a combination of milk and rehydration fluids result in a faster recovery?

### Bottom line One of your dairy clients calls you as he is worried about a few calves starting to scour in the preweaned calf shed. After you have discussed...

Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA.

BackgroundNorovirus is a leading cause of epidemic acute gastroenteritis (AGE), with most outbreaks occurring during winter. The majority of outbreaks are caused by GII.4 noroviruses; however, data to support whether this is true for sporadic medically attended AGE are limited. Therefore, we sought to compare the clinical characteristics and seasonality of GII.4 vs non-GII.4 viruses.MethodsChildren aged 15 days -17 years with AGE symptoms were recruited from the outpatient, emergency department, and inpatient settings at Vanderbilt Children’s Hospital, Davidson County, Nashville, Tennessee, from December 2012 -November 2015. Stool specimens were tested using qRT-PCR for GI and GII noroviruses and subsequently genotyped by sequencing a partial region of the capsid gene.ResultsA total of 3705 patients were enrolled, and stool specimens were collected and tested from 2885 (78%) enrollees. Overall, 636 (22%) samples were norovirus-positive, of which 567 (89%) were GII. Of the 460 (81%) genotyped GII-positive samples, 233 (51%) were typed as GII.4 and 227 (49%) as non-GII.4. Compared with children with non-GII.4 infections, children with GII.4 infections were younger, more likely to have diarrhea, and more likely to receive oral rehydration fluids. Norovirus was detected year-round and peaked during winter.ConclusionsApproximately 40% of sporadic pediatric norovirus AGE cases were caused by GII.4 norovirus. Children infected with GII.4 had more severe symptoms that required more medical care. Seasonal variations were noticed among different genotypes. These data highlight the importance of continuous norovirus surveillance and provide important information on which strains pediatric norovirus vaccines should protect against.

Preliminary Results on the Use of Oral Rehydration Fluid in the Form of Gelato for Rehydration of Patients at the Children’s Clinical University Hospital’s Emergency and Infectiology Units

Oral rehydration fluids (ORS) are used to reverse dehydration that, in case of children, mostly is due to acute gastroenteritis. The key of successful dehydration treatment is to replenish the lost water and electrolytes. This is best done by consuming oral rehydration solution, containing both salt and sugar. ORS enhances fluid absorption because sodium and glucose transport in the small intestine are coupled, and glucose promotes absorption of both sodium ions and water. Studies show that children refuse ORS due to its salty-sweet taste and unpalatability. To improve oral rehydration therapy, we hypothesized that freezing ORS containing a fruit/berry juice to a likeable texture in “gelato” form could promote oral rehydration. The results provide a basis for further development of the ORS gelato with attention to flavor, sweetness and texture.

Relative Efficacy of Probiotics Compared with Oral Rehydration Solution for Diarrhea Treatment in Children under Five Years Old: a Meta-Analysis from Developing Countries

Background : Children under five experience an average of three episodes of diarrhea each year in developing countries. Based on World Health Organization (WHO) guidelines, therapy for acute diarrhea is oral rehydration fluid and zinc to treat fluid and electrolyte loss. But unfortunately, this therapy does not reduce the duration of diarrhea without the intestinal barrier function of pathogenic microorganisms. The ability to inhibit pathogens is one of the three main mechanisms of probiotics. This study aims to examine the efficacy of using probiotics compared to oral rehydration solution (ORS) in the treatment of acute diarrhea in children under five in developing countries. Sub j ects and Method: This study is a meta-analysis conducted using PRISMA systematic guidelines. The process of searching for articles was carried out between 2009 and 2019 using a database search engine consisting of PubMed, British Medical Journal (BMJ), CAB Direct, Oxford Academy, Clinical Key, ScienceDirect, and Scopus. Based on a database search, six articles that meet the criteria of the Randomized Controlled Trial (RCT) and research conducted in developing countries were found. The study involved 1234 children who were divided into two groups: 762 probiotic groups and 472 ORS groups. The analysis was performed with the Review Manager (RevMan) software 5.3. The results were assessed using Standardized Mean Difference (SMD). Results: There was heterogeneity between experiments (I2 = 91%; p <0.001) so Random Effects Model (REM) was used. Probiotics could reduce the duration of acute diarrhea in infants rather than just ORS, with a pooled estimate of 1.13 (SMD = -1.13; 95% CI = -1.54 to -0.72; p <0.001). Conclusion: Probiotics can reduce the duration of acute diarrhea in infants in developing countries rather than just the administration of ORS. Keywords : Diarrhea, probiotics, oral rehydration solution, meta-analysis. Correspondence : Nurul Aini Suria Saputri. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: ainisuriasaputri@gmail.com. Mobile: 085­743401971 Indonesian Journal of Medicine (2019), 4(4): 354-363 https://doi.org/10.26911/theijmed.2019.04.04.08

Detection and Estimation of Arsenic and Lead in Coconut Water-A Kerala Study

Coconut is a popular food ingredient in many parts of the world and the water it contains is believed to be the purest form of natural drink available. The water is rich in potassium, sodium, chloride and many vitamins, and hence is considered the beverage of choice. In medical practice, coconut water is recommended as the preferred oral rehydration fluid in cases of severe dehydration due to diarrhoea. Chronic heavy metal poisoning has been shown to occur from plant products. However there is scanty research work relating to coconuts and heavy metal contamination. Among the various metals, lead is said to be the commonest metal involved. Arsenic is only second to lead in the incidence of chronic toxicity. When plants are exposed to heavy metals, mostly through contaminated water (irrigation), or contaminated soil, they accumulate in edible parts such as the fruits. This study was undertaken to detect the presence of two of the commonest heavy metals - arsenic and lead – in coconut water present in coconuts sold in different parts of Ernakulam district of Kerala state, and to quantitatively assess their levels. It was also decided to detect the differences in the levels of the metals between tender and mature coconut water, and also to detect inter-zonal variations within Ernakulam district in the levels of the two heavy metals, in tender and mature coconut water.

Non-prescribed sale of antibiotics for acute childhood diarrhea and upper respiratory tract infection in community pharmacies: a 2 phase mixed-methods study

BackgroundAlthough prohibited by law and legal regulatory frameworks, non-prescribed sale of antibiotics in community medicine retail outlets (CMROs) remains a serious problem in Ethiopia. The aim of this study was to document the extent of and motivations behind non-prescribed sale of antibiotics among CMROs in Gondar town, Ethiopia.MethodsA 2 phase mixed-methods study (a simulated patient visit followed by an in-depth interview) was conducted among CMROs in Gondar town, Ethiopia. Two clinical case scenarios (acute childhood diarrhea and upper respiratory tract infection) were presented and the practice of non-prescribed sale were measured and results were reported as percentages. Pharmacy staff (pharmacists and pharmacy assistants) were interviewed to examine factors/motivations behind dispensing antibiotics without a valid prescription.ResultsOut of 100 simulated visits (50 each scenarios) presented to drug retail outlets, 86 cases (86%) were provided with one or more medications. Of these, 18 (20.9%) asked about past medical and medication history and only 7 (8.1%) enquired about the patient’s history of drug allergy. The most frequently dispensed medication for acute childhood diarrhoea simulation were oral rehydration fluid (ORS) with zinc (n = 16) and Metronidazole (n = 15). Among the dispensed antibiotics for upper respiratory infection simulation, the most common was Amoxicillin (n = 23) followed by Amoxicillin-clavulanic acid capsule (n = 19) and Azithromycin (n = 15). Perceived financial benefit, high expectation and/or demand of customers and competition among pharmacies were cited as the main drivers behind selling antibiotics without a prescription.ConclusionsA stringent law and policy enforcement regarding the sale of antibiotics without a valid prescription should be in place. This will ultimately help to shift the current pharmacy practices from commercial and business-based interests/practices to the provision of primary healthcare services to the community.

Management of minor ailments in a community pharmacy setting: Findings from simulated visits and qualitative study in Gondar town, Ethiopia.

Community pharmacy professionals are being widely accepted as sources of treatment and advice for managing minor ailments, largely owing to their location at the heart of the community. The aim of the present study was, therefore, to document the involvement of community pharmacy professionals in the management of minor ailments and perceived barriers that limit their provision of such services. Simulated patient (SP) visits combined with a qualitative study using in-depth interviews was conducted among community pharmacy professionals in Gondar town, Northwest Ethiopia. Scenarios of three different minor ailments (uncomplicated upper respiratory tract infection, back pain and acute diarrhea) were selected and results were reported as percentages. Pharmacy professionals were also interviewed about the barriers in the management of minor ailments. Out of 66 simulated visits, 61 cases (92.4%) provided one or more medications to the SPs. Pharmacy professionals in 16 visits asked SPs information on details of symptoms and past medical and medication history. Ibuprofen alone or in combination with paracetamol was the most commonly dispensed analgesics for back pain. Oral rehydration fluid (ORS) with zinc was the most frequently dispensed medication (33.3%) for the management of acute diarrhea followed by mebendazole (23.9%). Moreover, amoxicillin-clavulanic acid capsule (35%) followed by Amoxicillin (25%) were the most commonly dispensed antibiotics for uncomplicated upper respiratory tract infection. Lack of clinical training and poor community awareness towards the role of community pharmacists in the management of minor ailments were the main barriers for the provision of minor ailment management by community pharmacy professionals. Overall, community pharmacists provided inadequate therapy for the simulated minor ailments. Lack of access to clinical training and poor community awareness were the most commonly cited barriers for providing such services. So as to improve community pharmacists’ involvement in managing minor ailments and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers.

Qualitative study of healthcare providers' current practice patterns and barriers to successful rehydration for pediatric diarrheal illnesses in Kenya.

BackgroundFor children worldwide, diarrhea is the second leading cause of death. These deaths are preventable by fluid resuscitation. Nasogastric tubes (NGs) have been shown to be equivalent to intravenous fluids for rehydration and recommended by the World Health Organization (WHO) for use in severe dehydration. Despite this, NGs are rarely used for rehydration in Kenya. Our objective was to evaluate clinicians’ adherence to rehydration guidelines and to identify barriers to the use of NGs for resuscitating dehydrated children.MethodsA case-based structured survey was administered to pediatric care providers in western Kenya to determine their choices for alternative rehydration therapies when oral rehydration and intravenous fluids fail. Providers then participated in a qualitative, semi-structured interview to identify barriers to using nasogastric tubes for rehydration. Analysis included manual, progressive coding of interview transcripts to identify emerging central themes.ResultsOf 44 participants, only four (9%) followed WHO guidelines that recommend quickly switching to NG for rehydration in their case responses. Participants identified that placing intravenous lines in dehydrated children is a challenge. However, when discussing NG use, many believed NGs are not effective for rehydration. Other participants’ concerns surrounded knowledge and training regarding guidelines as well as not having NGs available.DiscussionHealthcare providers in western Kenya do not report using NGs for rehydration in accordance with WHO guidelines for diarrheal illness with severe dehydration. Barriers to the use of NG tubes were lack of knowledge and availability. Education and implementation of guidelines using NG tubes for rehydration may improve outcomes of children suffering from diarrheal illness with severe dehydration.

Diluted apple juice an alternative to oral rehydration fluid for children with mild gastroenteritis

Diluted apple juice an alternative to oral rehydration fluid for children with mild gastroenteritis

Carbohydrate-Electrolyte Characteristics of Coconut Water from Different Varieties and Its Potential as Natural Isotonic Drink

Coconut water is known as a nutritious natural drink. It is not only considered functional, but also nutraceutical. Coconut water is widely used as isotonic drink or oral rehydration fluid, since it showed excellent rehydration index and blood glucose response in previous researches. The quality of isotonic drink is determined by its sugar content (as the source of carbohydrate) and electrolyte content. Moreover, its organoleptic properties should be able to stimulate the urge to spontaniously drink more. However, the processing of coconut water into isotonic drink usually applies ultra high or very low temperature which might deteriorate its nutrition value and organoleptic properties, causing the needs to use a considerable amount of food additives. There are plenty varieties of coconut in Indonesia, each produces different characteristics of coconut water. The objectives of this research are to compare the carbohydrate-electrolyte characteristics of coconut water, and also other essential characteristics from several varieties and to determine which variety is closest to the quality standard of isotonic drink. Therefore, isotonic drink can be developed with only minimum food additives. We compared Dalam Pangandaran, Genjah Salak and Hybrid PB121. The characteristics observed were total sugar, sucrose, glucose, fructose, potassium, sodium, magnesium, vitamin B1, vitamin B6 and vitamin C content, as well as pH, total soluble solids, clarity and colour. Coconut water obatined from Genjah (Dwarf) variety showed the more suitable characteristics for the development of isotonic drink. Thus the product can be developed by cold sterilitation process with minimum food additives.

Targeted therapy of short-bowel syndrome with teduglutide: the new kid on the block.

Extensive intestinal resection impairs the absorptive capacity and results in short-bowel syndrome-associated intestinal failure (SBS-IF), when fluid, electrolyte, acid-base, micro-, and macronutrient homeostasis cannot be maintained on a conventional oral diet. Several factors, including the length and site of the resected intestine, anatomical conformation of the remnant bowel, and the degree of postresection intestinal adaptation determine the disease severity. While mild SBS patients achieve nutritional autonomy with dietary modification (eg, hyperphagia, small frequent meals, and oral rehydration fluids), those with moderate-to-severe disease may develop SBS-IF and become dependent on parenteral support (PS) in the form of intravenous fluids and/or nutrition for sustenance of life. SBS-IF is a chronic debilitating disease associated with a poor quality of life, and carries significant morbidity and health care costs. Medical management of SBS-IF is primarily focused on individually tailored symptomatic treatment strategies, such as antisecretory and antidiarrheal agents to mitigate fluid losses, and PS. However, PS administration is associated with potentially life-threatening complications, such as central venous thromboses, bloodstream infections, and liver disease. In pursuit of a targeted therapy to augment intestinal adaptation, research over the past 2 decades has identified glucagon-like peptide, an intestinotrophic gut peptide that has been shown to enhance intestinal absorptive capacity by causing an increase in the villus length, crypt depth, and mesenteric blood flow and by decreasing gastrointestinal motility and secretions. Teduglutide, a recombinant analog of glucagon-like peptide-2, is the first targeted therapeutic agent to gain approval for use in adult SBS-IF. Teduglutide was shown to result in significant (20%–100%) reduction in PS-volume requirement and have a satisfactory safety profile in three randomized control trials. Further research is warranted to see if reduction in PS dependency translates to improved quality of life and reduced PS-associated complications.

Thermoregulatory Responses Are Attenuated after Fructose but Not Glucose Intake

We examined whether plasma hyperosmolality induced by oral monosaccharide intake attenuated thermoregulatory responses and whether the responses were different between fructose and glucose. Ten healthy young subjects performed three trials in a sitting position in an artificial climate chamber (ambient temperature, 28°C; relative humidity, 40%). After resting for 10 min, the subjects drank 300 mL of water alone (control), or 300 mL of water supplemented with 75 g fructose or 75 g glucose. Twenty minutes later, they were heated passively by immersing the lower legs in water at 42°C for 60 min. Plasma osmolality (Posm), sodium ([Na+]p) and insulin concentrations ([Ins]p), and percent change in plasma volume (%ΔPV) were measured, and esophageal temperature (Tes) thresholds for cutaneous vasodilation (THCVC) and sweating (THSR) at the forearm were determined. Posm was significantly increased by fructose and glucose intake compared with water alone, although %ΔPV and [Na+]p were not significantly different among the three trials. [Ins]p was significantly higher after glucose intake than after fructose or water alone. THCVC and THSR were significantly higher after fructose intake than after glucose intake, which showed similar values to water intake. These results suggest that the Tes threshold for thermoregulation is elevated after fructose intake, indicating the attenuation of thermoregulatory responses, whereas it is not attenuated after glucose intake. These results provide a novel insight to better determine the carbohydrate component of oral rehydration fluids for preventing dehydration and/or heat disorders.

Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria.

Acute diarrhea in children leads to dehydration and death if not appropriately managed. World Health Organization (WHO) recommends treating diarrhea with oral rehydration therapy (ORT), fluids and foods. Proper management is hinged on accurate assessment of patients to identify the acute watery diarrhea. To compare the knowledge and attitude of community pharmacists in the management of acute diarrhea in children with their observed practice. THIS STUDY WAS CARRIED OUT USING TWO INSTRUMENTS: structured self-administered questionnaire to assess knowledge and attitude of community pharmacists in the management of acute diarrhea in children and simulated patient visits to evaluate assessment of patients, recommendation of products and instructions on feeding and fluid intake. The simulated patient visits were done in 186 pharmacies in the city of Lagos, Nigeria. The study reveals that the knowledge and attitude of community pharmacists in the management of acute diarrhea in children was different from their observed practice. The difference was statistically significant (p<0.05). During the simulations, 23% carried out appropriate assessment before recommending any products, and 15% recommended ORT alone. Although information to the pharmacists indicated non-dysentery, non-cholera, acute watery diarrhea, antibiotics and antidiarrheals were irrationally recommended and these were the mainstay of symptoms' management in practice. Questionnaire data revealed that 24% of pharmacists knew the correct instructions to give on food and fluid intake during diarrhea, whereas 8% followed WHO guideline on food and fluid intake during the visits. Assessment of patients to determine acute diarrhea was inadequate. Observed practice in managing acute diarrhea in children was inappropriate and significantly different from their claims in the questionnaire. The recommendation of ORT was scanty and advice on food and fluid intake was inadequate and sometimes inappropriate. This study shows that only 15% of community pharmacists managed acute diarrhea in children according to the WHO guidelines.

Magnitude, distribution, and estimated level of underreporting of acute gastroenteritis in Jamaica.

Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey during the periods of 21 February-7 March and 14-27 June 2009, corresponding to high- and low-AGE season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process, 1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95% CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18 cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7% received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens. The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days, with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly the laboratory aspect, need to be strengthened.