Oral Rehydration Research Articles

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.

Acute Diarrhea in Early Post-Transplant Period in Living Donor Kidney Transplant Recipients

Background: Acute diarrhea is common in Myanmar. People are so used to diarrhea at least once a year that they do not think diarrhea as an important problem. Acute diarrhea in early post-operative period in renal transplant recipient may result in pre-renal failure and delay graft function. This study aimed to identify the prevalence of diarrhea, its severity and response to treatment in early post-operative period (3 weeks after transplant) in living donor kidney transplant (LDKT) recipients. Patients and Methods: LDKT recipients having acute diarrhea in early post-transplant period at two transplant centers (Mingaladon and Nay Pyi Taw) in Myanmar were analyzed over 10 years period; from 2013 to 2023 September. Acute diarrhea is defined as three or more semisolid or liquid stools per day for a minimum of 1 day duration. It was a hospital based observational study. After obtaining diet history and physical examination, laboratory tests were done. Clinical parameters (diet, fever, features of oral candidiasis, features of dehydration, examination of abdomen), stool examination (stool inspection, stool examination for ova and cyst, stool for Clostridium difficle toxin, stool culture), blood tests (total WBC count, serum creatinine, liver function tests) and blood trough level for Tacrolimus and mycophenolate mofetil were done. Management was given according to algorithm and their response to treatment was recorded. Dose modification of immunosuppressants were done depending on full blood count and blood level of them. Results: A total of 230 LDKT recipients were observed; among them, thirteen percent (30/230) of recipients developed acute diarrhea in early post-operative period. The age ranged from 14 to 73 years. A majority of them had mild form; mild dehydration without significant changes in hemodynamic status. The peak onset of diarrhea was 4 to 5 days after transplant; majority resolved over one week. They did not have oral candidiasis. Abdominal examination was normal except mild tenderness over grafted kidney in all of them. Total WBC count and platelet count were normal except in two cases. Stool examination did not show trophozoite or cyst. Stool for Clostridium difficile toxin was not identified. With dietary modification and oral rehydration solution, their motion was back to normal in sixteen percent (5/30). Folic acid therapy with or without probiotics made resolution of diarrhea in 33.3% (10/30). Anti-infective therapy was given in 10% (3/30) of cases; norfloxacin to 2 cases. Intravenous colistin to one case as he had enterocolitis and septicemia due to Klebsiella pneumonia. His stool culture as well as blood culture showed Carbepenem resistant Klebsiella pneumonia; he was known case of myelodysplastic syndrome. Blood level of mycophenolate mofetil was normal; however, the dose was reduced in 2 cases owing to leucopenia or thrombocytopenia. Blood tacrolimus trough level was normal in two-third (20/30); and, it was high in one-third of them (20/30). They passed formed stool 24 - 48 hours after dose reduction of tacrolimus. Conclusion: In this study, 13% of the LDKT recipients had acute diarrhea in early post-operative period. Majority of them had mild form. Half of them recovered with oral rehydration solution, diet modification, folic acid and probiotics. Only one tenth of them had infective in origin and responded to anti-infective therapy. Raised blood tacrolimus trough level was found in one third of LDKT recipients with acute diarrhea; diarrhea improved dramatically after reduction of tacrolimus dose.

Randomized Clinical Trial Comparing The Effect Of Oral Rehydration Therapy With And Without Racecadotril In The Management Of Acute Diarrhea In Children

Objective: This study aimed to investigate the beneficial effect of racecadotril in children with acute diarrheal illness. Methods: This randomized case-control study was conducted at Watim General Hospital over four months from April to July 2023. A total of 120 children aged 3 months to 12 years with acute diarrhoea were included and randomly allocated to two groups. Group A (n=60) received standard treatment with oral rehydration therapy, while Group B (n=60) received oral rehydration therapy, zinc, probiotics, and racecadotril. The primary outcome measured was the mean duration of illness, and the secondary outcome was the number of stools 48 hours after the start of treatment. Data were collected using a pre-designed proforma and analyzed using SPSS version 24. Results: The study population had an average age of 50.35±41.52 months, with equal gender distribution. The mean duration of illness in Group A was 2.72±1.34 days, while in Group B, it was 2.70±1.29 days. There was no statistically significant difference in the mean duration of illness between the two groups (p=0.945). Conclusion: This study did not demonstrate a significant reduction in the mean duration of illness for children with acute gastroenteritis using standard treatment with or without racecadotril. Further investigations and large-scale studies may be needed to establish the efficacy of racecadotril in the management of acute diarrhoea in children. Keywords: Acute diarrhoea, ORS, Racecadotril.

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.

Role of nursing in the management of acute diarrheal diseases. Decalogue

Acute diarrheal diseases (ADEs) are a major cause of morbidity and mortality, especially in children under five years of age and the elderly, aggravated by limited access to safe water and sanitation in developing countries. This paper highlights the crucial role of nursing in the management of ADEs, focusing on oral rehydration, health education and infection control. Nurses not only administer treatments, but also educate communities on hygiene and nutritional practices. Implementation of effective nursing strategies can significantly reduce the incidence and severity of ADEs, improving the quality of life of affected patients. Ten key recommendations for the management of these diseases are presented, emphasizing the importance of prevention, early diagnosis and continuous follow-up.

Oral rehydration beverages for treating exercise-associated dehydration: a systematic review.Part I: carbohydrate-electrolyte solutions.

Exercise-associated dehydration is a common problem, especially at sporting events. Although there are recommendations to drink a certain volume per kg body mass lost after exercise, there is no clear guidance about the type of rehydration beverage. The aim of this systematic review is to assess the effectiveness of carbohydrate-electrolyte solutions as a rehydration solution for exercise-associated dehydration. Medline (via the PubMed interface), Embase and the Cochrane Library were searched for relevant studies. The search is up to date until June 2022. Controlled trials involving adults and children were included if dehydration was the result of physical exercise and if drinking carbohydrate-electrolyte solutions, of any percentage carbohydrate, was compared with drinking water. All languages were included as long as an English abstract was available. Data on study design, study population, interventions, outcome measures and study limitations were extracted from each included article. Certainty was assessed using GRADE. Out of 3485 screened articles, 19 studies were included that assessed carbohydrate-electrolyte solutions (0% - 9% carbohydrate) compared with water. Although there is variability amongst the identified studies, drinking 0-3.9% and, especially, 4-9% carbohydrate-electrolyte (CE) solution may be effective for rehydration. A potential beneficial effect of drinking CE drinks compared with water was seen for many of the reviewed outcomes. Commercial CE drinks (ideally 4-9% CE drinks or alternatively 0-3.9% CE drinks) could be suggested for rehydration in persons with exercise associated dehydration when whole foods are not available.

Dehydration: Need For an Improved Rehydrating Energy Drink

Oral rehydration therapy (ORT) is the cornerstone treatment for managing dehydration. However, ORT cannot “halt” the underlying intestinal fluid loss, a significant mechanism of infectious organisms responsible for causing diarrhea. Reports have demonstrated the role of calcium in treating contagious diarrhea through the calcium-sensing receptor (CaSR), which is absent in oral rehydration solution (ORS). CaSR is a novel target that has demonstrated its effectiveness in treating diarrhea. CaSR is activated by a simple calcium agonist, an easily accessible, inexpensive, and safe-to-use option in the pediatric population. Adding nutrients would be simple and may increase the efficacy of the current ORS treatment. Maltodextrin (MDs) over glucose in ORS has shown benefits in these patients as the osmolality of MDs is significantly lower than that of disaccharide sugars. Thus, adding multivitamins, nutrients, and energy boosters to WHO- ORS may improve the efficacy of ORS in treating diarrhea, reducing malnutrition, and providing energy to curb fatigue.

Acute gastroenteritis-changes to the recommended original oral rehydrating salts: a review.

The World Health Organization recommended a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis. While of value for the replacement of fluids and electrolytes, the formulation does not reduce stool volume, frequency, or symptom duration. This may prevent wide acceptance. To increase tolerability, shorten the duration of diarrhea and improve parental quality of life, several modifications to the original formula have been proposed. These include; low osmolarity, rice-based, glucose polymers as an alternative to glucose, the addition of probiotics, prebiotics and/or zinc, and various other ingredients. Here we summarize evidence regarding such changes and additions.

Comparison between Preoperative Overnight Fasting Versus Oral Rehydration Solution (ORS) Administration Until Two Hours before Abdominal Surgery Under General Anaesthesia

Background: Preoperative fasting is a major concern to protect the gastric aspiration which is very dangerous. However overnight fasting is uncomfortable and has many deleterious effects on the human body. In many countries fasting until 2 to 3 hours before surgery has been practiced but in Bangladesh, overnight fasting is still being practiced in routine cases.
 Objectives: The objective of this study was to compare the effectiveness between preoperative overnight fasting and oral rehydration solution administration until two hours before abdominal surgery under general anaesthesia.
 Methods: A total of 100 patients of ASA (American Society of Anesthesiologist) class I and II, age above 18 years, and BMI < 30 kg/m2 were scheduled for abdominal surgery under GA (General Anaesthesia) were included in this study. Then all patients were randomized into two groups as patients who were on overnight fasting for 10 hours (Group A-Controlled, n=50), and patients who were on ORS until 2 hours before abdominal surgery (Group B-ORS, n=50). All patients had their last meal at 11 AM before the day of surgery. Patients in group A will not take anything orally or via any route, except their ongoing vital medications if present. Patients in group B received 500 ml of standard ORS in the early morning on the day of surgery after waking up from bed (from 05 AM to 06 AM) and another 500 ml until 2 hours before the surgery (06 AM to 07 AM). As the primary outcome gastric residual volume and gastric fluid pH in both group was measured immediately after anaesthesia induction. Several physiological measures (thirst and hunger, nausea/vomiting, cognitive function) were measured with the help of a preformed questionnaire.
 Results: Mean gastric residual volume immediately after induction was statistically significant (p<0.05) between the two groups. However, the mean gastric fluid pH was statistically insignificant (p>0.05). The ORS group (Group B) became less thirsty before surgery (P=0.001). Postoperative nausea/vomiting (PONV) was less in group B (P=0.029) than in group A. The patient’s recovery time was significantly less in ORS group (P=0.003). Postoperative cognitive performance was better in group B (P=0.001).
 Conclusions: Oral rehydration solution administration until two hours before surgery is effective and can be considered routinely before abdominal surgery conducted under general anaesthesia except for delayed gastric emptying.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 20-27

Assessing the relationship of recommended diarrhea case management practices with the nutritional status of children aged between 0 to 59.9 months.

Background Paediatric diarrhoea and malnutrition have a bidirectional relationship, which in turn augments the presence of each other. The diarrhoeal diseases in children can be prevented by using oral rehydration solution (ORS) and oral zinc sulfate. The relationship between paediatric diarrhoea treatment guidelines with the nutritional status is not yet investigated, and this study primarily aims to examine the relationship of recommended diarrhoea case management practices with paediatric undernutrition (wasting, stunting and underweight) among children aged between 0 to 59 months. Methods Data from Pakistan Demographic & Health Surveys (PDHS) conducted in 2012–2013 and 2017–2018 were used in this study to investigate the relationship between paediatric diarrhoea treatment adherence with the various forms of paediatric undernutrition. Data from children with complaints of acute watery non-dysenteric diarrhoea was used in this study, whereas data from those children presented with complaints of either dysentery, and/or severe dehydration, and/or incomplete anthropometry were excluded. Children were classified as complete adherent, partial adherent and non-adherent based on ORS and oral zinc sulfate consumption. The relationship of diarrhoea case management practices with different types of nutritional status was assessed using a binomial logistic regression method. Results The malnutrition in children with acute non-dysenteric diarrhoea is 54.2% in 2012–2013, which decreased to 48.2% in the succeeding survey of 2017–2018. Only 6.2% (1% in 2012–2013 ~ 10% in 2017–2018) children of Pakistan received appropriate treatment for managing their diarrhoea. However, no relationship between the diarrhoea case management and paediatric undernutrition was observed. Conclusion This study found did not demonstrate a significant connection of diarrhoea case management strategies with paediatric undernutrition. This highlights the complexity of addressing both diarrhoea and malnutrition in children. Future research should emphasize the identification and resolution of the multifactorial factors, which contribute to paediatric undernutrition, integrating both diarrhoea management and nutritional improvement strategies.

Barriers to acute management of diarrhea in the home setting: An explorative study of under-five caregivers in southwestern Nigeria

Objectives: Diarrhea remains the second leading cause of morbidity and mortality among children under 5 years of age. Persistent mortality and poor outcomes despite available treatments such as oral rehydration salts (ORS) and zinc tablets are indicators of possible barriers to home management among under-five caregivers. This study was designed to explore the potential barriers encountered by under-five caregivers in providing home management for acute diarrhea within the first 24 hours of recognition. Materials and Methods: This qualitative study was conducted among under-five caregivers attending Primary Health Centers in Ikorodu Local Government Area of Lagos State, Nigeria. Twelve under-five caregivers, who indicated in the larger cross-sectional study that they did not provide any form of home management for the child within the first 24 hours of recognizing diarrhea were interviewed. Interviews were recorded. Naturalized transcription, peer in vivo inductive coding, and debriefing w ere done. Th ematic a nalysis was c onducted and findings were presented as themes and subthemes. Results: Three themes emerged: (1) Waiting for natural stoppage of diarrhea, (2) perceived function of ORS/ zinc, and (3) disconnect between potential consequences of diarrhea and action taken. Subthemes include perceived cause and seriousness of diarrhea, misdiagnosis, misinformation on the functions of ORS/ zinc from health-care providers, and lack of awareness of potential consequences of untreated diarrhea. Conclusion: The study showed that the main barriers to providing adequate home management were caregivers’ perception of the cause and seriousness of diarrhea and the misinformation about the function of ORS and zinc therapy. Continuous and accurate education of under-five caregivers would improve the timely initiation of ORS/ zinc and correct home management of acute 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

Pharmacological Management of Cholera: A Century of Expert Opinions in Cecil Textbook of Medicine.

Cholera is a potentially lethal diarrheal disease produced by Vibrio cholerae serotypes O1 El Tor and O139. Known since antiquity, the condition causes epidemics in many areas, particularly in Asia, Africa, and South America. Left untreated, the mortality may reach 50%. The crucial therapeutic intervention is intravenous or oral rehydration and correction of acidosis, dyselectrolytemia, and renal impairment. Antibiotic use represents the main pharmacological intervention. What are the milestones of the antibiotics use recommended by experts for the pharmacological management of cholera in the past century? To determine the changes in the experts' approach to the management of cholera and particularly the use of antibiotics as presented in a widely used textbook in the United States. The chapters describing the management of cholera in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Sulfonamides were recommended in 1947, followed by the introduction of tetracyclines, chloramphenicol, and furazolidone in 1955. The options were restricted in 2000 to doxycycline. In the past decade, patients infected with strains known to have a degree a resistance to tetracyclines were treated with azithromycin or ciprofloxacin. Antibiotic use decreases the volume of stool and the duration of diarrhea but has not been considered lifesaving. Drugs with antimotility, antiemetic, or antisecretory properties are not useful. The utility of antibiotic use in cholera has been endorsed by experts, but only as an adjunct to rapid and complete fluid and electrolyte replacement.

Role of Fluid Resuscitation and Supportive Management of Diarrhea

The pediatric population is sensitive in every aspect. There are several parts of their bodies that need extreme levels of care and support until these children have reached a mature age. Similarly, there are several aspects of health that require immediate and urgent intervention, particularly in the pediatric population for better care and management. The reason behind this is the delicate and sensitive nature of the children’s health. Compromising any aspect of pediatric care might lead to severe consequences, which could be life-threatening too. Therefore, it is in the best interest of both the parents of the children and the physicians to be vigilant about the affected children’s symptoms just so they do not miss out on any important signs that could be transient or short-lived. Diarrhea is among the pediatric conditions that can very easily take a turn for the worse if it is not managed appropriately. Diarrhea can lead to severe consequences, including death in children, especially the malnourished ones. Diarrhea results in the excessive excretion of water, and electrolytes including sodium, potassium, bicarbonate, and zinc through watery stools. Dehydration ensues when these losses are not sufficiently replenished, leading to deficits in both water and electrolytes. The extent of dehydration is categorized based on symptoms and signs that mirror the quantity of fluid expelled. Depending upon these extents and degrees of dehydration, performing immediate resuscitation measures might be necessary. Among these measures, oral rehydration therapy is considered to be one of the most useful ones. It helps replenish the electrolytes rapidly and without causing any life-threatening consequences, especially when done within the specified time. On the brighter side, these fluid resuscitative measures might be the only interventions required to stop the child's progression further towards a severe form of the disease. This review is based on this fact only, and it revolves around the importance of performing fluid resuscitation and other elementary-level supportive measures that might be the only shot at saving the life of the child if done at an early stage. Thai review will help take action under the right circumstances if such a case arises in the clinical setting.

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.

Nutritional status of under-5 Rohingya Children admitted for Diarrheal Diseases at Primary Health Centers in Cox’s Bazar District of Bangladesh

Background: One of the leading causes of mortality and morbidity in under-5 children is Diarrhea. Malnutrition, in association with the diarrheal disease, affect children negatively. On 2018, Bangladesh saw massive influx Rohingya people with almost 29% under-5 children. Objective: The purpose of the present study was to determine the prevalence of malnutrition among children admitted with acute diarrheal diseases at the Primary health Centers at Cox’s Bazar. Methodology: This cross-sectional study was conducted among the diarrhea affected under-5 Rohingya children who reported to primary health centers at cox’s bazar. The study was conducted from January to December 2018. Primary caregiver of 276 respondents were interviewed, their hospital records were reviewed. Data were collected by face-toface interview using a semi-structured questionnaire. Results: The majority (60.1%) of the participants were male. Only 2.9% of the participants reported passing of macroscopic blood in stool. Oral Rehydration Solution (ORS) was not taken by most of the participants (50.7%), prior to visit to the hospital. The mean (±SD) age was 18.54 (±12.44) months. Among the participants, 14.1% had severe underweight (<-3 WAZ score) and 27.2% had moderate underweight (-3 to <-2 WAZ score). No death was reported, and 97.1% were discharged with advice from the hospital. Statistically significant relationship was found between age of the participants and underweight (p<0.05) with a Moderate effect size (Φ=.21). Conclusion: The study findings would be helpful to identify the need for raising awareness among Rohingya caregiver and help healthcare providers to become more cautious in treating diarrheal patients. Bangladesh Journal of Infectious Diseases, June 2023;10(1):31-37

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.

AMBA CUP: Ensuring Accuracy in Measurement of Volume of Water for Salt Sugar Solution or Oral Rehydration Solution Preparation in Diarrhea Management.

Diarrhea remains a major cause of under-five mortality globally. In 2016, it accounted for 8% of under-five mortality worldwide. Most of these deaths occur in developing countries. Fluid replacement using Oral Rehydration Solution (ORS) or Salt Sugar Solution (SSS), has been the mainstay of diarrhea management. Gaps in knowledge and practice regarding the preparation of these solutions have been identified by various researchers. One challenge encountered by healthcare providers and caregivers of under-five children has been lack of a standard, easy to clean cup for measurement of accurate volume of water for ORS or SSS preparation. Soft drink bottles, which are currently being used, are difficult to clean because of their narrow necks. More so, the size and volume of these bottles change so often that non-numerate caregivers get easily confused. The aim of this paper is to introduce the AMBA CUP, an easy-to-clean cup that can be used to accurately measure one litre of water for SSS or ORS preparation.

Oral rehydration solution (ORS) for fasting doping: Examining the Twitter data in Indonesia.

Oral rehydration solution (ORS) or oralit is a sugar and salt-based solution that restores electrolyte balance, counters dehydration and mitigates metabolic acidosis. In Indonesia, particularly during the month of Ramadan, the use of ORS as a form of fasting doping has become increasingly prevalent. This study aimed to analyze the patterns of communication, key influencers, and sentiment within the Twitter network in Indonesia regarding the use of ORS as fasting doping. From March 15 to March 26, 2023, Twitter data was collected using NodeXL software. The dataset was then analyzed using NodeXL and Gephi software to identify key influencers and patterns within the network. To assess attitudes towards the use of ORS as fasting doping expressed in tweets, sentiment analysis was conducted using Azure Machine. The dataset consisted of 13,746 tweets, from which the analysis revealed that Twitter discourse concerning the use of ORS as fasting doping demonstrated a diverse range of individuals. The top five users with the highest betweenness centrality scores were medical doctors, mention and confess (menfess) accounts, and personal accounts. The sentiment analysis of the collected tweets unveiled a relatively high negative sentiment toward the use of ORS for fasting purposes. Notably, the proportion of positive and neutral sentiments were comparable. Our data indicate that ORS use as fasting doping is controversial in Indonesia. Most tweets express concerns about misuse and negative consequences, indicating a need for guidance and regulation from public health authorities. Further research and guidelines are necessary to ensure the safe and appropriate use.