Risk Of Persistent Diarrhea Research Articles

Effect of dose reduction of supplemental zinc for childhood diarrhoea: study protocol for a double-masked, randomised controlled trial in India and Tanzania

BackgroundDiarrhoea-associated mortality and morbidity are highest in infants and young children in low-income and middle-income countries (LMICs). Zinc supplementation during acute diarrhoea has been shown to reduce the duration of...

THE RATIONALE FOR ALPHA-INTERFERON IMMUNOTHERAPY IN INFANTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS AND ACUTE INVASIVE INTESTINAL INFECTION

Background: Acute intestinal infections in children are a considerable medical and social problem worldwide. Immune therapy could help to reduce the frequency of post-infectious functional intestinal dysfunction in patients with comorbidities. Aim: To evaluate the efficacy of human recombinant interferon alpha-2b, administered at acute phase of an acute invasive intestinal infection to infants in the first months of age, suffering from functional bowel disorders. Materials and methods: This was an open-label, randomized (envelope method), prospective study in two parallel groups. The study included 59 infants of the first months of life, who were breastfed, had a history of intestinal dysfunction and were hospitalized to an infectious department. We studied efficacy of recombinant interferon alpha-2b administered in rectal suppositories at a dose of chromatography with measurement of short-chain fatty acids. Results: Standard treatment was ineffective in 63.3% (95% CI 43.9–80.0%) of patients. Administration of interferon alpha-2b reduced the rate of treatment failure by day 14 to 32% (95% CI 9–56%) and the risk of persistent diarrhea for more than one month to 29% (95% CI 5–53%). In those patients who were administered interferon, inflammation at days 25 to 55 was less severe and the levels of i-forms of short-chain fatty acids were lower. Conclusion: Immunotherapy with recombinant interferon alpha-2b seems to be a promising way to improve combination treatment of acute invasive intestinal infections in infants with a history of intestinal dysfunction, as it reduces the risk of post-infectious intestinal disorders.

Recent Advances and Evidence Gaps in Persistent Diarrhea

Recent Advances and Evidence Gaps in Persistent Diarrhea

Risk factors for persistent diarrhea in infants

Persistent diarrhea is a multicausal disease. The analysis of risk factors for persistent diarrhea includes environmental and biological variables as well as therapeutical management. To identify risk factors for persistent diarrhea among children hospitalized with acute diarrhea. This is a case-control study. The sample consisted of 212 infants under 24 months, hospitalized with acute diarrhea, at the "Instituto Materno-Infantil de Pernambuco", Recife, PE, Brazil. Cases were infants with persistent diarrhea and controls those with acute diarrhea. Cases and controls were compared to a series of socio-economic, biological and clinical variables, previous morbidities and therapeutic management prior to hospital admission. Unadjusted and adjusted odds ratio were used with the respective 95% confidence intervals. It was adopted the level of significance of 5%. Logistic regression analysis was conducted to control for potential confounding factors. The risk of persistent diarrhea was higher for infants with: dysentery, fever at the onset of diarrhea, fasting and taking antibiotics prior to hospital admission. The variables that showed the highest adjusted odds ratios for persistent diarrhea were infants living in households without refrigerator and perianal hyperemia at hospital admission. The improvement of environmental conditions and an adequate clinical management of diarrhea for hospitalized infants may contribute to the reduction of diarrhea morbidity.

Episode-specific risk factors for progression of acute diarrhoea to persistent diarrhoea in West African children

The aim of the present study, carried out in Guinea-Bissau, West Africa, was to identify episode-specific risk factors for persistent diarrhoea (PD) related to clinical observations and management efforts. We followed 319 episodes of childhood diarrhoea by repeated household interviews until the episode stopped or after 14 days with diarrhoea. Children who still had diarrhoea after 14 days ( n = 40, 12·5% of episodes) were regarded as suffering from PD. Clinical signs, perceived by the mother, were recorded together with care-seeking behaviour and management actions. Tired and rapid breathing prior (OR = 6·52 (95% CI 1·69-25·1)), mother had to force breast feeding (OR = 8·01 (2·99-21·5)) and current infection with Cryptosporidium (OR = 5·53 (2·10–14·6)) were the most important independent risk factors for the development of PD. Late consultation (>48 h) was associated with PD, reflecting that these episodes initially were less acute. Use of oral rehydration salts did not have an impact on development of PD, whereas home medication tended to increase the risk of PD. Our study confirms the close association between systemic illness and PD as well as the importance of cryptosporidiosis as a cause of PD. We were unable to identify management factors with a significant influence on the risk of developing PD.

Persistent diarrhea in a cohort of Israeli Bedouin infants: role of enteric pathogens and family and environmental factors.

This study examined the role of enteric pathogens and infant, family, and household characteristics in persistent diarrhea. Bedouin infants from southern Israel were followed from birth to age 18-23 months. During monthly home visits, stool samples were obtained, and feeding practices and history of diarrhea were determined, and at age 3 months, an environmental assessment was done. Diarrhea surveillance was either via a network covering all community health care facilities or via weekly interviews with the mother. None of the enteric pathogens examined, including Cryptosporidium parvum and enteroaggregative Escherichia coli, were associated with persistent diarrhea. In multivariate analyses, age at first diarrheal illness and maternal age and maternal education were independently and significantly associated with the risk of persistent diarrhea. These data suggest that persistent diarrhea is a clinical entity that may be related less to a specific enteric pathogen and more to the health experiences of children and their home environment.

Type of milk feeding during acute diarrhoea and the risk of persistent diarrhoea: a case control study.

The role of feeding breast milk, unmodified bovine milk or adapted infant formula during acute diarrhoea in protecting against or causing persistence of the episodes was investigated in a population-based case control study in an urban area of north India. After adjustment for confounding variables, exclusive breast-feeding was associated with an odds ratio of 0.06 (95% CI 0.002-2.1), a 16.5 times lower odds in favour of developing persistence of an episode. Infants fed unmodified bovine milk in addition to breast milk had an odds of 2.5 times (95% CI 1.0-9.9) in favour of developing persistence of acute diarrhoea (p = 0.04). In infants receiving unmodified bovine milk and no breast milk, this odds ratio was 11.1 (95% CI 1.0-228.8) (p = 0.05). This study indicates that promoting exclusive breastfeeding may reduce the persistence of diarrhoea over and above its effect in decreasing the incidence of acute diarrhoea. In urban areas of the developing countries where working mothers often use milk supplementation beyond the age of three months, our findings suggest that use of adapted spray dried formula may be safer than unmodified bovine milk with respect to the risk of developing persistent diarrhoea.

Association of indicators of hygiene behavior with persistent diarrhea of young children.

We examined the association between water and hygiene-related behaviors and persistent diarrhea (duration > or = 14 days) among children under age three years in an indigenous rural Guatemalan community. Behavior indicators were specific aspects of the appearance of the mother, study child, other children and household that could be observed using a spot observation technique. Thirty-four percent of children had one or more episodes of persistent diarrhea during the year of study. Bivariate analyses found that a higher proportion of observations in which the anti-hygienic condition was observed was significantly associated with persistent diarrhea for 11 of 26 behavior indicators; these 11 indicators were also strongly correlated with each other. In individual logistic regression models, which included overall rate of diarrhea and other child characteristics associated with persistent diarrhea, six behavior indicators maintained significant association with persistent diarrhea: presence of toy on the ground, presence of baby bottle on the ground, the hands of the mother being dirty, presence of a fecally soiled diaper on the ground in the household compound, presence of feces in the yard, and the study child wearing a fecally soiled diaper. Three additional indicators closely approached significant association with persistent diarrhea. Excluding the three soiled diaper indicators, which might be the result rather than the cause of diarrhea, we found the six other behavior indicators to demonstrate a significant dose-response effect in increasing risk of persistent diarrhea. These findings suggest that behaviors which promote increased exposure of young children to enteric pathogens increase risk of persistent diarrhea.