Chronic diarrhoea due to trichohepatoenteric syndrome (THES) in an infant

An infant was admitted with suspected postinfectious malabsorption with watery diarrhoea, fever and failure to thrive. She had dehydration, acute kidney injury and metabolic acidosis, which were corrected with intravenous fluids and managed with empiric antibiotics and prophylactic antifungals. She also developed Escherichia coli sepsis, meningitis and Candida skin infections during hospitalisation, which were treated according to the culture reports. Intrauterine growth restriction, woolly hair and a broad nasal bridge with chronic refractory diarrhoea prompted genetic testing to rule out syndromic diarrhoea. Whole-exome sequencing revealed a pathogenic compound heterozygous mutation causing trichohepatoenteric syndrome. She succumbed to severe infections at 80 days of life. The condition is rare, and no established guidelines or specific treatments exist; the focus is to promote optimal growth through parenteral nutrition, elemental formula and infection control. Early suspicion and molecular genetic testing can help reduce the time to diagnosis, treatment and genetic counselling.

Long term outcomes in children with trichohepatoenteric syndrome

Trichohepatoenteric syndrome (THES) is a rare autosomal recessive disorder caused by mutations in either TTC37 or SKIV2L, usually leading to congenital diarrhea as part of a multisystem disease. Here, we report on the natural history of the disease for the largest UK cohort of patients with THES from 1996 to 2020. We systematically reviewed the clinical records and pathological specimens of patients diagnosed with THES managed in a single tertiary pediatric gastroenterology unit. Between 1996 and 2020, 13 patients (7 female and 6 male) were diagnosed with THES either by mutation analysis or by clinical phenotype. Two patients died from complications of infection. All patients received parenteral nutrition (PN) of which six patients were weaned off PN. All patients had gastrointestinal tract inflammation on endoscopy. Almost half of the cohort were diagnosed with monogenic inflammatory bowel disease (IBD) by the age of 11 years, confirmed by endoscopic and histological findings. Protracted diarrhea causing intestinal failure improves with time in all patients with THES, but monogenic IBD develops in later childhood that is refractory to conventional IBD treatments. Respiratory issues contribute to significant morbidity and mortality, and good respiratory care is crucial to prevent comorbidity.

Traditional Chinese Medicine Moxibustion in the Treatment of Infantile Diarrhea

The main contribution of this research paper is to summarize the results of Meta-analysis of moxibustion in the treatment of infantile diarrhea which is one the common disease and requires considerable attention from the research community and funding organizations. In order to verify that the proposed scheme has merits, a comprehensive searching methodology was adopted by considering various databases such as China Biomedical Literature Database (CBM), China National Knowledge Network Infrastructure (CNKI), Wanfang Database, Pub Med Database, Google Academic, and Cochrane Library. It is important to note that a powerful computer has been utilized to carry out this searching. Finally, only those literature contents are selected which meet the inclusion criteria. Likewise, exclusion criteria was used to exclude irrelevant contents of the literature. RevMan 5.3 was used to analyze the collected data and after reading the titles and abstracts, 29 well-designed studies were selected. Through searching the full text, reading literature, and quality evaluation, 17 papers were finally included. Response rates were reported in all 17 studies, and subgroup analysis was performed based on whether or not other therapies were combined. 7 studies compared the effectiveness of simple moxibustion and conventional therapy in the treatment of infantile diarrhea, and the results showed statistically significant differences [OR = 4.01, 95% CI (2.03, 7.84), P < 0.0001]; 10 studies compared the effectiveness of moxibustion combined with other therapies and conventional therapies in the treatment of diarrhea in children, and the results showed that the difference had general meaning [OR = 4.45, 95% CI (2.83, 7.10), P < 0.00001]. The funnel plot (in Figure) showed that the distribution of included studies was asymmetrical on both sides of the baseline, which could be considered as publication bias. Traditional Chinese medicine moxibustion could effectively relieve the symptoms of infantile diarrhea, and the effect was significant.

Moxibustion for diarrhea in children: A protocol for systematic review and meta-analysis

BACKGROUND

Infantile Diarrhea is a common and frequent digestive tract disease in children. The causes of this disease are relatively complex and the onset time is relatively long. At present, there is no specific treatment method in Western medicine. Moxibustion is a simple and painless external treatment. However, due to the lack of high-quality evidence to support the effectiveness and safety of moxibustion therapy for pediatric diarrhea. Therefore, the purpose of this study is to verify the effectiveness and safety of moxibustion in the treatment of pediatric diarrhea.

METHODS

We will use PubMed, Cochrane Library, Wan Fang Database, Web of Science, China National Knowledge Infrastructure Database, Chinese Science Journal Database, China Biomedical Literature Database to carry out a progressive search of diseases. The study will be screened according to eligibility criteria, and quality of the study will be assessed by using the Cochrane Risk of Bias Tool.

RESULTS

Through this study, we will systematically evaluate the effectiveness and safety of moxibustion in the treatment of pediatric diarrhea.

CONCLUSION

The results of this study will provide reliable evidence of the safety and effectiveness of moxibustion in the treatment of infantile diarrhea, and provide a therapeutic basis for the future clinical application.

ETHICS AND DISSEMINATION

Since this paper does not involve ethical issues, it does not need to pass the review of the ethics committee. It can only collect relevant literature and study.

INPLASY REGISTRATION NUMBER

INPLASY202130091.

A comparative study of the prevalence of zinc deficiency among children with acute diarrhoea in SouthWestern Nigeria

Background

Zinc deficiency has been associated with increased incidence, severity and duration of childhood diarrhoea.

Objective

The objective of the study was to determine the prevalence of zinc deficiency among under-five children with acute diarrhoea.

Methods

The study was a comparative cross-sectional study in which serum zinc levels were determined using atomic absorption spectrometry in under-five children with acute diarrhoea and in apparently healthy contols. Two hundred and fifty children with acute diarrhoea and 250 controls were studied at the Wesley Guild Hospital, Ilesa, Nigeria.

Results

The diarrhoea patients had a mean ± SD serum zinc level of 78.8 ± 35.6 µg/dl, while the controls had a mean of 107.3 ± 46.8 µg/dl. The mean serum zinc level was significantly lower in the patients than the controls (t = -7.66; p < 0.001). Furthermore, the prevalence of zinc deficiency was significantly higher among the patients (30.4% versus 12.4% in the controls; OR = 3.09; 95% CI = 1.94 – 4.90; χ2 = 24.08; p < 0.001). Low social class was associated with a significantly higher prevalence of zinc deficiency among the patients (p = 0.013).

Conclusion

Zinc deficiency is significantly associated with diarrhoea among under-five children in the study community. Hence, routine zinc supplementation should be encouraged for the treatment of diarrhoea, and availability should be ensured.

The role of price and convenience in use of oral rehydration salts to treat child diarrhea: A cluster randomized trial in Uganda

BACKGROUND

Over half a million children die each year of diarrheal illness, although nearly all deaths could be prevented with oral rehydration salts (ORS). The literature on ORS documents both impressive health benefits and persistent underuse. At the same time, little is known about why ORS is underused and what can be done to increase use. We hypothesized that price and inconvenience are important barriers to ORS use and tested whether eliminating financial and access constraints increases ORS coverage.

METHODS AND FINDINGS

In July of 2016, we recruited 118 community health workers (CHWs; representing 10,384 households) in Central and Eastern Uganda to participate in the study. Study villages were predominantly peri-urban, and most caretakers had no more than primary school education. In March of 2017, we randomized CHWs to one of four methods of ORS distribution: (1) free delivery of ORS prior to illness (free and convenient); (2) home sales of ORS prior to illness (convenient only); (3) free ORS upon retrieval using voucher (free only); and (4) status quo CHW distribution, where ORS is sold and not delivered (control). CHWs offered zinc supplements in addition to ORS in all treatment arms (free in groups 1 and 3 and for sale in group 2), following international treatment guidelines. We used household surveys to measure ORS (primary outcome) and ORS + zinc use 4 weeks after the interventions began (between April and May 2017). We assessed impact using an intention-to-treat (ITT) framework. During follow-up, we identified 2,363 child cases of diarrhea within 4 weeks of the survey (584 in free and convenient [25.6% of households], 527 in convenient only [26.1% of households], 648 in free only [26.8% of households], and 597 in control [28.5% of households]). The share of cases treated with ORS was 77% (448/584) in the free and convenient group, 64% (340/527) in the convenient only group, 74% (447/648) in the free only group, and 56% (335/597) in the control group. After adjusting for potential confounders, instructing CHWs to provide free and convenient distribution increased ORS coverage by 19 percentage points relative to the control group (95% CI 13-26; P < 0.001), 12 percentage points relative to convenient only (95% CI 6-18; P < 0.001), and 2 percentage points (not significant) relative to free only (95% CI -4 to 8; P = 0.38). Effect sizes were similar, but more pronounced, for the use of both ORS and zinc. Limitations include short follow-up period, self-reported outcomes, and limited generalizability.

CONCLUSIONS

Most caretakers of children with diarrhea in low-income countries seek care in the private sector where they are required to pay for ORS. However, our results suggest that price is an important barrier to ORS use and that switching to free distribution by CHWs substantially increases ORS coverage. Switching to free distribution is low-cost, easily scalable, and could substantially reduce child mortality. Convenience was not important in this context.

TRIAL REGISTRATION

Trial registry number AEARCTR-0001288.

Association between health service use and diarrhoea management approach among caregivers of under-five children in Nepal

INTRODUCTION

Diarrhoea among children under-five is a serious public health problem in many developing countries, including Nepal. This study aimed to examine the association between health service utilization and diarrhoea management approaches among children under-five years in Nepal.

METHODS

The combined 2001, 2006 and 2011 Nepal Demographic and Health Survey (NDHS) data sets were examined and the sample included 2,655 children aged 0-59 months who had diarrhoea 2-weeks prior to the each survey. Multilevel logistic regression analyses that adjust for clustering and sampling weight were used to examine the association between health service utilization and diarrhoea management approaches (Oral Rehydration Solution, increased fluids and/or continued feeding).

RESULTS

The prevalence of extra fluids decreased significantly from 27% in 2001 to 15% in 2011 while that of ORS increased significantly from 32% in 2001 to 40% in 2011. The prevalence of continued feeding fluctuated between 83-89%. Multivariate analysis revealed that caregivers whose children received treatment or advice from health care providers during diarrhoea were 5.78 times more likely to treat diarrhoea with Oral Rehydration Solution (ORS) [adjusted Odds Ratio (aOR) 5.78, 95% confidence interval (CI) 4.50, 7.44], 1.56 (aOR 1.56, 95% CI 1.19, 2.05) times more likely to offer extra fluids, and 2.25 (aOR 2.25, 95% CI 1.50, 3.39) times more likely to use continued feeding than those who did not seek advice.

CONCLUSIONS

Our findings indicate that health service utilization significantly improves diarrhoea management among under-five children. However, a broader national diarrhoeal disease control program to further reduce diarrhoea related morbidity and mortality in Nepal should focus on educating caregivers about the importance of the use of ORS as well as increase fluid intake to children under-five years with diarrhoea.

Tricho-hepato-enteric syndrome with novel SKIV2L gene mutations: A case report

RATIONALE

Tricho-hepato-enteric syndrome (THES) is a rare disorder caused by mutations in the TTC37 or SKIV2L genes and characterized by chronic diarrhea, liver disease, hair abnormalities, and high mortality in early childhood due to severe infection or liver cirrhosis.

PATIENT CONCERNS

The patient is the second child of three siblings born to non-consanguineous healthy Japanese parents. She had intrauterine growth retardation and was delivered at 33 weeks of gestation due to placental abruption. She presented with watery diarrhea, elevated levels of liver enzymes, multiple episodes of recurrent bacterial infection, and mild mental retardation. She had facial dysmorphism, including prominent forehead and hypertelorism, and had woolly hair without trichorrhexis nodosa.

DIAGNOSIS

Clinical features led to consideration of THES. Novel compound heterozygous nonsense mutations, c.1420G>T (p.Q474*) and c.3262G>T (p.E1088*), in the SKIV2L gene were identified in the patient, and decreased levels of SKIV2L protein expression were revealed by flow cytometry and confirmed by western blot analysis using patient peripheral blood mononuclear cells (PBMCs).

INTERVENTIONS

Total parenteral nutrition was required from day 30 to day 100. Trimethoprim-sulfamethoxazole prophylaxis was started at the age of 7 years after multiple episodes of bacterial pneumonia and otitis media.

OUTCOMES

Chronic diarrhea persisted for more than 10 years, but the symptoms gradually improved with age. At the age of 13 years, she started a normal diet in combination with oral nutritional supplementation and her height and weight were just below the 3rd percentile for healthy individuals. She developed secondary sex characteristics, and menarche occurred at the age of 12 years. Facial dysmorphism, including prominent forehead and hypertelorism, and woolly hair without trichorrhexis nodosa became noticeable as she matured.

LESSONS

Physicians must be aware of THES when they encounter a patient with infantile diarrhea, hair abnormalities, immune deficiency, mental retardation, and liver disease. Moreover, flow cytometric detection of SKIV2L protein in PBMCs may facilitate early diagnosis.

Oral zinc provision in acute diarrhea

PURPOSE OF REVIEW

The clinical management of acute diarrhea is based on the use of oral rehydration salts and appropriate nutrition. In addition, the WHO and The United Nations Children's Fund recommend zinc supplementation for diarrhea in children below 5 years. This article aims at reviewing recent literature on the effects of oral zinc for treating acute diarrhea in children.

RECENT FINDINGS

Recent studies confirm that zinc supplementation has a benefit in children below 5 years with acute diarrhea in countries at medium or high risk of zinc deficiency. A few small trials have reported a benefit of zinc in children at low risk of zinc deficiency, with heterogeneity in results. No recent study has explored the effects of zinc in children younger than 6 months, and in this age group previous research refuted any benefit from zinc.

SUMMARY

Current literature supports the use of oral zinc in treating diarrhea in children older than 6 months, especially if at risk of zinc deficiency, such as children with poor diets exposed to recurrent gastrointestinal infections. More research is needed to confirm findings in children at low risk of zinc deficiency. Currently there is no evidence that zinc benefits children younger than 6 months.

Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria

BACKGROUND

In Nigeria, diarrhea remains one of the leading causes of death among children under five years old. Oral Rehydration Therapy (ORT) corners were introduced to health facilities in Bauchi and Sokoto states to serve as points of treatment for sick children and equip caregivers with necessary skills in case management of diarrhea and diarrhea prevention.

OBJECTIVES

The operations research study examined the effect of facility-based ORT corners on caregivers' knowledge and skills in management of simple and moderate diarrhea at home, as well as caregivers' and service providers' perceived facilitators and barriers to utilization and delivering of ORT corner services. It also examined whether ORT activities were conducted according to the established protocols.

METHODS

This quantitative study relied on multiple sources of information to provide a complete picture of the current status of ORT corner services, namely surveys with ORT corner providers (N = 21), health facility providers (N = 23) and caregivers (N = 229), as well as a review of service statistics and health facility observations. Frequency distribution and binary analysis were conducted.

RESULTS

The study revealed that ORT corner users were more knowledgeable in diarrhea prevention and management and demonstrated better skills for managing diarrhea at home than ORT corner non-users. However, the percentage of knowledgeable ORT users is not optimal, and providers need to continue to work toward improving such knowledge. ORT corner providers identified a lack of supplies as the major barrier for providing services. Furthermore, the study revealed a lack of information, education and communication materials, supportive supervision, and protocols and guidelines for delivering ORT corner services, as well as inadequate documentation of services provided at ORT corners.

RECOMMENDATIONS

Recommendations for ORT corners program planners and implementers include ensuring all ORT corners have oral rehydration salt (ORS) packages and salt, sugar, and zinc tablets in stock, a secured commodity supply chain to avoid stockouts, and adequate policies and procedures in place.

Knowledge about prevention and management of acute diarrhoea among caregivers of children aged under 5 years treated at an emergency department in Pernambuco, Brazil

BACKGROUND

The World Health Organization stresses the need for training families in the adequate management of acute diarrhoea to reduce child mortality and morbidity. This study analysed caregiver knowledge about diarrhoea prevention and management in north-east Brazil.

METHODS

Cross-sectional study of 213 children aged under 5 years treated at a public emergency department in Pernambuco, Brazil. Caregiver knowledge was assessed with a questionnaire.

RESULTS

Caregivers believed that breastfeeding until age 6 months, not using tap water for food preparation, vaccination against rotavirus and other diseases help prevent diarrhoea. Regarding treatment, caregivers reported taking children to the hospital at the first sign of diarrhoea (57.3%), administering medication (68.1%) and withholding solids (63.7%). Only 40.8% knew how to prepare oral rehydration solution; 78.4% believed it could cure diarrhoea. Only 43.9% of caregivers mentioned one or more signs of dehydration.

CONCLUSIONS

Caregivers in this region had limited knowledge of appropriate diarrhoea management.

Estimation of maternal and child mortality one year after user-fee elimination: an impact evaluation and modelling study in Burkina Faso

OBJECTIVE

To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso.

METHODS

Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change, we used interrupted time series, propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility, and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea, antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios.

FINDINGS

Coverage increased for all variables, however, the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact, the intervention saved approximately 593 (estimate range 168-1060) children's lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189-228) in 2009. If a similar intervention were to be introduced nationwide, 14,000 to 19,000 (estimate range 4000-28,000) children's lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios.

CONCLUSION

In this setting, eliminating user fees increased use of health services and may have contributed to reduced child mortality.

Spatial variation of management of childhood diarrhea in Malawi

This study reports the spatial variability in household management of diarrhea among under-fives in Malawi. Using data from 2010 Malawi Demographic and Health Survey, we examined oral rehydration and feeding practices of mothers and caregivers of 3105 children with an episode of diarrhea by mapping district effect residual in geo-additive probit model and analyzing residual spatial effects in a Bayesian approach. The findings suggest that although diarrhea is relatively less prevalent in the Northern Region, this region lags behind in terms of adoption of appropriate practices for home-based management of diarrhea in children compared to the Central Regions and Southern Regions. A cluster of five predominantly rural districts in the eastern part of the Southern Region showed remarkably high level of household care for childhood diarrhea relative to the rest of the country. The fixed effects show the importance of breastfeeding, paternal education, wealth index, and ethnicity on oral rehydration, while paternal education, marital status, and ethnicity show significant influence on feeding for children with a diarrhea episode. The paper discusses the apparent inverse relationship between regional prevalence of diarrhea episodes and care-seeking practices for childhood diarrhea in Malawi, and makes relevant recommendations for policy.

Prevalence, clinical predictors, and outcome of hypocalcaemia in severely-malnourished under-five children admitted to an urban hospital in Bangladesh: a case-control study

Hypocalcaemia is common in severely-malnourished children and is often associated with fatal outcome. There is very limited information on the clinical predicting factors of hypocalcaemia in hospitalized severely-malnourished under-five children. Our objective was to evaluate the prevalence, clinical predicting factors, and outcome of hypocalcaemia in such children. In this case-control study, all severely-malnourished under-five children (n=333) admitted to the Longer Stay Ward (LSW), High Dependency Unit (HDU), and Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b between April 2011 and April 2012, who also had their total serum calcium estimated, were enrolled. Those who presented with hypocalcaemia (serum calcium <2.12 mmol/L) constituted the cases (n=87), and those admitted without hypocalcaemia (n=246) constituted the control group in our analysis. The prevalence of hypocalcaemia among severely-malnourished under-five children was 26% (87/333). The fatality rate among cases was significantly higher than that in the controls (17% vs 5%; p < 0.001). Using logistic regression analysis, after adjusting for potential confounders, such as vomiting, abdominal distension, and diastolic hypotension, we identified acute watery diarrhoea (AWD) (OR 2.19, 95% CI 1.08-4.43, p = 0.030), convulsion on admission (OR 21.86, 95% CI 2.57-185.86, p = 0.005), and lethargy (OR 2.70, 95% CI 1.633-5.46, p = 0.006) as independent predictors of hypocalcaemia in severely-malnourished children. It is concluded, severely-malnourished children presenting with hypocalcaemia have an increased risk of death than those without hypocalcaemia. AWD, convulsion, and lethargy assessed on admission to hospital are the clinical predictors of hypocalcaemia in such children. Presence of these features in hospitalized children with severe acute malnutrition (SAM) should alert clinicians about the possibility of hypocalcaemia and may help undertake potential preventive measures, such as calcium supplementation, in addition to other aspects of management of such children, especially in the resource-poor settings.

Persistent diarrhea: still a serious public health problem in developing countries

Diarrhea is still responsible for high rates of morbidity and mortality in children under 5 years of age. The prolongation of the acute episode may cause digestive and absorptive malfunction and, consequently, malnutrition, raising the risk of death. The objective of this review is to supply the most recent knowledge in the field of persistent diarrhea and to contribute to the decrease of its incidence. Some possible etiologic agents may be involved, including viruses, bacteria, and parasites. Treatment must be addressed to avoid malabsorption of the nutrients of the diet, associated with replacement of the hydroelectrolytic losses, to prevent its prolongation. In the great majority of the episodes, antibiotics are not indicated. Breastfeeding, introduction of safe dietary strategies to prevent protein-energy malnutrition, and improvement of sanitary conditions and hygiene are measures to be promoted with the objective of decreasing the morbidity/mortality of the diarrheic disease in children less than 5 years of age.

Perceptions regarding oral rehydration solutions for the management of diarrhea in Guatemalan children: implications for diarrheal management in the Americas

OBJECTIVE

To describe knowledge and perceptions regarding the use of oral rehydration solution (ORS) for the management of diarrheal diseases among formal and informal health care providers and community caregivers in the Guatemalan department of Santa Rosa, and to recommend strategies to increase ORS use for management of diarrhea in children.

METHODS

From July to September 2008, in-depth, semi-structured interviews were conducted with formal health care providers; open-ended interviews were conducted with informal health care providers; and focus group discussions and pile sorting were carried out with community caregivers.

RESULT

The study participants attributed episodes of diarrhea in children to culturally recognized or folk ailments (empacho, cuajo, and varillas) that are primarily treated by traditional healers. There were knowledge deficits about 1) dehydration as a manifestation of diarrhea, and 2) management of dehydration, including the use of ORS and the need to continue feedings during diarrheal episodes. Caregivers perceived bottled/ready-made ORS products and the more expensive over-the-counter antidiarrheal medications as superior to ORS packets in the treatment of diarrhea.

CONCLUSIONS

In Guatemala, folk etiologies of disease differ from those of the biomedical establishment and influence the decisions made by caregivers when treating ill children, including those related to the use of ORS. Public health campaigns addressing the treatment and management of diarrheal diseases in Santa Rosa should recognize the ailments known as empacho, cuajo, and varillas and target them for ORS use by community caregivers as well as health care providers in both the formal and informal health sectors.

Health care-seeking behavior during childhood diarrheal illness: results of health care utilization and attitudes surveys of caretakers in western Kenya, 2007-2010

We interviewed caretakers of 1,043 children < 5 years old in a baseline cross-sectional survey (April to May 2007) and > 20,000 children on five separate subsequent occasions (May of 2009 to December 31, 2010) to assess healthcare seeking patterns for diarrhea. Diarrhea prevalence during the preceding 2 weeks ranged from 26% at baseline to 4-11% during 2009-2010. Caretakers were less likely to seek healthcare outside the home for infants (versus older children) with diarrhea (adjusted odds ratio [aOR] = 0.33, confidence interval [CI] = 0.12-0.87). Caretakers of children with reduced food intake (aOR = 3.42, CI = 1.37-8.53) and sunken eyes during their diarrheal episode were more likely to seek care outside home (aOR = 4.76, CI = 1.13-8.89). Caretakers with formal education were more likely to provide oral rehydration solution (aOR = 3.01, CI = 1.41-6.42) and visit a healthcare facility (aOR = 3.32, CI = 1.56-7.07). Studies calculating diarrheal incidence and healthcare seeking should account for seasonal trends. Improving caretakers' knowledge of home management could prevent severe diarrhea.

Health care seeking for childhood diarrhea in developing countries: evidence from seven sites in Africa and Asia

We performed serial Health Care Utilization and Attitudes Surveys (HUASs) among caretakers of children ages 0–59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case-control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0–11 months of age), from 0.4% to 4.7% for toddlers (12–23 months of age), and from 0.3% to 2.4% for preschoolers (24–59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15–56%, 17–64%, and 7–33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial HUASs as a tool for optimizing operational and methodological issues related to the performance of a large case-control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings.

Health Care Utilization and Attitudes Survey: understanding diarrheal disease in rural Gambia

Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0–11, 12–23, and 24–59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1–9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1–23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population.

Oral rehydration salt use and its correlates in low-level care of diarrhea among children under 36 months old in rural Western China

BACKGROUND

Since 2000, there has been a decline in the proportion of oral rehydration salts (ORS) therapy in childhood diarrhea. How to sustain and achieve a high level of ORS therapy continues to be a challenge.

METHODS

The data of 14112 households and 894 villages in 45 counties across 10 provinces of Western China were collected in 2005. Generalized estimated equation logistic regression models were used to identify the determinants of ORS use in home-based and village-level care.

RESULTS

The therapy rate of ORS was 34.62%. This rate in home-based care (HBC) was significantly lower than that in village-level care (VLC), township-level care or county-level-or-above care. The children in the families with several pre-school-aged children (OR = 0.29 95% CI: 0.10, 0.86) or of the smaller age (12 vs 36 months: OR = 0.10 95% CI 0.02, 0.41; 24 vs 36 months: OR = 0.26 95% CI 0.09, 0.77) were less likely to receive ORS therapy against diarrhea in HBC. The children whose family had the habit of drinking boiled water (OR = 2.77 95% CI 1.30-5.91), or whose caretakers received educational materials about childhood diseases (OR = 3.08 95% CI 1.54, 6.16), or who were living in the villages in which village clinics had the available ORS packages (OR = 3.94 95% CI 2.25, 6.90) were more likely to receive ORS therapy against diarrhea in VLC.

CONCLUSION

There thus, ORS promoting program should give the highest priority to home care. ORS promoting strategies for low-level care could be strengthened based on children characteristics, the habit of drinking water and the situation of receiving educational material in the families and on the availability of ORS packages in village clinics in rural Western China.

Global paediatric advanced life support: improving child survival in limited-resource settings

Nearly all global mortality in children younger than 5 years (99%) occurs in developing countries. The leading causes of mortality in children younger than 5 years worldwide, pneumonia and diarrhoeal illness, account for 1·396 and 0·801 million annual deaths, respectively. Although important advances in prevention are being made, advanced life support management in children in developing countries is often incomplete because of limited resources. Existing advanced life support management guidelines for children in limited-resource settings are mainly empirical, rather than evidence-based, written for the hospital setting, not standardised with a systematic approach to patient assessment and categorisation of illness, and taught in current paediatric advanced life support training courses from the perspective of full-resource settings. In this Review, we focus on extension of higher quality emergency and critical care services to children in developing countries. When integrated into existing primary care programmes, simple inexpensive advanced life support management can improve child survival worldwide.

Reinforcing outpatient medical student learning using brief computer tutorials: the Patient-Teacher-Tutorial sequence

BACKGROUND

At present, what students read after an outpatient encounter is largely left up to them. Our objective was to evaluate the education efficacy of a clinical education model in which the student moves through a sequence that includes immediately reinforcing their learning using a specifically designed computer tutorial.

METHODS

Prior to a 14-day Pediatric Emergency rotation, medical students completed pre-tests for two common pediatric topics: Oral Rehydration Solutions (ORS) and Fever Without Source (FWS). After encountering a patient with either FWS or a patient needing ORS, the student logged into a computer that randomly assigned them to either a) completing a relevant computer tutorial (e.g. FWS patient + FWS tutorial = "in sequence") or b) completing the non-relevant tutorial (e.g. FWS patient + ORS tutorial = "out of sequence"). At the end of their rotation, they were tested again on both topics. Our main outcome was post-test scores on a given tutorial topic, contrasted by whether done in- or out-of-sequence.

RESULTS

Ninety-two students completed the study protocol with 41 in the 'in sequence' group. Pre-test scores did not differ significantly. Overall, doing a computer tutorial in sequence resulted in significantly greater post-test scores (z-score 1.1 (SD 0.70) in sequence vs. 0.52 (1.1) out-of-sequence; 95% CI for difference +0.16, +0.93). Students spent longer on the tutorials when they were done in sequence (12.1 min (SD 7.3) vs. 10.5 (6.5)) though the difference was not statistically significant (95% CI diff: -1.2 min, +4.5).

CONCLUSIONS

Outpatient learning frameworks could be structured to take best advantage of the heightened learning potential created by patient encounters. We propose the Patient-Teacher-Tutorial sequence as a framework for organizing learning in outpatient clinical settings.

Community case management of childhood diarrhea in a setting with declining use of oral rehydration therapy: findings from cross-sectional studies among primary household caregivers, Kenya, 2007

We sought to determine factors associated with appropriate diarrhea case management in Kenya. We conducted a cross-sectional survey of caregivers of children < 5 years of age with diarrhea in rural Asembo and urban Kibera. In Asembo, 61% of respondents provided oral rehydration therapy (ORT), 45% oral rehydration solution (ORS), and 64% continued feeding. In Kibera, 75% provided ORT, 43% ORS, and 46% continued feeding. Seeking care at a health facility, risk perception regarding death from diarrhea, and treating a child with oral medications were associated with ORT and ORS use. Availability of oral medication was negatively associated. A minority of caregivers reported that ORS is available in nearby shops. In Kenya, household case management of diarrhea remains inadequate for a substantial proportion of children. Health workers have a critical role in empowering caregivers regarding early treatment with ORT and continued feeding. Increasing community ORS availability is essential to improving diarrhea management.

[Acute infantile diarrhea treated with infantile Tuina: a multicentre randomized controlled trial]

OBJECTIVE

To generalize the application of Tuina in treating infantile diseases and evaluate the validity and safety of Tuina.

METHODS

By a multicentre randomized controlled study, 240 patients were randomly divided into an observation group (n = 180) and a control group (n = 60). The observation group was treated by tonifying Pijing and clarifying Dachangjing, and Tuina on Lanmen, Qi, Fu Shangqijiegu, Guiwei and Zusanli (ST 36), etc. Banmen and Sanguan were used as the supplementary point according to the syndrome differentiation. The control group was treated by oral administration of Smecta. After 5 day treatments, Chinese syndrome score and the clinical effect were evaluated.

RESULTS

After the third and fifth treatment, the Chinese syndrome score of both groups descended obviously. The decline of the observation group was superior to that of the control group (all P < 0.01). The cured rate of 75.6% (136/180) in the observation group was better than 21.7% (13/60) in the control group (P < 0.001). The clinical cured rate of 95.0% (171/180) according to Chinese syndrome score in the observation group was better than 58.3% (35/60) in the control group (P < 0.001). There was no adverse reaction in both groups.

CONCLUSION

Infantile Tuina has a better therapeutic effect in the treatment of acute infantile diarrhea than oral administration of Smecta.

Cost-effectiveness of improving pediatric hospital care in Nicaragua

OBJECTIVE

To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures.

METHODS

Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness.

RESULTS

Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204).

CONCLUSIONS

After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

[Congenital diarrhoea]

Congenital diarrhoea of heterogenic etiology is a rare cause of chronic diarrhoea. Characteristic features are: onset in the first weeks of life, life-threatening severe dehydratation and electrolyte disorders leading to a necessity of long-term parenteral nutrition. The clinical onset may be delayed and the degree of diarrhoea may be modest, making the diagnosis difficult. The main causes of congenital diarrhoea such as intestine electrolytes, carbohydrates, lipid and protein transport disorders and congenital enzymatic deficiencies, enterocyte polarization disorders, hormonal, immunological, metabolic, genetic and congenital anatomic disorders are presented in the paper. Some of them, such as: microvillus inclusion disease, tufting enteropathy, intestinal anedocrynosis, IPEX syndrome (immunodysregulation polyendocrinopathy enteropathy X-linked syndrome) have been described recently. One of the basic investigations, when congenital diarrhea is suspected, is general examination of the stool, its electrolyte concentration and serum electrolytes and blood gas analysis. Often, small bowel biopsy with histological examination (with the use of electronic microscopy and PAS staining) is indicated. In some cases molecular examination is possible and indicated. In differential diagnosis other, more frequent causes of chronic diarrhea of infancy, have to be excluded. In most of the cases of congenital diarrhoea there is no casual treatment available - usually long-term parenteral nutrition is necessary.

Evaluation of a social marketing intervention promoting oral rehydration salts in Burundi

BACKGROUND

Diarrhea is the second leading cause of death for children under five in Burundi; however, use of oral rehydration salts (ORS), the recommended first-line treatment, remains low. In 2004, PSI/Burundi launched a social marketing intervention to promote ORASEL among caregivers of children under five; the product was relaunched in 2006 with a new flavor. This study evaluates the intervention after the ORASEL relaunch, which included mass media and interpersonal communication activities. The study looks at trends in ORASEL use in Burundi and in behavioral determinants that may be related to its use.

METHODS

In 2006 and 2007, PSI conducted household surveys among Burundian females of reproductive age (15-49). Both surveys used a two-stage sampling process to select 30 households in each of 115 rural and urban collines throughout the nation. Survey respondents were asked about diarrhea treatment-related behavior; key behavioral determinants; and exposure to the ORASEL intervention. Data were analyzed to identify trends over time, characteristics of ORASEL users, and associations between exposure to the intervention and changes in ORASEL use and related behavioral determinants.

RESULTS

ORASEL use among caregivers at their children's last diarrheal episode increased significantly from 20% in 2006 to 30% in 2007, and there were also desirable changes in several behavioral determinants associated with ORASEL use. Evaluation analysis showed that a higher level of exposure to the social marketing campaign was associated with greater use of ORASEL and with significant improvements in perceived availability, knowledge of the signs of diarrhea and dehydration, social support, and self-efficacy.

CONCLUSIONS

ORS use can be improved through social marketing and educational campaigns that make the public aware of the availability of the product, encourage dialogue about its use, and increase skills and confidence relating to correct product preparation and administration. Further interventions in Burundi and elsewhere should promote ORS through a variety of mass media and interpersonal communication channels, and should be rigorously evaluated in the context of the total market for diarrhea treatment products.

Effectiveness of packed rice-oral rehydration solution among children with acute watery diarrhea

OBJECTIVE

This study aims to compare the effectiveness between the packed rice-oral rehydration solution (R-ORS) and the glucose-based oral rehydration solution (G-ORS) in children with acute watery diarrhea.

MATERIAL AND METHOD

Randomized control trial was conducted to compare duration of diarrhea, stool frequency, incremental weight gain, intravenous fluid requirement, and duration of admission. Subjects were 70 pediatric patients (9-60 months-old) and were equally divided into two groups (n=35 for each): treatment group (with R-ORS treatment) and control group (with G-ORS treatment). The data were collected during January 1, 2007 to January 2008. All patients were treated with oral rehydration therapy within first 4 hours of admission. Intravenous rehydration was also scheduled. Both groups were fed with rice gruel or lactose-free formula as tolerated.

RESULTS

Using survival analysis, both duration of diarrhea and admission was significantly shortened in the treatment group compared to the control group. (27.5 hrs. vs. 40.5 hrs: p = 0.01 and 40.1 hrs. vs. 56.0 hrs: p = 0.02 respectively). However, stool frequency, incremental weight gain and intravenous fluid requirement between the two groups remained insignificantly different.

CONCLUSION

R-ORS was more effective in the management of acute watery diarrhea in children. Duration of diarrhea and treatment was shortened when compared to G-ORS.

Performance of a community-based health and nutrition-education intervention in the management of diarrhoea in a slum of Delhi, India

Diarrhoeal infections are the fifth leading cause of death worldwide and continue to take a high toll on child health. Mushrooming of slums due to continuous urbanization has made diarrhoea one of the biggest public-health challenges in metropolitan cities in India. The objective of the study was to carry out a community-based health and nutrition-education intervention, focusing on several factors influencing child health with special emphasis on diarrhoea, in a slum of Delhi, India. Mothers (n=370) of children, aged >12-71 months, identified by a door-to-door survey from a large urban slum, were enrolled in the study in two groups, i.e. control and intervention. To ensure minimal group interaction, enrollment for the control and intervention groups was done purposively from two extreme ends of the slum cluster. Baseline assessment of knowledge, attitudes, and practices on diarrhoea-related issues, such as oral rehydration therapy (ORT), oral rehydration salt (ORS), and continuation of breastfeeding during diarrhoea, was carried out using a pretested questionnaire. Thereafter, mothers (n=195) from the intervention area were provided health and nutrition education through fortnightly contacts achieved by two approaches developed for the study--'personal discussion sessions' and 'lane approach'. The mothers (n=175) from the control area were not contacted. After the intervention, there was a significant (p=0.000) improvement in acquaintance to the term 'ORS' (65-98%), along with its method of reconstitution from packets (13-69%); preparation of home-made sugar-salt solution (10-74%); role of both in the prevention of dehydration (30-74%) and importance of their daily preparation (74-96%); and continuation of breastfeeding during diarrhoea (47-90%) in the intervention area. Sensitivity about age-specific feeding of ORS also improved significantly (p=0.000) from 13% to 88%. The reported usage of ORS packets and sugar-salt solution improved significantly from 12% to 65% (p=0.000) and 12% to 75% (p=0.005) respectively. The results showed that health and nutrition-education intervention improved the knowledge and attitudes of mothers. The results indicate a need for intensive programmes, especially directed towards urban slums to further improve the usage of oral rehydration therapy.

Greater years of maternal schooling and higher scores on academic achievement tests are independently associated with improved management of child diarrhea by rural Guatemalan mothers

Appropriate home management can alleviate many of the consequences of diarrhea including malnutrition, impaired development, growth faltering, and mortality. Maternal cognitive ability, years of schooling, and acquired academic skills are hypothesized to improve child health by improving maternal child care practices, such as illness management. Using information collected longitudinally in 1996-1999 from 466 rural Guatemalan women with children <36 months, we examined the independent associations between maternal years of schooling, academic skills, and scores on the Raven's Progressive Matrices and an illness management index (IMI). Women scoring in the lowest and middle tertiles of academic skills scored lower on the IMI compared to women in the highest tertile (-0.24 [95% CI: -0.54, 0.07]; -0.30 [95% CI: -0.54, -0.06], respectively) independent of sociodemographic factors, schooling, and Raven's scores. Among mothers with less than 1 year of schooling, scoring in the lowest tertile on the Raven's Progressive Matrices compared to the highest was significantly associated with scoring one point lower on the IMI (-1.18 [95% CI: -2.20, -0.17]). Greater academic skills were independently associated with maternal care during episodes of infant diarrhea. Schooling of young girls and/or community based programs that provide women with academic skills such as literacy, numeracy and knowledge could potentially improve mothers' care giving practices.

How do pharmacists manage acute diarrhoea in an 8-month-old baby? A simulated client study

OBJECTIVES

Community pharmacists claim a role in health care based on their added value as counsellors and providers of pharmaceutical care. The aim of this study was to assess to what extent they fulfil this role with respect to the management of acute diarrhoea in an 8-month-old baby. METHODS In February 2008, two female simulated clients of 55 and 35 years old visited 101 Belgian pharmacies. Both entered the pharmacy and said: 'I'm here for my grandchild/ my sister's baby. She has diarrhoea.' They only provided more information if the pharmacist asked for it. All the questions and the verbal advice provided by the pharmacist were audio-recorded and the suggested medicines were registered.

KEY FINDINGS

One pharmacist did not ask any questions. All the other pharmacists asked the age of the child, 19% asked how long the symptoms had been on-going, 27% asked whether the baby had a fever and 24% inquired about vomiting. Seventy-five per cent of the pharmacists emphasized the importance of sufficient fluid intake and/or the risk of dehydration, while 4% described how to recognize such dehydration symptoms. Oral rehydration solution was suggested by 30% of the pharmacists, while 86% suggested the yeast probiotic Saccharomyces boulardii. Of the 28% spontaneously giving dietary advice, no-one said that normal feeding should restart 'as soon as possible'. Thirty-one per cent advised consulting a doctor, either immediately or in the case of the symptoms not improving after a while.

CONCLUSIONS

Apart from inquiring about the child's age, the majority of pharmacists asked too few questions to be able to analyse the situation properly. Ample information was provided on the risk of dehydration, but counselling on the suggested medicines was insufficient.

[Efficiency of lactose-free formula feeding as an adjunctive therapy in infants with acute diarrhea]

OBJECTIVE

To study the efficiency of lactose-free formula feeding as an adjunctive therapy in infants with acute diarrhea.

METHODS

A rigorous double-blind, randomized, controlled equivalence trial was performed. One hundred and twenty infants with acute diarrhea were randomly divided into two groups: lactose-free formula and conventional formula feeding. The two groups were given conventional medical treatment and oral rehydration therapy. The therapeutic effects were observed 1 week after treatment.

RESULTS

The cure rate and the total effective rate were 58.3% and 96.7% respectively in the lactose-free formula group, and they were 8.3% and 85.0% respectively in the conventional formula group. There were significant differences in the therapeutic effect between the two groups (p<0.05). The duration of diarrhea remission (3.17+/-1.04 days) in the lactose-free formula group was significantly shorter than that in the conventional formula group (5.25+/-1.58 days) (p<0.05). After treatment the incidence of fecal flora disturbance was lower in the lactose-free formula group than that in the conventional formula group (p<0.05). No aderverse events were observed in the two groups.

CONCLUSIONS

Lactose-free formula feeding together with conventional therapy can significantly shorten the disease course and improve the treatment outcome in infants with acute diarrhea.

Prevention and management of gastrointestinal infections in infants from a nutritional perspective

This article considers infections of the gastrointestinal (GI) tract. This is a complex organ, which exists in a range of environments. Despite containing defence mechanisms against microorganisms, GI infections are common throughout infancy; however, the risk of infection can be reduced through careful hygiene and the encouragement of breast-feeding. Although research into the role of dietary factors in preventing or treating GI infection is in its early days, there is some evidence for the use of prebiotics and probiotics. The role of health care professionals is to give parents and carers advice to manage these infections, and to differentiate those infants at risk of dehydration, or those where diarrhoea and vomiting signifies something more serious. Informing parents and carers about the treatment and management of minor ailments will also help avoid unnecessary demand on the health service associated with regular consultation about these conditions.

Resource utilization and costs of treating severe rotavirus diarrhea in young Mexican children from the health care provider perspective

BACKGROUND

Rotavirus is the most common cause of severe diarrhea in infants. The economic costs of treating severe rotavirus can be quite significant and are important to include in any evaluation of prevention programs. The aim of this study was to determine utilization of health care resources and costs incurred due to severe diarrhea associated with rotavirus infection in Mexican children < 5 years of age.

MATERIAL AND METHODS

The costs of rotavirus infection evaluated in this observational study consisted of hospital, emergency room care and out-patient visit expenses at three hospitals of the Mexican Institute of Social Security throughout 1999-2000. Service costs were estimated from costs of care for rotavirus versus non-rotavirus diarrhea obtained through a follow-up study data of 383 children and administrative records.

RESULTS

Diarrhea cases due to rotavirus infection comprised 36% of the sample. Participants with rotavirus diarrhea spent an average of 3.2 days in the hospital, 5.9 hours in the emergency room, and had 1.3 visits to an outpatient physician's office. Some differences in the consumption of health care were found between rotavirus and non-rotavirus diarrhea cases, although the mean costs of rotavirus and nonrotavirus cases were not significantly different. The mean cost per case of severe rotavirus diarrhea was estimated to be US $936. The total cost of treating severe rotavirus diarrhea, including 5,955 rotavirus hospitalizations for 2004, was estimated at US $5.5 million.

CONCLUSION

Health care costs due to treatment for severe rotavirus diarrhea are a significant economic burden to the Mexican Social Security system.

Metchnikoff and the centenary of probiotics: an update of their use in gastroenteric pathology during the age of development

Acute gastroenteritis, antibiotic-associated diarrhea, diarrhea due to Clostridium difficile and traveller's diarrhea, Helicobacter pylori infection and intestinal inflammatory diseases are primitive and/or secondary pathological conditions that alter the intestinal mucosa and microbiota. For years researchers have searched for solutions to restore and rebalance normal transit and intestinal flora. Elia Metchnikoff was the first one to introduce oral bacteriotherapy, that uses very efficient microorganisms that prevent putrefaction and aging. Oral bacteriotherapy has now evolved in probiotics, whose helpful action to prevent and treat some gastroenteric pathologies is currently being studied.

[Multi-central randomized controlled investigation on the massage for supplementing qi and removing obstruction in the Governor Vessel for treatment of infantile diarrhea due to spleen deficiency]

OBJECTIVE

To make multi-central clinical evaluation of the massage for supplementing qi and removing obstruction in the Governor Vessel for treatment of infantile diarrhea due to spleen deficiency.

METHODS

By using multi-central, randomized and controlled method, 275 cases were randomly divided into an observation group (n = 137) and a control group (n = 138). The observation group were treated by the massage for supplementing qi and removing obstruction in the Governor Vessel, and the control group by routine massage therapy in Tuina Science, a teaching material for college and school of TCM. After treatment for 7 days, their therapeutic effects were compared.

RESULTS

The cured rate was 83.2% in the observation group and 69.6% in the control group with a signifi cant difference between the two groups (P < 0.05), the former being better than the latter. The mean cured time was (3.22 +/- 1.04) days in the observation group and (4.20 +/- 1.11) days in the control group with a significant difference between the two groups (P < 0.05), the former being shorter than the latter.

CONCLUSION

The massage for supplementing qi and removing obstruction in the Governor Vessel has a definite therapeutic effect on infantile diarrhea due to spleen deficiency, with rapid effect.

Enterotoxigenic Escherichia coli (ETEC): a recurring decimal in infants' and travelers' diarrhea

Enterotoxigenic Escherichia coli (ETEC) is an important cause of diarrhea in infants and in travelers from developed to underdeveloped countries, especially in regions of poor sanitation. The ETEC are acquired by the ingestion of contaminated food and water, and adults living in endemic areas develop immunity. The disease condition manifests as a minor discomfort to a severe cholera-like syndrome and requires colonization by the microorganism and the elaboration of one or more enterotoxins. The ETEC attach to the epithelial cells of the gastrointestinal tract and release substances that affect the normal functioning of the tract, thereby resulting in diarrhea, and subsequently millions of deaths everyday, particularly in children. The prevention of the spread of this strain of diarrheagenic E. coli depends on ensuring appropriate sanitary measures; hand-washing and proper preparation of food; chlorination of water supplies; and appropriate sewage treatment and disposal. Parenteral or oral fluid and electrolyte replacement is used to prevent dehydration, and broad-spectrum antibiotics are used in chronic or life-threatening cases, but in most cases, should be avoided because of severe side effects.

[Clinical observation on drug-separated moxibustion at Shenque (CV 8) for treatment of infantile autumn diarrhea]

OBJECTIVE

To observe therapeutic effect of drug-separated moxibustion at Shenque (CV 8) for treatment of infantile autumn diarrhea.

METHODS

One hundred and thirty-six cases were randomly divided into an obser vation group and a control group, 68 cases in each group. The observation group were treated with drug-separated moxibustion at Shenque (CV 8) and the control group with oral administration of Smecta. The mean diarrhea-stopping time, the negative conversion rate of Human Rotavirus antigen in stool after treatment for 72 h, and the markedly-effective rate and the total effective rate were observed after treatment for 6 days in the twO groups.

RESULTS

The markedly-effective rate and the total effective rate were 79.4% and 94.1% in the observation group and 35.3% and 75.0% in the control group, respectively, with very significantly or significantly difference between the two groups (P < 0.01 or P < 0.05); the mean diarrhea-stopping time in the observation group was shorter than that in the control group (P < 0.01); the negative conversion rate of Human Rotavirus antigen in stool after treatment for 72 h was 88.2%0 in the observation group and 69.1% in the control group with a very significantly difference between the two groups (P < 0.01).

CONCLUSION

Drug-separated moxibustion at Shenque (CV 8) has a significant therapeutic effect on infantile autumn diarrhea, helps negative conversion of Human Rotavirus antigen in stool and shortens duration of disease.