Home Management of Diarrhea among Underfives in a Rural Community in Kenya: Household Perceptions and Practices

Introduction: Diarrheal disease is a major cause of morbidity and mortality among under-fives especially in rural and peri-urbancommunities in developing countries. Home management of diarrhea is one of the key household practices targeted for enhancement in the Community Integrated Management of Childhood Illness (C-IMCI) strategy. Objective: The aim of this study was to determine the perceptions of mothers/caregivers regarding the causes of diarrhea among under-fives and how it was managed in the home before seeking help from Community Health Workers or health facilities. Design: A household longitudinal study was conducted in Nyando district; Kenya in 2004-2006 adopting both qualitative and quantitative approaches. Subjects: A total of 927 mothers/caregivers of under-fives participated in the study. Main outcome measures: Perceived causes of childhood diarrhoea; action taken during diarrhea; fluid intake; recognition of signs of dehydration; feeding during convalescence; adherence to treatment and advice. Results: Majority of the respondents 807(87.1) reported that their children had suffered from diarrhea within the last 2 weeks before commencement of the study. Diarrhea was found to contribute to 48of child mortality in the study area. Perceived causes of diarrhea were: unclean water 524(55.6); contaminated food 508(54.9); bad eye 464 (50.0); false teeth 423(45.6) and breast milk 331(35.8). More than 70of mothers decreased fluid intake during diarrhea episodes. The mothers perceived wheat flour; rice water and selected herbs as anti-diarrheal agents. During illness; 239(27.8) of the children were reported not to have drunk any fluids at all; 487(52.5) drunk much less and only 93(10.0) were reported to have drunk more than usual. A significant 831(89.6) withheld milk including breast milk with the notion that it enhanced diarrhea. Conclusion: Based on these findings; there is need to develop and implement interactive communication strategies for the health workers and mothers to address perceptions and miscon- ceptions and facilitate positive change in the household practice on management of diarrhea among under-fives

Screening of metal ion chelators against Leishmania donovani-infected Syrian hamsters

Leishmania donovani-infected Syrian hamsters were treated intraperitoneally with 0.23 mmoles/kg/day of EDTA; EGTA; HEEDTA and 100 mg/kg/day of Pentostam R. The control group received 0.1 ml of phosphate buffered saline. After 30 days of treatment; the animals were sacrificed. Of the Pentostam-treated animals; 5 out 6 had negative spleen cultures; while all the chelator and PBS-treated ones yielded parasites. While all the Pentostam-treated hamsters yielded had negative bone marrow cultures; only 1 out of 6 HEEDTA-treated hamsters yielded parasites. Spleen; liver and bone marrow parasite-loads calculated from chelator-treated animals were consistently significantly higher than for Pentostam-treated animals. These results suggest that although metal ion chelators have some antileishmanial potential; their in vivo activity against L. donovani is low compared to Pentostam

Comparison of Giemsa and acridine orange stains for the diagnosis of Leishmania donovani in biopsies of infected hamsters

Identical impression smears of spleen; liver and bone marrow biopsy materials from Leishmania donovani-infected hamsters were stained using either acridine orange or Giemsa. Spleen parasite-loads calculated from the two stains for identical biopsy material were significantly different from each other. However; liver and bone marrow parasite-loads calculated from either Giemsa-stained or acridine orange-stained biopsies were not significantly different from each other. This study has shown that acridine orange; which is a quick and simple technique; has great potential in the diagnosis of kala-azar when liver and bone marrow biopsies are used

Determination of the optimal EDTA and Pentostam concentration in the treatment of Leishmania donovani-infected laboratory animal rodent models

The objective of this study was to undertake a dose response study to determine the optimal Pentostam and Ethylenediamine tetraacetic acid (EDTA) dose that could be used in the treatment of leishmania-infected golden hamsters or BALB/c mice for a period of 30 days. This pilot experiment was done using only one chelator; EDTA and the toxicity results obtained from this experiment formed the basis for the selection of a suitable chelator dose of this class for the future treatment of leishmania-infected laboratory animal rodent models. It is concluded that Pentostam concentrations beyond 600 mg/kg are highly toxic to mice and therefore unsuitable for use. Although Pentostam have been used to treat leishmania-infected BALB/c mice; this study has shown that a concentration of 100 mg/KG/day is the most suitable dose for use in the treatment of rodent animal models

Screening of metal ion chelators against Leishmania donovani-infected BALB/c mice

Previous in vitro experiments by Mbati et al. have shown that Ethylenediamine tetraacic acid (EDTA) and Ethyleneglycol-bis (B-aminoethyl ether) N;N;N1;N1; tetraacetic acid (EGTA) substantially reduce parasite burdens of leishmania donovani in either cell free media or when engulfed in mouse peritoneal macrophages. The objective of this study was to compare the activity of the same chelators against Leishmania donovani in BALB/c mice infected with a much lower parasite inoculum