Diarrhoea case management experience from a specialised unit

ABSTRACT

The Ugandan Diarrhoeal training unit was started in 1992 at Mulago Hospital; Makerere Medical School. The Unit provides a 24 hours service of inpatient and outpatient care and carries out daily routine immunization of its clients. The unit offers training in diarrhoea and lactation management to various categories of health workers and carries out research. In 1993 the unit took training and management of ARI as well as now known as the child survival training Unit (CSTU).The Unit focuses five major areas for training and management. 1. Understanding diarrhoea; ARI and breastfeeding . 2. Patient care with particular emphasis on ORT; feeding and breastfeeding. 3. Communication skills acquisition. 4. Supervisory skills acquisition; record keeping; interpretation and use. 5. Training skills. 6. Outreach service in the form of home visiting and clinical support supervision. This article focuses on the units's experience in the management of diarrhoea during a period of nearly 2 years between February 1992 and June 1994. Of the 6693 cases of diarrhoea; 131(2) had severe dehydration; 412(6.2) had some dehydration and the remainder 6150; (91.8) had none. These were 5731 first attendances and 1423 (26.6)re-attendances. Of the 6693 cases; 6049 (90.4) were cases of acute diarrhoea and persistent diarrhoea accounted for the rest (9.6) of 545 cases.The management is by assessment ; institution of correct treatment and giving an appropriate advice on home using the standard WHO plans; A; B; and C. The commonest associated problems which may be considered risk factors were; stopped or reduced breastfeeding before or during the diarrhoea episode under-weight or overt malnutrition; oral candiasis; malaria and ARI; Bloody diarrhoea (dysentry) either as acute or persistent accounted for 169(2.5) of cases. The mortality rate during this period was 144 out of 4242 cases (3.4). Persistent diarrhoea was a major contribution to the mortality rate of the 123 deaths. 34 were cases with persistent diarrhoea (PD). It is unusual that even in a specialised unit there is only diarrhoea to deal with. Many dehydrated children or even those with symptomatic diarrhoea are referred to this unit. The most common associated conditions were failure to thrive 425(6.3). Persistent diarrhoea was a major contribution to the mortality rate of the 123 deaths. 34 were cases with persistent diarrhoea (PD). It is unusual that even in a specialised unit there is only diarrhoea to deal with. Many dehydrated children or even those with symptomatic diarrhoea are referred to this unit. The most common associated conditions were failure to thrive 425(6.3); malnutrition 424(6.3); pneumonia 246(3.7); malaria 711(10.6). One hundred and seventy eight (2.7)had symptom complexes suggestive of HIV infection.Other problems accounted for 322 cases (4.8) and these included Acute Upper Respiratory Infection (AUR); oral thrush; skin sepsis and anemia. The oral thrush was seen most commonly in patients with persistent diarrhoea who had received many medications including antibiotics. The challenge and implications of these findings are discussed