Defining episodes of diarrhoea: results from a three-country study in Sub-Saharan Africa.

The study was conducted to assess the effect of definition of episode on diarrhoeal morbidity and to develop a means of adjusting estimates of morbidity for the definition of episode used. This paper reports on a cohort study of 374 children, aged 9-32 months, in three African countries, which recorded frequency and consistency of stool over a seven-month period. Different definitions of episode were applied to these data to assess their effect on annualized diarrhoeal morbidity. Adjustment factors were then derived that corrected morbidity for non-standard definitions of episode. Applying non-standard definitions of episode gave estimates of an annualized number of episodes between 38% and 137% of the internationally-accepted definition. Researchers should be encouraged to use the standard definition of episode of diarrhoea and to use appropriate field protocols. Where this is not possible, correction factors should be applied, particularly where estimates of diarrhoeal morbidity are pooled in systematic reviews.

Bacterial contamination of Vhuswa--a local weaning food and stored drinking-water in impoverished households in the Venda region of South Africa.

Bacterial contaminants of Vhuswa--a traditional maize-based weaning food, and domestic drinking-water stored in impoverished rural households in Venda of Limpopo province, South Africa, were determined. One hundred and twenty-five samples of Vhuswa fed to children aged less than five years were assessed for Escherichia coli, Campylobacter jejuni, Salmonella, and Shigella. The microbiological quality of 125 drinking-water samples was also evaluated using total coliforms, faecal coliforms, and faecal streptococci as indicators. The frequency of isolation of E. coli, Salmonella, Shigella, and C. jejuni from the Vhuswa samples was 70%, 5%, 5%, and 2% respectively. The geometric mean counts of total coliforms, faecal coliforms, and faecal streptococci in tap-water stored in household containers ranged from 4.9x10(2) to 5.8x10(3) cfu 100 mL(-1), 2.6x10(2) to 3.7x10(3) cfu 100 mL(-1), and 3.1x10(3) to 5.8x10(3) cfu 100 mL(-1) respectively, and for stored spring water it was 5.1x10(3) cfu 100 mL(-1), 3.2x10(3) cfu 100 mL(-1), and 5.1x10(3) cfu 100 mL(-1) respectively. The frequent contamination of water and food samples in this study has important implications for the health of children from impoverished communities.