Síndrome urémico hemolítico del adulto / Adult hemolytic uremic syndrome

El síndrome urémico hemolítico (SUH), descripto en 1955, se caracteriza por la tríada de anemia hemolítica no inmunomediada, trombocitopenia y lesión renal aguda. En su patogenia interviene la toxina Shiga, producida con mayor frecuencia por E. coli O157:H. Puede manifestarse a cualquier edad, aunque es infrecuente en adultos, y se desarrolla en forma esporádica o en brote. Se presenta con un cuadro de dolor abdominal, diarrea, fiebre y vómitos. Puede afectar el sistema nervioso central, pulmones, páncreas y corazón. En adultos, el síndrome evoluciona tras un período de incubación de 1 semana posterior a la diarrea y tiene alta morbimortalidad, a diferencia de los casos pediátricos. Presentamos el caso de una paciente adulta, que cursó internación por síndrome urémico hemolítico. (AU)

Hemolytic uremic syndrome (HUS), described in 1955, is characterized by the triad of non-immune mediated hemolytic anemia, thrombocytopenia, and acute kidney injury. Shiga toxin, produced most frequently by E coli O157:H, is involved in its pathogenesis. Hus can manifest at any age, although it is rare in adults and develops sporadically or in outbreaks. HUS presents with a picture of abdominal pain, diarrhea, fever and vomiting. It can affect the central nervous system, lungs, pancreas, and heart.In adults, the syndrome evolves after an incubation period of 1 week after diarrhea, with high morbidity and mortality, unlike pediatric cases.We present the case of an adult patient who was hospitalized for hemolytic uremic syndrome. (AU)

Clinical spectrum & changing presentation of celiac disease in Indian children

Background & objectives: Celiac disease (CD) is a genetic immune mediated disorder characterised by gluten intolerance. This single centre study, from north India was aimed to assess the clinical, serological and histological profile of CD in a large cohort of children and the changing trends in its presentation. Methods: A review of clinical details of CD children diagnosed between 2000 and 2019 and currently on follow up was performed. Information on demography, symptoms, associated conditions, serology, biopsy findings and gluten-free diet were analyzed. Results: The mean age (±standard deviation) of 891 children included in the study, at onset and at diagnosis was 4.0±2.7 and 6.2±3.1 yr, respectively. Growth faltering, abdominal pain, abdominal distension and diarrhoea were presenting symptoms in 70, 64.2, 61.2 and 58.2 per cent, respectively. A positive family history of CD was present in 14 per cent and autoimmune conditions in 12.3 per cent of children. Thyroid disorders were seen in 8.5 per cent of children and Type 1 diabetes mellitus (T1DM) in 5.7 per cent. The duration of breastfeeding had a weak positive correlation with age at onset and diagnosis of CD (P<0.001). Non-classical CD was significantly more common in children aged >10 yr and in those presenting after 2010 (P<0.01). T1DM and hypothyroidism occurred more frequently in non-compliant children. Interpretation & conclusions: This was the largest single centre study, pertaining to the presentation and follow up of CD in children. Infants and young children were more likely to present with classical symptoms of diarrhoea, abdominal distension and growth failure while older children presented with non-classical CD. There was a trend towards non-classical forms of CD in recent years.

Management of diarrhea after kidney transplantation / 器官移植

Diarrhea is a frequent complication after kidney transplantation, which is a common clinical manifestation of prevalent diseases following multiple types of organ transplantation. The common causes of diarrhea after kidney transplantation include adverse reactions of immunosuppressants, infectious diseases and de novo postoperative inflammatory bowel disease, etc. Diarrhea could seriously affect the quality of life of kidney transplant recipients, and may lead to allograft dysfunction or even death of recipients. Because the causes of diarrhea after kidney transplantation are complicated and probably overlap with each other, along with individual differences among recipients, the etiological diagnosis and targeted treatment of diarrhea after kidney transplantation should follow the principles of gradual and phased treatment. In this article, the epidemiology and harm, common causes and management strategies of diarrhea after kidney transplantation were summarized, aiming to deepen the clinicians' understanding and enhance the diagnosis and treatment levels of diarrhea after kidney transplantation, thereby improving the quality of life and prognosis of kidney transplant recipients.

Review on Herbal Remedies for Dysentery and Diarrhea from the Melghat Region of Maharashtra State, India

The rapid advancement in fast pacing lifestyle of people and more dependent on fast food is the major leading cause of the increase in stomach infections leading to dysentery and diarrhea. Diarrhoea / Diarrhea and Dysentery are major causes of morbidity and mortality in rural communities of the developing world. The current review focus on herbal remedies from the Melghat region for dysentery and diarrhea-related symptoms. A total of 287 medicinal plant species from 90 families have been compiled for Dysentery (210) and Diarrhea (243). Most reported plant families were Fabaceae contributing 11.14% plants of the total population, followed by Asteraceae (5.57%), Malvaceae (4.52%), Apocynaceae (3.48%), Rubiaceae (3.48%), Lamiaceae (3.13%), Combretaceae (3.13%), Amaranthaceae (2.78%), Euphorbiaceae (2.78%), Moraceae (2.78%), Mimosoideae (2.43%), etc. In this study, out of 287 species reviewed, trees represented 34.49% of species, followed by herbs (32.75%), shrubs (21.95%), climbers (8.01%), grasses (2.43%), and orchids (0.34%). Curated data presented along with the plant's botanical name, plant's family, category (habit), ailments, the part used with relevant traditional, folk, ethnobotanical uses and patterns with cross citations offers scope for researchers engaged in herbal drug discovery and development to dwell into the herbal reservoir and find suitable plant compounds for fighting this disease.

Aetiology of hospital-acquired diarrhoea in under-five children from an urban hospital in East Delhi, India

Background & objectives: Majority of the studies of hospital-acquired diarrhoea conducted in Western countries have focused on the detection of Clostridium difficile in stool samples. Limited Asian and Indian literature is available on hospital-acquired diarrhoea. This study was aimed to describe the aetiological profile for hospital-acquired diarrhoea in children aged below five years. Methods: One hundred children aged one month to five years who developed diarrhoea (?3 loose stools for >12 h) after hospitalization for at least 72 h were enrolled. Children who were prescribed purgatives or undergoing procedures such as enema and endoscopy or those with underlying chronic gastrointestinal disorders such as celiac disease and inflammatory bowel disease were excluded from the study. Stool samples from the enrolled children were subjected to routine microscopic examination, modified Ziel- Nielson (ZN) staining for Cryptosporidium and culture for various enteropathogens. Multiplex PCR was used to identify the strains of diarrhoeagenic Escherichia coli. Rotavirus detection was done using rapid antigen kit. Toxins (A and B) of C. difficile were detected using enzyme immunoassay. Results: Of the 100 samples of hospital-acquired diarrhoea analysed, diarrhoeagenic E. coli (DEC) was found to be the most common organism, detected in 37 per cent of cases (enteropathogenic E. coli-18%, enterotoxigenic E. coli-8%, enteroaggregative E. coli-4% and mixed infections-7%). Cryptosporidium was detected in 10 per cent of cases. Rotavirus was detected in six per cent and C. difficile in four per cent of cases. Interpretation & conclusions: The findings of this study suggest that the aetiological profile of hospital- acquired diarrhoea appears to be similar to that of community-acquired diarrhoea, with DEC and Cryptosporidium being the most common causes. The efforts for the prevention and management of hospital-acquired diarrhoea should, thus, be directed towards these organisms.

Isolation and therapeutic efficacy of enteropathogenic E. coli phage cocktail against colibacillosis in neonatal goats

Phage based therapeutics have shown promising results against the infections caused by the drug resistant bacteria. To combat the problem of antibiotic resistance posed by diarrhoeagenic E. coli, here, we identified and characterized 38 E. coli phages which were isolated from 70 solid sources (goat-faeces and soil). The in vitro lytic range of phage isolates (n=38) against 439 isolates of E. coli was found between 16 and 53%. Three phage isolates with highest host range showed lytic efficacy against 53, 48 and 46% of E. coli isolates, respectively. A preparation with above three phages was developed, and the phages of the preparation were found stable at wide range of temperature, pH and chloroform treatment. Endotoxin content of the preparation was found below the threshold level and it also passed safety and sterility tests. a total of 40 diarrheic goat kids were administered orally with the therapeutic phage preparation for two days twice daily. Total 21 diarrheic goat-kids were successfully treated using the therapeutic phage preparation, whereas 19 kids could not be treated (success rate: 52.5%; 21/40). The results of the current study provide insight for using lytic bacteriophages for therapeutic interventions against drug resistant E. coli responsible for colibacillosis in neonatal goat kids

Drug utilization pattern in the treatment of acute diarrhea in children aged 1–12 years

Background: Pediatric diarrhea is the second most common cause of childhood mortality globally. Despite being self-limiting, polypharmacy is rampant in their treatment. The adherence of practitioners to the recommended guidelines can be assessed by drug utilization studies. Aim and Objectives: The aim of the study was to assess the drug utilization pattern of acute diarrhea management in children. Materials and Methods: A prospective observational study was undertaken for 12 months at pediatric inpatient unit of BRIMS, Bidar. Prescriptions of 400 cases of acute diarrhea in children of either gender aged 1?12 years were evaluated for the pattern of drugs prescribing using the WHO core indicators. Results: The study showed male preponderance with 54.75% being males. Every prescription, on an average had five drugs for diarrheal management. About 43.5% prescriptions had at least two antibiotics. Out of a total of 2237 drugs prescribed, 1392 (62.2%) drugs were prescribed as injections. About 78.5% medicines were selected from the National List of Essential Medicines (NLEM), 2015 and 87.12% drugs were from the hospital formulary. Drugs were categorized as per ATC/DDD system using the WHO reference DDDs and ATC codes website. PDD to DDD ratio of majority of drugs was 0.99. Conclusion: We observed polypharmacy in practice for diarrheal illness in our study. Accentuation on evidence-based management and adherence to the treatment guidelines may help in improved and rational drug use in children.

RAPID DIAGNOSIS OF VIRAL DIARRHEA IN CHILDREN UNDER 5 YEARS, TO STRENGTHEN THE EXISTING ADD PROGRAM

RAPID DIAGNOSIS OF VIRAL DIARRHEA IN CHILDREN UNDER 5 YEARS, TO STRENGTHEN THE EXISTING ADD PROGRAM Original Research Paper Sornajeyanthi P* M.D., Professor, Department of Microbiology, Tirunelveli Medical College, Tirunelveli - 627011, Tamil Nadu, India *Corresponding Author X 67GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Background: Gastroenteritis in childhood is one of the most prevailing cause of morbidity and mortality across the globe. Rotavirus is the most common etiological agent among viruses causing gastroenteritis in children below ?ve years. Adenovirus has been evidenced as the second most common cause of childhood gastroenteritis in certain parts of the world. The present study was conducted to estimate the incidence of Rotavirus and Adenovirus among diarrhoeal cases in children under 5 years of age. A total of 40 children younger than 5 years of age Materials and methods: suffering from acute diarrhoea were included in the present study. A total of 40 samples were collected and analyzed for Rotavirus and Adenovirus using commercially available Immunochromatography kit. The prevalence of Rotavirus and Results: Adenovirus was found to be 7.5% and 2.5% respectively among children under ?ve years of age with acute diarrhoeal disease. Conclusion: The disease burden of Rota viral illness has decreased due to increased coverage of Rotavirus vaccination through inclusion in National immunization schedule and thus effective and ef?cient vaccination coverage is fundamental rationale in the process of strengthening of Acute Diarrhoeal Disease(ADD) program

Evaluation of Phytochemical and Antibacterial Potential of Vernonia amygdalina and Elaeis guineensis on Some Bacteria Associated with Diarrhea

Background: Bitter leaf and palm oil combination in treating diarrhoea is common in Africa. The aim of this study is to determine the synergistic and antimicrobial potential of Vernonia amygdalina and Elaeis guineensis on bacteria isolates from diarrheic stool.Methodology: One hundred and fifty (150) diarrheic stool samples from the Diagnostic Laboratory in Rivers State University Teaching Hospital (RSUTH), Port Harcourt, were inoculated in Selenite F broth, MacConkey, Nutrient and Salmonella-Shigella agar plates using standard methods. Fresh and dry bitter leaf extracts were prepared by mashing, weighing and dissolving 100 grams(g) and 150 g concentrations of each in 100 milliliters(mls) of ethanol and sterile distilled water respectively. Undiluted mixture of bitter leaf and palm oil were prepared by mixing 2 mls of each in a sterile beaker. Zero-point one milliliter (0.1ml) of each undiluted extract, their mixture, ethanol and palm oil were separately dispensed into appropriately labeled wells using sterile pipette for sensitivity test on the isolated bacteria. The pH, temperatures and the phytochemical contents of the bitter extracts and palm oil were determined using pH meter, thermometer and spectrophotometric method.Results: Escherichia coli, Staphylococcus aureus and Salmonella sp. were isolated. The pH and temperature of bitter leaf extract and palm oil were 7.2 and 26?C and 6.7 and 26?C respectively while the pH and temperature for bitter leaf and the palm oil mixture was 6.9 and 26?C. The bitter leaf and palm oil extracts, their combination, ethanol and distilled water used on the isolates as antibiotics did not show any sensitivity. The phytochemicals identified in the bitter leaf were saponins, alkaloids and tannins while carotene was detected in the palm oil.Conclusion: It can be concluded that the bitter leaf extract, palm oil and their combination did not inhibit the growth of bacteria as a result of lack of bioactive components from the bitter leaf. The nature of the diluents used for the extraction may not have been the right one as it would have caused the low concentration, dilution and disfiguring of the molecules of the bioactive compounds that prevented the proper reaction between the bacteria and the extracts used.

Assessment of Epidemiological Factors in a Cholera Outbreak in an Urban Area of Western India

Background: Cholera is a preventable disease, still it remains a major public health problem among developing countries like India. Access to safe water and a sanitary environment can easily control many gastrointestinal infections including Cholera. In the last week of June 2021 large number of acute diarrhoeal cases were reported which was higher than expected subsequently confirmed as an outbreak of Cholera. Objective: To verify the diagnosis, identify risk factors and institute appropriate control measures to control the outbreak. Materials and Methods: A cross-sectional study was undertaken to identify the time, place and personal distribution of the disease. Based on the findings of the descriptive study, sanitary survey and environmental examination a hypothesis was formulated. A case-control study was carried out to test a hypothesis Results: A total of 158 cholera cases were reported with one death. Male and females were affected equally. All age groups affected, 18.35% of the cases were reported among children aged 0-5 years old. It was a common source epidemic and water was source of infection. The water sample reported faecal contamination. Those households not using water purification methods were 1.454 times more affected (OR=1.454) than those using water purification methods. Conclusion: The Vibrio Cholerae bacterium caused the cholera outbreak in Nadiad. Infection was caused by contaminated drinking water.

Risk Factors for Dyselectrolytemia in Children with Acute Diarrhoea in the Inpatient Setting in North India

Background: Dyselectrolytemia is a common accompaniment of acute diarrheal illnesses and contributes to increased morbidity and mortality. Aim: To study the incidence and identify the risk factors for developing dyselectrolytemia in children getting admitted with acute diarrhoea. Study design: Prospective observational study. Methods: Detailed history, examination, and investigations were recorded in specially designed proforma. Serum electrolyte levels were measured at admission in all the study subjects and correlated with clinical presentation and demographic profile. Results: Out of 107 children, 64.5% had no dehydration, 31.8% had some dehydration, and only 3.4% were severely dehydrated at the time of admission. Most common electrolyte abnormality were hyponatremia(25.2%) and hypochloraemia (25.2%), followed by hypokalaemia (11.2%), hyperchloremia (9.3%) and hypernatremia (6.5%). The degree of dehydration was found to significantly affect serum electrolyte profile (p value<0.05). Hyponatremia (41%), hypokalaemia(26.5%), and hypochloraemia(35%) were seen more commonly in patients with some dehydration, while a higher proportion of patients with severe dehydration had hypernatremia (50%) and hyperkalaemia (25%). Consumption of diluted ORS was significantly associated with the development of hyponatremia (73.9%), hypokalaemia(34.8%), and hypochloraemia(56.5%) p value<0.05. Conclusion: Dyselectrolytemia is a common accompaniment of diarrheal dehydration, the most common being hyponatremia. The severity of dehydration and dilute ORS administration are important risk factors for dyselectrolytemia.

Tubular enteric duplication presenting as jejuno-colic fistula in a 38 years old adult

Colo-enteric fistula is a rare entity, malignancy being the commonest cause. Both adenocarcinoma and rarely lymphoma have been known to cause it. Benign jejuno-colic fistulas are mostly secondary to tuberculosis or inflammatory bowel disease. Here we present a case of a young adult male, who presented with altered bowel habits. Colonoscopy and oesophago-gastro-duodenoscopy (OGD) revealed a fistulous tract between the proximal jejunum to the splenic flexure of colon. Surgery revealed a small fistulous connection between the above-mentioned parts of the bowel about 1cm long. Histopathology demonstrated it to have all the layers of the intestinal anatomy, hence indicating a possibility of congenital aetiology, probably enteric duplication of communicating tubular variety.

Role of Bacterial and Parasitic Pathogens in Occurrence of Neonatal Diarrhoea in Goat-Kids

Infectious diarrhoea in neonates of animals is one of the most common and economically important conditions encountered in the livestock industry. Faecal samples (n=210) from diarrhoeic neonatal goat-kids of different livestock sheds of ICAR-CIRG, Makhdoom, Mathura (U.P.), were aseptically collected, and immediately processed for isolation of bacterial pathogens and parasitic evaluation. A total of 178 isolates of E. coli from 210 samples were identified on the basis of cultural, morphological, biochemical and molecular characteristics. Out of 178 E. coli isolates, 3.93 % (7/178) isolates were identified as STEC by PCR amplification of stx-1 and stx-2 gene. A total of 64 isolates of E. coli were sent to National Salmonella and Escherichia Centre, Central Research Institute, Kasauli for the serotyping. The common serogroups of E. coli responsible for neonatal diarrhoea in goat-kids were identified as O36, O26, O59, O29, O43, O91, O82, O9 and O171, out of which, 46.15% were O36, O26 and O59. Cryptosporidium spp. infection was detected in 46 samples out of 148 faecal samples by ZN staining and nested PCR.Based on cultural, morphological, biochemical and molecular characteristics,16 isolates of Salmonella spp. and 5 of Klebsiella spp. were identified from 210 fecal samples. The present study concluded that E. coli followed by Cryptosporidium spp. and Salmonella spp. were the prevalent infectious agents associated with neonatal diarrhoea in goat-kids

A prospective study to evaluate the protective effect of breastfeeding on diarrheal morbidity in infants in rural Rajasthan

The benefits of breastfeeding on infant and child morbidity and mortality are well known since ages. Human milk protectsbreastfed infants against diarrhoeal disease by virtue to its various immunological properties. As diarrhoeal diseases are amajor cause of deaths among children aged 0-12 months, it is important to quantify the preventive effect of breastfeeding ondiarrhoea-specific morbidity and mortality. To assess the breast-feeding practices and its effect on incidence of diarrhoea ininfants in rural Rajasthan. A Prospective study was carried out in Achrol village, field practice area of National Institute ofMedical Science (NIMS) Hospital and Research Centre, Jaipur, over a period of one year. 246 infants were enrolled byconvenience sampling through house to house visits and followed-up on monthly basis to record information on feedingpractices and episodes of diarrhoea by interviewing their mothers. Descriptive statistics were presented as frequencies andpercentages and association between breastfeeding practices and incidence of diarrhoea was found using Chi-square test.48.8% of the infants studied were started on breast feeding between 1-6 hours while only 13% started breastfeeding withinan hour of birth. Majority (66.3%) of infants were denied colostrum feed and 92.68% infants were given pre lacteal feeds asis customary in the area. Among infants who were put on breastfeeding within 1 hour of their birth, 12.2% suffered fromdiarrhoeal where as infants who were started on breast feeding within 1-6 hours, 46.6% reported diarrhoeal episodes duringthe follow up period. This difference in diarrhoeal episodes based on initiation of breastfeeding was found to be statisticallysignificant (p< 0.05). There is enough evidence in favour of breast feeding (exclusive breast feeding for 6 months andcontinued breastfeeding up-to 2 years) as an effective tool against diarrhoeal morbidity in the studied infants.

A randomized open label efficacy clinical trial of oral guava leaf decoction in patients with acute infectious diarrhoea

Diarrhoea is amongst the first ten causes of death and its treatment faces an increased threat of drug resistance. Previous studies on the guava leaf decoction (GLD) revealed its suitability for use in infectious diarrhoea of unknown etiology.ObjectiveThe objective of this trial was to establish efficacy, dose and safety of GLD prepared from the Indian Sardar variety in adults with acute infectious diarrhoea.MethodsThe current trial was an open efficacy randomized 5-day, parallel group multi-arm interventional study. Amongst 137 adults (18–60 years) suffering with acute diarrhoea, 109 were included (57% females, 43% males). Three doses of GLD (6-leaf, 10-leaf and 14-leaf) were compared with controls receiving oral rehydration solution. Decrease in stool frequency and improvement in consistency were the outcomes measured. The data was analyzed using ANOVA, Tukey's post-hoc test, Kruscal-Wallis test and Chi-Square test where applicable.ResultsThe trial showed that the 14-leaf (7.4 g) decoction was the most effective. Administration of the decoction, thrice daily helped the patients regain normalcy in 72 h as opposed to 120 h in controls. Safety of the intervention was reflected by normal levels of haemoglobin, liver and kidney parameters. No adverse events were reported.ConclusionThe 14 leaves decoction was a safe treatment for adult acute uncomplicated diarrhoea of unknown etiology. Moreover due to component synergy and divergent mechanisms of action, it could possibly combat the generation of drug resistance and destruction of gut microbiota. Hence GLD has the potential for development as a first line treatment for diarrhoea.

Socio-demographic characteristics, breast feeding practices and household sanitation as risk factors for diarrhoeal illness in under five children

Background: Acute diarrhoeal disease among children under 5 years remains a major cause of morbidity and mortality. In India, diarrhoea attributes to 13% of under-5 mortality. As most diarrhoeal diseases have feco-oral route of transmission, the source of water supply, sanitary measures and personal hygiene are important factors in prevention of same. This study aims to determine various risk factors for diarrhoeal illnesses.Methods: A descriptive cross-sectional observational case-control study done among under-5 children hospitalized during rainy months in paediatric ward of tertiary care centre. Information regarding participant's age, sex, immunization status and breast feeding practices collected from the mother or caregiver of the child using a structured questionnaire.Results: Out of 55 cases and 55 controls enrolled, there was no significant difference in birth weight, gender, immunization status, socio economic profile, hygiene practices and sanitation facility between two groups. Statistically significant difference (p 0.01717) was seen in wasting associated with cases and controls however no difference in proportion of stunting was noted. The cases showed early age of start of complimentary feeding (5.86' 1.38m) and less duration of total breast feeding (15.94'4.09m) as compared to controls. Bottle feeding was seen in 69% cases as compared to 53% controls.Conclusions: In socio economically and environmentally similar conditions, faulty feeding is a significant risk factor for diarrhoeal illness in under 5 children. Wasting is also a significant risk factor associated with the same.

Diarrhoeal disease surveillance in Papua New Guinea: findings and challenges

Abstract@#Diarrhoeal diseases are among the leading causes of morbidity and mortality in the Western Pacific Region. However, data on the major causes of infectious diarrhoea are limited in many countries within the Region, including Papua New Guinea. In 2013–2014, we conducted surveillance for acute diarrhoeal illness in four provinces in Papua New Guinea. One rural health clinic from each province participated in the surveillance activity. Samples were sent to central laboratories and batch analysed for bacterial and viral gastrointestinal pathogens that are commonly associated with diarrhoea. Across the four sites, the most commonly detected pathogens were Shigella spp., Campylobacter spp. and rotavirus. In this paper, we report the results of the surveillance activity and the challenges that we faced. The lessons learnt may be applicable to other parts of the Region with a similar socioeconomic status.

Knowledge, attitude and practices of childhood diarrhoea among mothers of children under five years of age: a cross sectional study

Background: Diarrhoea is an important communicable disease which can be prevented by proper hygiene and other simple practical measures. We assessed the knowledge, attitude and practices among mothers regarding childhood diarrhoea in a secondary care hospital in Dimapur, Nagaland.Methods: Cross-sectional observational study conducted over a period of one year including 449 mothers in the age group <45 years with atleast one child under 5 years of age using an interviewer administered, pilot tested, semi-structured questionnaire under the following as categories demography, knowledge, attitude and practices.Results: 97.8% had good knowledge regarding causes and prevention of diarrhoea, 65% had good knowledge regarding the management of diarrhoea while 31% mothers had moderate knowledge. 98% mothers had good attitude but only 17.8% had good practice scores. Multivariate regression analysis showed education > class 10 and residence in urban area were significantly associated with good knowledge and education >class 10, age of mothers ≥29 years, employed mothers, family income Rs. ≥28000 were significantly associated with good practice.Conclusions: Good knowledge and attitude regarding diarrhoea prevention and management among our study population did not translate to good practice. These could also be due to the lower knowledge about management of diarrhoea. Widespread prevalence of wrong practices in the community like irrational use of antibiotics could also have resulted in low practice scores. The gaps between knowledge and attitude and practices among the mothers need to be addressed.

Knowledge and practices among caregivers in cases of persisitent diarrhoea in children of age group 6 months-12 years

Background: Persistent diarrhoea has a variety of infectious and non-infectious etiology and it seriously affects the growth and development of children. The objective of the is to the identify the knowledge and practices prevalent amongst caregivers of children to understand environmental and behavioral risk factors and their interactions associated with the disease and its management.Methods: It is a hospital based cross-sectional study which included 70 children in the age group 6 months-12 years admitted in a tertiary care center at Bhopal over a period of one year with complaints of loose stools lasting for more than 14 days. A pre-tested questionnaire was used as a data collection tool for face-to-face interviews with the mothers or caretakers of the cases. Statistical analysis was done using Statistical Package of Social Science (SPSS Version 20; Chicago Inc., USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons.Results: Most of children's mother were Illiterate, 27.1% were educated till primary school and only 5.7% were graduate. Out of 70 cases, most of 51(72.8%) were have understanding that drinking untreated water is a risk factor, only 11(15.7%) understands the value of filtered water and 8(11.4%) know the importance of doing boiling. Most of 46(65.7%) were using open field for sanitation and only 11(15.7%) were using toilets at home. 42(60.0%) were having the habit of hand washing before taking meal.'Conclusions: Community education about the prevention and management of diarrhoea will reduce the mortality and morbidity associated with persistent diarrhoea.

Prognostic significance of initial management of childhood diarrhoea in rural areas: an observational study

Background: To identify current evidence in order to guide scaling up of initial management of diarrhoea among children of age group 2-60 months in rural areas of the country.Methods: This hospital based cross sectional study included all children 2 months to 60 months of age admitted with chief complains of loose stools in the last 7 days over a period of one year. A pre-tested questionnaire was used as the data collection tool and face to face interviews were conducted on mothers of children.' All the data were analyzed using IBM SPSS version 20 software. Chi-square/Fisher Exact/ Student t-test and ANOVA test has been used. Significance was assessed at 5%.Results: Data showed the use of antibiotic in 55.9% cases, IV fluids in 50.3%, ORS in 6.7%, zinc in 2.0% and blood transfusion in 13.8% cases as an initial management of diarrhoea in peripheral health care centers. Of these, 37.6% cases were severely dehydrated, and 8.14% cases were in shock at the time of admission. 10.1% mothers did not intervene in the first 3 days of the disease whereas 45.2% consulted some health care center only in the later part. 4.5% cases expired after admission of which 69% were malnourished.Conclusions: This study summarizes the importance of initial management of a child with diarrhoea in defining the further course of the disease and also the failure of effective promotion and propagation of the most appropriate and cost-effective therapy (ORS and Zinc) for diarrhoea in this part of the country. Pre-existing malnutrition further complicates the situation.