ABSTRACT
Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described.Objectives. To document pre-hospital home and primary care management of diarrhoea; and certain risk factors and complications of diarrhoea.Methods. We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital; Parow; Cape Town; between 1 February 2007 and 31 May 2008. Caregivers were interviewed; and demographic; clinical and laboratory variables were collected.Results. We recruited 142 children; median age 8.9 months. A third had moderate malnutrition. Twenty-four (16.9) were HIV-exposed; with 9 (6.3 HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed; uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines. Conclusions. Most caregivers do give ORT; but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition; and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies; pre-hospital management and nutritional rehabilitation
