Correct case management of childhood diarrhea: a survey of nine state capitals in northeast Brazil

The National Program for Maternal and Child Health (COSMI) of the Ministry of Health (MOH) of Brazil conducted a survey in nine state capitals from 29 March to 30 April 1993 to assess how well health facilities were managing diarrhea cases in patients under 5 years of age. One of seven PAHO/WHO health facility survey performed in Latin America and the Caribbean in 1992-1993, the Brazilian survey took place in the Northeast Region where most diarrheal morbidity and mortality occur. Like the other six surveys, it used a new PAHO/WHO methodology designed to collect data on certain principal indicators through observation, interviews, and review of clinical records. Overall, 475 cases of patients with diarrhea were observed in 192 facilities, and 463 health workers and 474 caretakers were interviewed. The results indicated that few diarrhea patients received care that strictly followed the PAHO/WHO/Ministry of Health treatment guidelines. In terms of these guidelines, the correct procedure was used to assess the patient's hydration status only 8 percent of the time, and only 1 percent of the health workers provided correct advice to the caretaker on prevention and home care aspect of diarrheal diseases. The procedure used to rehydrate patients with oral rehydration salts (ORS) was correct in only 6 percent of the cases.Of those patients with bloody stools, 24 percent were treated appropriately with antibiotics. Besides collecting information on correct case management, the survey provided a basis for developing two-year operational plans of action in each of the nine participating states to strengthen efforts directed at controlling and preventing diarrheal diseases, including cholera

The rational use of drugs in the management of acute diarrhoea in children / The rational use of drugs in the management of acute diarrhoea in children

An estimated 4 million children under 5 years of age die annually as a direct result of diarrhoea, and many other from causes that are aggravated by diarrhoea. Adequate feeding during and after diarrhoeal episodes and timely action to prevent or treat dehydration could substantially reduce these numbers, yet the inappropriate or injudicious use of drugs frequently diverts attention and resources away from these meaures. A number of pharmaceutical agents have been, and continue to be, promoted for the treatment of acute diarrhoea. At best, many of these are of questionable therapeutic value, and at worst they may be positively harmuful. This book reviews experimental and clinical experience of the use of a range of these agents. Extensive evidence is cited in support of its conclusions- that use of adsorbents or of drugs purporting to reduce intestinal motility cannot be justified, and that paediatric use of antibiotics and antiparasitics should be strictly confined to cases of diarrhoea of specific etiology

Costs of treating diarrhoea in a children's hospital in Mexico City

The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Gómez), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25 per cent fall in the number of inpatients with diarrhoea(AU)