Inter-country technical consultation on improvement of diarrhoea management in the context of child survival and technical updates of the IMCI guidelines.

It is over seven years since IMCI has been introduced and much has been learnt through the adaptation and implementation processes in countries. The current technical updates have compiled the experience learnt and the new research findings. Research results are emerging with potential implications for updating the technical guidelines of IMCI. The technical updates are provided for use by countries whenever there are opportunities to revise the country IMCI adaptations. It will be necessary to have a series of technical updates as new research findings become available. The current technical updates have compiled new evidence to inform countries immediately about IMCI adaptations and recommend adaptations in six areas. Two recent advances in managing diarrhoeal disease – lower concentration oral rehydration salts (ORS) for prevention and treatment of dehydration, and zinc supplementation during and after the diarrhoea episode – can drastically reduce child morbidity and mortality. May 2004, WHO and UNICEF signed a joint statement that recommends use of the new low osmolarity ORS and zinc in management of diarrhoeal diseases. To accelerate the use of zinc and new low osmolarity ORS for effective treatment of diarrhoea WHO, UNICEF, USAID, Johns Hopkins Bloomberg School of Public Health, and the Bill & Melinda Gates Foundation set up a global Operational Team for zinc. This time the Operational Team for zinc and the WHO Regional Office for Europe organized a three-day workshop in Bishkek, Kyrgyzstan for decision makers to overview the updates in management of diarrhoeal diseases.

Inter-country technical consultation on management of diarrhoeal diseases in children in hospitals: Almaty, Kazakhstan, 16–18 May 2006

According to the guidelines on the Integrated Management of Childhood Illnesses (IMCI), between 10% and 20% of sick children seen in primary care will need referral to first-referral level hospitals. The findings of the assessment made by the WHO Regional Office for Europe of paediatric hospital care in some first-referral level hospitals in Kazakhstan, the Republic of Moldova and the Russian Federation showed that, despite good access for seriously ill children, low reported hospital case fatality rates, good health networks and skilled and committed doctors caring for children, there were a number of problems that led to the inadequate management of diarrhoea in patients. Confirming the importance of improving the evidence-based management of diarrhoeal diseases in children in both inpatient and outpatient primary health care facilities, and the need to develop an agenda for change in national policies, protocols and guidelines, the WHO Regional Office for Europe decided to hold a technical consultation with representatives of the health ministries of the countries of the Commonwealth of Independent States, leading national experts in the area of paediatrics and epidemiology, and experts from WHO and other international organizations.

Effect of exclusive breastfeeding and complementary feeding on infant growth and morbidity

A cohort study was conducted in the Islamic Republic of Iran between January 1997 and February 1998 to compare the growth and morbidity of 100 infants who were exclusively breastfed for 6 months and 100 who received breast milk and complementary foods between 4-6 months. Infants' feeding pattern, weight and height were assessed and recorded. There were no significant differences in infants' weight and height gain between 4 and 6 months. The rate of diarrhoea between ages 4 and 6 months was significantly lower in exclusively breastfed infants than in complementary food-fed infants [11% versus 27%] and respiratory infections were also lower [23% versus 35%]. We conclude that exclusive breastfeeding is superior at least until an infant is 6 months of age

Studies on diarrhoeal illness among hospitalized children under 5 years of age in Baghdad during 1990-97

A retrospective study of all infants and children admitted to two paediatric teaching hospitals in Baghdad city complaining of acute diarrhoea during 1990-1997 was carried out. Of all children admitted, 14.9% were for diarrhoea, 55.5% of whom were under 1 year of age. The peak incidence was at 3-6 months and tended to be during the summer months. In 97% of cases only one pathogen was identified, enteropathogenic Escherichia coli being the most frequently isolated organism, isolated from 13% of the patients. The proportion of deaths associated with diarrhoea was 28.6%. The documented frequency and patterns of occurrence of diarrhoeal disease emphasize the need for improved diagnostic, preventive and therapeutic measures against this potentially life-threatening condition

Rotavirus infection in infants and young children with acute gastroenteritis in the Islamic Republic of Iran

The incidence of rotavirus infection was studied in 704 children less than five years of age who were suffering from acute gastroenteritis, between July 1993 and June 1994 in Teheran. Rotavirus antigen was detected by ELISA in 15.3% of the stool samples examined, as compared to 1.1% in a group of healthy controls. The frequency of rotavirus infection was significantly higher among patients under 24 months of age [19.7%] than among children two years old or more [5.1%]. Breast-feeding had a protective action against rotavirus infection and the peak of incidence was in the spring. This study revealed that rotavirus is an important etiological agent of acute gastroenteritis among children in Teheran

Nutritional outcome of appropriate feeding during and after acute diarrhoea in children

A sample of 120 children with acute diarrhoea was divided into two equal study groups. There was no difference between groups in pre-intervention and post-intervention findings during the acute phase of diarrhoea. Upon discharge, Group A patients were supplied weekly with sufficient milk formula and cereal together with adequate nutritional advice while Group B patients were supplied with food or nutritional advice only if requested by the mothers. Forty nine patients from each group were followed each week for four weeks. Group B infants showed a higher incidence of recurrent diarrhoeal attacks and a significantly longer duration of recurrent diarrhoea than Group A infants. Moreover, Group A infants scored a significantly higher weight increment than Group B ones after four weeks of follow up