Bifidobacterium lactis CCT 7858 Improves Gastrointestinal Symptoms by Antibiotics Treatment: a Double-Blind, Randomized, Placebo-Controlled Trial.

Diarrhea is one of the most frequent side effects of antibiotic treatment and occurs in 25 to 40% of patients in use. One potential strategy to prevent this side effect is the concurrent use of probiotics. This study evaluated the efficacy of the strain Bifidobacterium lactis CCT 7858 in the prevention of diarrhea and improvement of gastrointestinal symptoms in hospitalized patients using antibiotics. This was a randomized, blinded, placebo-controlled clinical trial. This study included 104 patients in antibiotic treatment. Patients were randomized into two groups: placebo (maltodextrin) and intervention (strain Bifidobacterium lactis CCT 7858 at 9 × 1010 CFU concentration; GABBIA® Biotecnology, Santa Catarina, Brazil). Patients were supplemented depending on the duration of antibiotic therapy, and both were evaluated with scales in two moments: before and after treatment. We included 104 hospitalized patients. In follow-up, 38 (74.5%) of the B. lactis group have no reported diarrhea. In secondary outcomes, in five day strong abdominal distension was reported in 4 (7,3) placebo group and not reported in B. lactis. Abdominal noises, nausea, and vomiting were not registered in any group. B. lactis strain has been considered safe and with several benefits, including reduction of soft stools and gastrointestinal symptoms how abdominal noise, pain and distension, as well reduction of diarrhea.

Hyperimmune Bovine Colostral Anti-CS17 Antibodies Protect Against Enterotoxigenic Escherichia coli Diarrhea in a Randomized, Doubled-Blind, Placebo-Controlled Human Infection Model.

BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) commonly cause diarrhea in children living in developing countries and in travelers to those regions. ETEC are characterized by colonization factors (CFs) that mediate intestinal adherence. We assessed if bovine colostral IgG (bIgG) antibodies against a CF, CS17, or antibodies against CsbD, the minor tip subunit of CS17, would protect subjects against diarrhea following challenge with a CS17-expressing ETEC strain. METHODS: Adult subjects were randomized (1:1:1) to receive oral bIgG against CS17, CsbD, or placebo. Two days prior to challenge, subjects began dosing 3 times daily with the bIgG products (or placebo). On day 3, subjects ingested 5 × 109 cfu ETEC strain LSN03-016011/A in buffer. Subjects were assessed for diarrhea for 120 hours postchallenge. RESULTS: A total of 36 subjects began oral prophylaxis and 35 were challenged with ETEC. While 50.0% of the placebo recipients had watery diarrhea, none of the subjects receiving anti-CS17 had diarrhea (P = .01). In contrast, diarrhea rates between placebo and anti-CsbD recipients (41.7%) were comparable (P = 1.0). CONCLUSIONS: This is the first study to demonstrate anti-CS17 antibodies provide significant protection against ETEC expressing CS17. More research is needed to better understand why anti-CsbD was not comparably efficacious. Clinical Trials Registration. NCT00524004.

Vitamin D3supplementation and childhood diarrhea: a randomized controlled trial.

OBJECTIVE: To investigate the effect of vitamin D3 supplementation on the incidence and risk for first and recurrent diarrheal illnesses among children in Kabul, Afghanistan. METHODS: This double-blind placebo-controlled trial randomized 3046 high-risk 1- to 11-month-old infants to receive 6 quarterly doses of oral vitamin D3 (cholecalciferol 100000 IU) or placebo in inner city Kabul. Data on diarrheal episodes (≥ 3 loose/liquid stools in 24 hours) was gathered through active and passive surveillance over 18 months of follow-up. Time to first diarrheal illness was analyzed by using Kaplan-Meier plots. Incidence rates and hazard ratios (HRs) were calculated by using recurrent event Poisson regression models. RESULTS: No significant difference existed in survival time to first diarrheal illness (log rank P = .55). The incidences of diarrheal episodes were 3.43 (95% confidence interval [CI], 3.28-3.59) and 3.59 per child-year (95% CI, 3.44-3.76) in the placebo and intervention arms, respectively. Vitamin D3 supplementation was found to have no effect on the risk for recurrent diarrheal disease in either intention-to-treat (HR, 1.05; 95% CI, 0.98-1.17; P = .15) or per protocol (HR, 1.05; 95% CI, 0.98-1.12; P = .14) analyses. The lack of preventive benefit remained when the randomized population was stratified by age groups, nutritional status, and seasons. CONCLUSIONS: Quarterly supplementation with vitamin D3 conferred no reduction on time to first illness or on the risk for recurrent diarrheal disease in this study. Similar supplementation to comparable populations is not recommended. Additional research in alternative settings may be helpful in elucidating the role of vitamin D3 supplementation for prevention of diarrheal diseases.

From disease control to child health and development.

The control of diarrhoeal diseases, acute respiratory infections and other childhood killers--such as measles, malaria and malnutrition--is now combined in WHO's Division of Child Health and Development. The need for integrated management of childhood illness is shown in its historical context.

PIP: Until the late 1960s, health professionals most often recommended that people with diarrheal disease take antidiarrheal drugs and refrain from eating for at least 24 hours. At the same time, work was underway on the development of oral rehydration therapy (ORT), which was subsequently adopted in 1971 to complement the limited supply of intravenous treatment for thousands of patients in West Bengal. The success of ORT in treating diarrheal disease led to the establishment of the World Health Organization's (WHO) Program for the Control of Diarrheal Diseases in 1980, and the subsequent broader access to packets of oral rehydration salts in health facilities. WHO was also involved in efforts to control acute respiratory infections, establishing the Acute Respiratory Infections Program to validate the use of clinical signs for diagnosis and evaluate the impact of the approach. Since WHO's maintenance of these two parallel single-disease programs resulted in some duplication of effort, they were merged in 1990 to form the Division of Diarrheal and Acute Respiratory Disease Control. The division's mandate was later modified and expanded in 1996 in the creation of the Division of Child Health and Development responsible for the control of diarrheal diseases, acute respiratory infections, and other childhood killers like measles, malaria, and malnutrition.

Screening of anti-diarrhoeal profile of some plant extracts of a specific region of West Bengal, India.

Ethanol extract of four different plants of the Khatra region of the Bankura district of West Bengal, India were evaluated for anti-diarrhoeal activity against different experimental models of diarrhoea in rats. The extracts of Ficus bengalensis Linn. (hanging roots), Eugenia jambolana Lam. (bark), Ficus racemosa Linn. (bark) and Leucas lavandulaefolia Rees (aerial parts) showed significant inhibitory activity against castor oil induced diarrhoea and PGE2 induced enteropooling in rats. These extracts also showed a significant reduction in gastrointestinal motility in charcoal meal tests in rats. The results obtained establish the efficacy of all these plant materials as anti-diarrhoeal agents.

PIP: Diarrhea ranges from a mild and socially inconvenient illness to a major cause of malnutrition among children in developing countries and causes 4-5 million deaths worldwide annually. The people of the Khatra region of Bankura, West Bengal, India, use parts of various plants to treat and cure diarrhea. The region has a dense forest with a formidable number of medicinal plants which have been used by the local people for many years to treat illnesses. Ethanol extracts of Ficus bengalensis Linn., Eugenia jambolana Lam., Ficus racemosa Linn., and Leucas lavandulaefolia Rees from Khatra region were evaluated for anti-diarrheal activity against different experimental models of diarrhea in rats. The concoctions showed significant inhibitory activity against castor oil-induced diarrhea and PGE(2)-induced enteropooling in rats. The extracts also showed a significant reduction in gastrointestinal motility in charcoal meal tests in study subjects. These results attest to the efficacy of these plant materials as anti-diarrheal agents.

Prevention of diarrhoea in young children in developing countries.

An updated review of nonvaccine interventions for the prevention of childhood diarrhoea in developing countries is presented. The importance of various key preventive strategies (breast-feeding, water supply and sanitation improvements) is confirmed and certain aspects of others (promotion of personal and domestic hygiene, weaning education/food hygiene) are refined. Evidence is also presented to suggest that, subject to cost-effectiveness examination, two other strategies-vitamin A supplementation and the prevention of low birth weight-should be promoted to the first category of interventions, as classified by Feachem, i.e. those which are considered to have high effectiveness and strong feasibility.

PIP: A review of recent evaluations of non-vaccine interventions for the prevention of childhood diarrhea in developing countries both confirmed the importance of standard strategies (e.g., breast feeding, water supply and sanitation improvements) and suggested refinements in approaches to personal and domestic hygiene, weaning education, and food hygiene. Despite the risk of vertical transmission of human immunodeficiency virus in infected areas, the health risks of not breast feeding far outweigh the potential number of lives saved by abandoning this practice. Weaning education programs can produce a 2-12% reduction in diarrhea mortality. Also important is the promotion of food handling, preparation, and storage practices that reduce the risk of fecal contamination. Improvements in water quantity may have a greater impact on diarrhea than improvements in quality alone through their effect on personal and domestic hygiene. Two relatively new strategies, vitamin A supplementation and prevention of low birth weight, should be promoted. Vitamin A intake is significantly associated with both all-cause and diarrhea-specific child mortality; the feasibility of large-scale supplementation programs awaits investigation of their cost-effectiveness, however. The choice of specific diarrheal control strategies depends on local factors such as diarrhea etiologies, the existing infrastructure, and government priorities. In all countries, effective implementation of preventive strategies requires the involvement of a range of sectors (e.g., health, agriculture, water supply, and sanitation).

Oral rehydration therapy.

PIP: Oral rehydration solution (ORS), the best treatment of dehydration due to acute diarrhea, is the most important medical advance of this century since it is key to reducing infant and child morbidity and mortality. Pathogens responsible for acute diarrhea include those which produce enterotoxin at the intestinal mucosal surface, inducing secretion but are not invasive (e.g., Vibrio cholerae); those which invade and disrupt the mucosal lining (e.g., shigella species); and rotavirus. The World Health Organization (WHO)/UNICEF ORS is considered a universal ORS. Much research has been done on the ideal composition of an ORS. An ORS must have sufficient sodium to replace losses on a volume to volume basis, a glucose concentration that matches that of sodium to ensure its delivery to the ileum, sufficient amounts of potassium and base (e.g., sodium bicarbonate or trisodium citrate dihydrate) to correct acidosis and to enhance sodium absorption, and sufficient amounts of liquid. The risk of hypernatremia with use of the WHO/UNICEF ORS is a concern since infants and young children have an immature renal concentrating capacity, increased insensible water losses, and an impaired natriuretic response. Neonates and young infants may be prone to relatively slow correction of acidosis. It appears that the potassium content (20 mmol/l) of WHO-ORS should be higher to promote a net positive potassium retention. Too much glucose in the ORS will induce reverse osmosis of water into the gut, effectively making the ORS a dehydrating solution rather than a hydrating solution. Some carbohydrates other than glucose have proven effective glucose substitutes (e.g., sucrose, rice starch and powder, other cereals). Cereals have higher acceptability levels in developing countries. Research is investigating the nutritional benefits of supplementing ORS with micronutrients (e.g., vitamin A, folic acid, and zinc). ORS use with early refeeding has a beneficial effect on nutritional status after an acute diarrhea episode.^ieng

Dealing with diarrhoea.

PIP: Children with severe dehydration, persistent diarrhea with dehydration, or bloody diarrhea with no signs of improvement must be hospitalized. In-patient care for a child with severe dehydration includes rapid intravenous (IV) fluid therapy. Children who can still drink should be given oral rehydration salts (ORS) solution while the health worker sets up the IV drip. Children with difficulty drinking should be given ORS as soon as the IV fluid therapy restores their ability to drink (within 3-4 hours for babies, or 1-2 hours for older children), since ORS amends mineral deficiencies more effectively than the IV fluids. The IV drip should be re-administered if the child still exhibits dehydration after 3 hours for older children or 6 hours for babies. If improvement is noted, health workers should encourage the mother to administer ORS and to breast feed frequently. Hospital personnel should observe the child for at least 6 hours before discharge. This allows them to be sure that mothers can maintain the child's fluid balance. Children with diarrhea for more than 14 days face malnutrition or death. Any child with persistent diarrhea who exhibits moderate or severe malnutrition and signs of dehydration and is less than 4 months old needs to be admitted to a hospital. Management of persistent diarrhea involves fluid replacement, appropriate diet, and treatment of associated infections, if needed. ORS is usually effective for persistent diarrhea, although in a few cases poor absorption of glucose may necessitate initial rehydration with IV therapy. Breast feeding is encouraged for infants. Older infants and young children should eat 6 times a day as soon as they are able to eat. Recommended diets for these children are a low lactose diet (milk, yogurt, or curds; cooked rice; oil; sugar/glucose) and a low starch and no lactose diet (eggs, chicken, or fish; cooked rice; oil; sugar/glucose). Children with serious infections may require nasogastric feeding at first. Shigella bacteria tend to be responsible for dysentery. Children with this bloody diarrhea should be treated with an antibiotic. If their condition does not improve and they are malnourished, less than 1 year old, were initially dehydrated, or have recently had measles, they need to be hospitalized. Drugs to reduce frequency of stools should never be given in cases of bloody diarrhea. Older babies and children should be given an extra meal and supplementary vitamins and minerals each day for two weeks.^ieng

Acceptability of a rice-based oral rehydration solution in Port Moresby General Hospital's Children's Outpatient Department.

The guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department with a chief complaint of diarrhoeal disease were questioned regarding their preference of glucose-based vs rice-based oral rehydration solution (ORS) in order to determine the acceptability of a rice-based ORS. Of the 93 guardians interviewed, greater than 60% preferred the glucose-based solution in its mixability, appearance and taste, and 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution. In a country where diarrhoeal disease is a leading cause of child death and guardians are the primary health care providers, the acceptability of an ORS is critical to the morbidity and mortality of Papua New Guinea's children.

PIP: Killing an estimated 2.9 million children annually, diarrheal disease is the second leading cause of child mortality worldwide. Diarrheal disease is also the second leading cause of child mortality in Papua New Guinea (PNG), killing an average 193 inpatient children per year over the period 1984-90. However, despite the high level of diarrhea-related mortality and the proven efficacy of oral rehydration therapy (ORT) in managing diarrhea-related dehydration, standardized ORT has been underutilized in PNG. The current glucose-based oral rehydration solution (ORS) does not reduce the frequency or volume of a child's diarrhea, the most immediate concern of caregivers during episodes of illness. Cereal-based ORS, made from cereals which are commonly available as food staples in most countries, better address the short-term concerns of caregivers while offering a superior nutritional profile. A sample of guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department complaining of child diarrhea were asked about their preferences on glucose-based versus rice-based ORS in order to determine the acceptability of a rice-based ORS. More than 60% of the 93 guardians interviewed preferred the glucose-based solution for its mixability, appearance, and taste. 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution.

Paediatrics Forum. Acute diarrhoea.

PIP: Acute diarrhea is still responsible for about 40% of diarrhea-associated deaths, and oral rehydration therapy (ORT) does not actually reduce the duration of diarrhea. A species of lactobacilli specific for the human gut was first isolated in 1987, Lactobacillus casei strain GG, and several trials have used colonization of the gut by this organism as an adjunct to ORT. A placebo-controlled, triple-blind study in Pakistan showed a significant reduction in the number of children with persistent watery stools at 48 hours, as well as a reduction in stool output and vomiting. Dioctahedral smectite (DS) has been found to adsorb viruses, bacteria, and toxins resulting in the protection of gut mucosa. A randomized double-blind trial (placebo-controlled) studied outcome in 90 males, 3-24 months old, with acute diarrhea of or= 5 days duration. After rehydration, patients were given either 1.5 g of DS or placebo 4 times a day for 3 days. At 48 hours, 42% of the treatment group were free from diarrhea, as opposed to 13% of the placebo group, and at 3.5 days 20% of the placebo group still had diarrhea, as opposed to none in the treatment group. Mean duration of diarrhea in the treatment groups was 54.1 hours (placebo 72.9 hours, p 0.001). However, mean stool output was similar (97.9 g/kg vs. 110.9 g/kg). Bismuth subsalicylate (BSS) has been frequently used in adults with benefits in both prevention and treatment. 142 Chilean children 4-36 months old were randomized to receive either placebo or BSS (100 mg/kg/day) 5 times a day for 5 days. Stools were normal in the E. coli group by 72 hours as opposed 139 hours in the placebo group (p 0.01), while rotavirus-infected stools normalized in 57.5 hours, as opposed to 104.5 hours in the placebo group. Other effective approaches include micronutrient supplementation including zinc and folate.^ieng

Integrated management of the sick child.

Diarrhoea, pneumonia, measles, malaria and malnutrition account for more than 70% of deaths and health facility visits among children under 5 years of age in developing countries. A number of programmes in WHO and UNICEF have developed an approach to the integrated management of the sick child, which is being coordinated by WHO's Division for the Control of Diarrhoeal and Acute Respiratory Disease. Integrated clinical guidelines have been developed and a training course for health workers in outpatient (first level) health facilities has been completed. In addition to case management of these diseases, the course incorporates significant prevention of disease through promotion of breast-feeding, counselling to solve feeding problems, and immunization of sick children. Other materials to train and support health workers are also being developed: an inpatient case management training course, medical school curricular materials, a drug supply management course, and materials to support monitoring and reinforcement of skills after training. A planning guide for interventions to improve household management of childhood illness is also being developed. Since management of the sick child is a cost-effective health intervention, which has been estimated to have a large impact on the global burden of disease in developing countries, the completion of these materials and their wide implementation should have a substantial impact on child mortality.

Maternal beliefs and practices regarding the diet and use of herbal medicines during measles and diarrhea in rural areas.

PIP: Interviews with 208 mothers of children aged under 5 years were conducted in 21 villages of Jaipur District in Rajasthan State, India, to examine the dietary practices concerning food preferences and restrictions during measles and diarrheal disease. The researcher planned to use the findings to design nutrition education programs. 83.2% of the mothers were illiterate. 80% were of low or middle socioeconomic class. 66.4% worked in agriculture or animal husbandry. Preferred foods during diarrhea were khitchri (52.4%), thuli or daliya (48.5%), banana (37.9%), and chhach/curd (21.6%). Restricted foods included roti (69.7%), milk (47.1%), vegetables, chilies, and hot foods. The major herbal medicines used to cure diarrhea were isabgol ke bhusi mixed with curd (31.3%) and extracts of tea leaves, ajwain, sonth, peepla mul, black pepper, and tulsi leaves (14.4%). Preferred foods during measles were kishmish/munakka (38.5%), khitchri/rabdi of bajra (35.6%), daliya (25%), and cow's milk (23.1%). Restricted foods included roti (62.5%), all dals except moong dal (59.1%), and vegetables (42.8%). The leading herbal medicines used to treat measles were a mixture of nutmeg, mace, clove, tulsi leaves, and kishmish (26.9%) and a mixture of nutmeg, mace, clove, tulsi leaves, and brahmi (25.5%). The mothers believed that herbal medicines save their children's lives. These findings indicate the need to consider beliefs about culturally accepted and restricted foods when designing a nutritional and health education program.^ieng

Mothers' beliefs and practices regarding prevention and management of diarrheal diseases.

PIP: In India, 48 mothers with at least one child aged less than 5 years living in two villages of Raipur Rani block in Haryana were interviewed to determine whether their beliefs and practices had changed after the diarrheal diseases control program was implemented. The researchers planned to use the findings to improve the program's promotional strategy. 23% believed that eating uncovered food, eating dirty or stale food, eating mud, and dirty feeding bottles were causes of diarrhea. Other perceived causes of diarrhea to be excessive heat (75%), specific foods (52%), over-eating (22.9%), excessive cold (14.5%), teething (14.5%), side effects of medication (6.2%), top milk (4.2%), and constipation (4.1%). Only 10.4% knew specific ways to prevent diarrhea. 85.5% approved of continuing breast feeding during diarrhea, while, before the program, most mothers withheld breast milk. Previously, 98.1% would restrict foods during diarrhea, now only 35% would do so. 50% believed less fluids than the normal amount should be given during diarrhea. 65% thought that the usual amount of food should be given. 68.8% would administer home remedies to treat diarrhea. 18.8% would begin oral rehydration therapy at home. If diarrhea is serious or home remedies do not work, 83.7% would seek a local medical practitioner and 16.3% would go to government health facilities. 54% had used oral rehydration solution in the past. 42.9% of them knew how to prepare it correctly and 70.5% knew how to administer it correctly. Recognized danger signs during diarrhea included lethargy (54.1%), at least eight watery stools/day (41.6%), frequent vomiting (27.1%), weakness (20.8%), dry and sunken eyes (16.6%), anorexia (12.5%), loose skin (6.2%), fever (4.2%), noisy breathing (2.1%), convulsions (2.1%), dehydration (2.1%), facial edema (2.1%), and sunken fontanelle (2%). These findings emphasize the need to focus on preventive measures by educating the public about causes and methods of diarrhea prevention while considering the existing culture.^ieng

Nutrition. You can break the diarrhoea circle.

PIP: During a diarrheal episode, the body cannot absorb nutrients as well as it can when it is healthy. Nutrient intake may fall as much as 33% during the first days of a diarrheal episode. Loss of appetite or vomiting often occurs, or mothers may follow traditional beliefs or incorrect recommendations and feed the child less. This contributes to malnutrition, which, in turn, facilitates infections (e.g., diarrhea) because the body does not have the nutrients to fight infections. In fact, malnourished children usually have longer and more severe episodes of acute diarrhea (14 days) than well-nourished children. Good nutrition before, during, and after diarrhea can break the cycle of malnutrition and diarrhea. If a child develops dehydration, oral rehydration therapy (ORT) should be administered and feeding (other than breast feeding) should be suspended for a few hours. ORT may include home fluids (e.g., soup). Caretakers should resume feeding within 4-6 hours after ORT begins. The children should receive at least 6 small meals a day during and after diarrhea. Severely malnourished children should continue to receive food, especially potassium-rich foods (e.g., bananas and coconut water) during ORT. Rehydration should last longer (12-24 hours) in severely malnourished children. Growth slows down during diarrhea regardless of food intake. During the recovery period, the very hungry children may consume as much as 2 times the amount normally eaten. Caretakers should provide an extra meal for a recovering child for 2 weeks. Breast feeding should continue at least at the same level during diarrhea. Non-breast-fed infants should continue to receive undiluted animal milk or formula during acute diarrhea. Older infants (=or 4 months) who are already receiving soft or solid foods should continue to receive them during diarrhea. Adding 1-2 teaspoonfuls of vegetable oil (e.g., red palm oil) to staple foods increases the energy content.^ieng

Preliminary study on the attitude of people in two states of Nigeria on diarrhoeal disease and its management.

Questionnaires were given out randomly to 561 people to find out their knowledge, attitude and practices regarding diarrhoeal disease and its management. Most people know what diarrhoea is. Not many people can prepare the home-made salt-sugar solution. A variety of traditional remedies are used for treating diarrhoea and dehydration.

PIP: In Nigeria, researchers analyzed data on 561 residents of Calabar and its environs in Cross River State and in Akwa Ibon State to determine their knowledge, attitude, and practices concerning diarrhea and it management. Most everyone correctly defined diarrhea as frequent watery stools. Most people agreed that contaminated food and water cause diarrhea. Yet some people mistakenly believed diarrhea also had other causes such as eating unripe fruit (7.5%) and teething (2%). 60 respondents thought the person ill with diarrhea should neither eat solid food nor drink. In addition, 106 people believed mothers should not breast feed a child during a diarrheal episode. Radio, TV, hospitals, clinics and health centers informed 95.4% of the people about sugar salt solution (SSS). They tended to believe SSS does adequately treat diarrhea, but 1 person thought it was only useful at the hospital. 6.6.% claimed they would not administer it to their children when they experience a diarrheal episode. Just 12.7% knew how to correctly prepare SSS and 13.2% had no knowledge at all on how to prepare it. 28.5% did use only SSS when their children were ill with diarrhea. Many of the other respondents would use SSS along with antibiotics and antidiarrheals. 53.5% used antibiotics and 15.3% used antidiarrheals. Leading traditional remedies for diarrhea and/or dehydration included plantain (16.9%), ogi (15.5%), native herbs (10.3%), roasted or cooked yam (7.1%), and coconut water (7.1%). These results indicated the need to promote oral rehydration therapy (ORT) in these 2 Nigerian states. Health workers should target every member of the household so each one can learn about ORT and how to prepare and administer SSS.

Indicators of accessibility to primary health care coverage in rural Odukpani, Nigeria.

Indicators of accessibility were investigated in Odukpani Local Government Area using a structured questionnaire administered to mothers or heads of households in the study area. The indicators considered included proportion of births attended by trained health personnel, proportion of children with diarrhea treated with oral rehydration therapy (ORT), distance from home to regular immunization site, and acceptability of primary health care services to the target population. Sociodemographic data revealed a typical developing country population profile and surprisingly high literacy rate (57.8%) relative to the national rate, an observation which may account for the appreciable level of awareness.

PIP: In the Akpabuyo zone in the Odukpani local government area, Cross River State, Nigeria, data collected from a survey of 90 households, from health facilities, the State Ministry of Health, and the Ministries of Local Government and of Lands and Surveys were analyzed to examine accessibility to primary health care (PHC) coverage. Children under 5 years old and reproductive age women comprised 58% of the population. 5 km from home to PHC coverage was considered accessible and all the children lived within this distance. Most respondents (67.8%) considered an immunization site to be not far. The majority (88.9%) used PHC health facilities, suggesting a relatively high rate of acceptability. Health personnel made home visits to 55.5% of respondents. Many adults' work schedules limited their ability to take their children to health sites (52.2% were farmers and 18.9% were traders). Thus, inappropriate scheduling of immunizations and maternal and child health services likely explained low immunization coverage (5.3-12.7%). This coverage was low despite the relatively high literacy rate in Akpabuyo (57.8%). Trained health personnel attended 98.9% of all deliveries, but traditional birth attendants (TBAs) conducted 61.3% of all deliveries, suggesting inaccessibility to health services. Further, 3.7% of deliveries at health facilities resulted in newborn death compared to 9.8% of TBA deliveries. This indicated a need for appropriate supervision and health education of TBAs. Only 39 cases of diarrhea existed. Most (87.2%) received oral rehydration therapy (ORT), reflecting the relatively high literacy rate and awareness levels. Yet, just 2.9% received a home-based sugar/salt solution, suggesting a need to increase ORT education for mothers. Almost all respondents (97%) noted that no village health or development committee existed, indicating a low level of community participation.

Traditional methods in management of diarrhoeal diseases in Uganda.

A total of 292 traditional healers were interviewed in five districts of Uganda to discover how diarrhoeal diseases were treated by them. At least two healers were present in every village visited, and over 42% of their case-load was concerned with diarrhoeal treatment. The investigation showed that a great variety of herbs/plants are used by traditional healers in the treatment of diarrhoeal diseases. All those interviewed used water as the main vehicle for their herbal preparations, the amount prescribed daily ranging from 20 ml to over 100 ml for children (in the case of 54.5% of healers) and 100 ml to over 500 ml for adults (56.6%); 26.4% of healers considered fluid supplements as mandatory and 70.5% advised patients to take as much fluid as possible. Only 3.1% of healers either limited or did not advise fluid intake. These findings indicate that traditional healers could play an important role in interventions to control diarrhoeal diseases using modern oral rehydration therapy if they are assisted to improve their techniques.

Passive immunisation of children with bovine colostrum containing antibodies to human rotavirus.

The efficacy of a 10-day course of bovine colostrum with high antibody titre against the four known human rotavirus serotypes in protecting children against rotavirus infection was examined in patients admitted to hospital. Children aged 3 to 15 months were blocked in pairs according to ward accommodation (ie, isolation or open area). Each block contained 1 treated and 1 control child. The allocation to treatment or control (an artificial infant formula) was randomised. 9 of 65 control children but none of 55 treated children acquired rotavirus infection during the treatment period (p less than 0.001). The importance of protecting against rotavirus infection was highlighted by the fact that parents of symptomatic rotavirus-positive children sought medical attention seven times more often than did parents of symptomatic rotavirus-negative children (p less than 0.05).

PIP: One of the main reasons for hospital admission of infants and young children is infectious diarrhea usually caused by a rotavirus infection. Infants can also acquire rotavirus in hospital neonatal and pediatric wards; the infection can also be transmitted to adult members of the family. The most protection against rotavirus is the presence of an antibody in the lumen of the small intestine. However, both adults and children can be immunized against rotavirus through the ingestion of an antibody containing a modified rotavirus. A study was conducted on 120 children, aged 3 - 15 months. The aim of the study was to produce a preparation of bovine colostrum with a high antibody titre against the 4 known human rotavirus. 65 of the children were placed in a control group, while the remaining 55 were placed in a treatment group. A colostrum was produced by introducing a vaccine containing all 4 human rotavirus into 25 pregnant Freisian cows. The colostrum was then administered to the children, orally. Stool specimens were collected before admission, during the study and after discharge. The result of the study are as follows: 14% of the control group (9 of 65) acquired rotavirus during the study; 8 of the 9 patients probably acquired the infection on admission to the hospital. None of the treatment group were infected.

Vitamin A and diarrhoea. Reducing the risk?

PIP: Although no conclusive evidence has been found that administration of Vitamin A can be employed in the control of diarrhea, studies have not yet focused on the effects of Vitamin A on the duration and occurrence of diarrheal diseases. Vitamin A supplements have been positively linked to the prevention of xerophthalmia, a term used for a grouping of eye diseases. The growth and development of the epithelial cells of the eye is dependent upon a healthy level of Vitamin A. Because the human gut is also lined with epithelial cells, the assumption that Vitamin A deficiency may be connected to diarrheal disease has some validity. Other connections with children who had symptoms of xerophthalmia and who were more inclined to respiratory disease and diarrhea were observed. Even though a substantial case has not been made for the use of Vitamin A for diarrheal disease, there are reasons for administering Vitamin A to children with diarrhea: to aid in the control of Vitamin A deficiency; for the prevention of xerophthalmia; to assist in current attacks of diarrhea and to reduce the potential of future attacks.^ieng

Working with mothers for change.

PIP: An evaluation of the effectiveness of teaching mothers how to prevent childhood blindness was made in the Raipur District of Madhya Pradesh, India. Of the district's 700,000 inhabitants, 1/2 live in poorly housed urban areas. Adult females in all 270 houses in 1 urban slum were interviewed twice. They were asked the same questions in April 1985, and 18 months later in September 1986. During this period of time, each family was visited twice each month, and trained in the general health of mother and child. Each child was weighed once a month, and had his eyes examined. In the training, specific emphasis was given to breastfeeding and its timing, early infant feeding practice and introduction of semi-solids and vegetables, diarrhea and oral rehydration therapy, the implication of night blindness, the role of vitamin A, and also immunization. The basis for the teaching was the Road to Health Chart. For the post-teaching survey a new worker was introduced to increase objectivity. The evaluation of impact of this training shows an improvement in the answers. Some mothers appear more aware of their child's needs. 30% of them recognize breastfeeding as important from the 1st day, know that semi-solids should be introduced early, show some understanding of oral rehydration therapy for diarrhea (20%), of the interest of suitable foods to remedy night blindness (14%), and of the value of immunization. This progress in awareness, if not of the actual practice, leaves hopes that, in time, child care will be improved markedly.^ieng