Protective Effect of Low Molecular Weight Seleno-Aminopolysaccharide on the Intestinal Mucosal Oxidative Damage.

Low molecular weight seleno-aminopolysaccharide (LSA) is an organic selenium compound comprising selenium and low molecular weight aminopolysaccharide (LA), a low molecular weight natural linear polysaccharide derived from chitosan. LSA has been found to exert strong pharmacological activity. In this study, we aimed to investigate the protective effect of LSA on intestinal mucosal oxidative stress in a weaning piglet model by detecting the growth performance, intestinal mucosal structure, antioxidant indices, and expression level of intracellular transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) and its related factors. Our results indicated that LSA significantly increased the average daily gain and feed/gain (p < 0.05), suggesting that LSA can effectively promote the growth of weaning piglets. The results of scanning electron microscope (SEM) microscopy showed that LSA effectively reduced intestinal damage, indicating that LSA improved the intestinal stress response and protected the intestinal structure integrity. In addition, diamine oxidase (DAO) and d-lactic acid (d-LA) levels remarkably decreased in LSA group compared with control group (p < 0.05), suggesting that LSA alleviated the damage and permeability of weaning piglets. LSA significantly increased superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and total antioxidant capacity (T-AOC) levels, but decreased malondialdehyde (MDA) level, indicating that LSA significantly enhanced the antioxidant capacity and reduced oxidative stress in weaning piglets. RT-PCR results showed that LSA significantly increased GSH-Px1, GSH-Px2, SOD-1, SOD-2, CAT, Nrf2, HO-1, and NQO1 gene expression (p < 0.05). Western blot analysis revealed that LSA activated the Nrf2 signaling pathway by downregulating the expression of Keap1 and upregulating the expression of Nrf2 to protect intestinal mucosa against oxidative stress. Collectively, LSA reduced intestinal mucosal damage induced by oxidative stress via Nrf2-Keap1 pathway in weaning stress of infants.

Delivery practices, hygiene, birth attendance and neonatal infections in Karamoja, Uganda: a community-based study.

BACKGROUND: Drawing attention to home birth conditions and subsequent neonatal infections is a key starting point to reducing neonatal morbidity which are a main cause of mortality in sub-Saharan Africa. OBJECTIVES: To determine the proportion of respiratory, ophthalmic, and diarrhoeal infections in neonates; the proportion of mothers of neonates, following clean delivery practices; and to explore existing community practices during delivery and the neonatal period. METHODS: A descriptive, cross-sectional, exploratory study, including 10 questionnaires and five Key-Informant interviews, in rural Karamoja, Uganda. RESULTS: Post-delivery razor blade and string use was 90%, but clean delivery surface use only 30%, while 90% obtained bathing water for neonates from boreholes. No mothers washed hands after latrine-related activities compared with 83% for food-related activities. None delivered in health centres or with skilled birth attendants. Respiratory infections occurred in eight neonates, compared to two ophthalmic infections, and no diarrhoea. CONCLUSION: Use of clean delivery surfaces needs to be improved as well as washing after latrine-related activities. Diarrhoea was far less common than expected. Since rural Mother-Infant pairs spend the majority of their post-delivery time around the homestead, hygiene impacts neonatal infections to a large degree, possibly even more so than delivery practices.

Oral zinc and common childhood infections--An update.

Zinc is an essential micronutrient important for growth and for normal function of the immune system. Many children in developing countries have inadequate zinc nutrition. Routine zinc supplementation reduces the risk of respiratory infections and diarrhea, the two leading causes of morbidity and mortality in young children worldwide. In childhood diarrhea oral zinc also reduces illness duration and risk of persistent episodes. Oral zinc is therefore recommended for the treatment of acute diarrhea in young children. The results from the studies that have measured the therapeutic effect of zinc on acute respiratory infections, however, are conflicting. Moreover, the results of therapeutic zinc for childhood malaria also are so far not promising.This paper gives a brief outline of the current evidence from clinical trials on therapeutic effect of oral zinc on childhood respiratory infections, pneumonia and malaria and also of new evidence of the effect on serious bacterial illness in young infants.

N-Acetylcysteine treatment of rotavirus-associated diarrhea in children.

Rotaviruses are the leading cause of severe, acute, and dehydrating diarrhea affecting children under 5 years of age worldwide. Despite an important reduction in rotavirus-caused deaths as a consequence of the rotavirus vaccine, alternative or complementary strategies for preventing or treating rotavirus-associated diarrhea are needed mainly in the poorest countries. We describe the cases of four rotavirus-unvaccinated 12-13-month-old girls and a 5-year-old boy who developed rotavirus-associated diarrhea confirmed by enzyme-linked immunosorbent assay, Western blotting, and immunochemistry analyses. After the first day of diarrheal episodes, three of the five patients were immediately administered oral N-acetylcysteine (NAC) 60 mg/kg daily, divided into three equal doses every 8 hours. The other two patients did not receive NAC and served as controls. Administration of NAC resulted in a decreased number of diarrheal episodes, excretion of fecal rotavirus antigen, and resolution of symptoms after 2 days of treatment. Our results suggest that NAC treatment after the first diarrheal episode could be an efficient strategy for treating rotavirus-affected children and preventing the associated severe life-threatening accompanying dehydration.

Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

OBJECTIVE: To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. DESIGN: We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. SETTING: Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. SUBJECTS: The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. RESULTS: In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. CONCLUSIONS: This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

A review of enteral strategies in infant short bowel syndrome: evidence-based or NICU culture?

INTRODUCTION: Short bowel syndrome (SBS) is an increasingly common condition encountered across neonatal intensive care units. Improvements in parenteral nutrition (PN), neonatal intensive care and surgical techniques, in addition to an improved understanding of SBS pathophysiology, have contributed in equal parts to the survival of this fragile subset of infants. Prevention of intestinal failure associated liver disease (IFALD) and promotion of intestinal adaptation are primary goals of all involved in the care of these patients. While enteral nutritional and pharmacological strategies are necessary to achieve these goals, there remains great variability in the application of therapeutic strategies in units that are not necessarily evidence-based. MATERIALS AND METHODS: A search of major English language medical databases (SCOPUS, Index Medicus, Medline, and the Cochrane database) was conducted for the key words short bowel syndrome, medical management, nutritional management and intestinal adaptation. All pharmacological and nutritional agents encountered in the literature search were classified based on their effects on absorptive capacity, intestinal adaptation and bowel motility that are the three major strategies employed in the management of SBS. The Oxford Center for Evidence-Based Medicine (CEBM) classification for levels of evidence was used to develop grades of clinical recommendation for each variable studied. RESULTS: We reviewed various medications used and nutritional strategies included soluble fiber, enteral fat, glutamine, probiotics and sodium supplementation. Most interventions have scientific rationale but little evidence to support their role in the management of infant SBS. While some of these agents symptomatically improve diarrhea, they can adversely influence pancreatico-biliary function or actually impair intestinal adaptation. Surgical anatomy and liver function are two important variables that should determine the selection of pharmacological and nutritional interventions. DISCUSSION: There is a paucity of research investigating optimal clinical practice in infant SBS and the little evidence available is consistently of lower quality, resulting in a wide variation of clinical practices among NICUs. Prospective trials should be encouraged to bridge the evidence gap between research and clinical practice to promote further progress in the field.

Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial.

BACKGROUND: Powders containing iron and other micronutrients are recommended as a strategy to prevent nutritional anaemia and other micronutrient deficiencies in children. We assessed the effects of provision of two micronutrient powder formulations, with or without zinc, to children in Pakistan. METHODS: We did a cluster randomised trial in urban and rural sites in Sindh, Pakistan. A baseline survey identified 256 clusters, which were randomly assigned (within urban and rural strata, by computer-generated random numbers) to one of three groups: non-supplemented control (group A), micronutrient powder without zinc (group B), or micronutrient powder with 10 mg zinc (group C). Children in the clusters aged 6 months were eligible for inclusion in the study. Powders were to be given daily between 6 and 18 months of age; follow-up was to age 2 years. Micronutrient powder sachets for groups B and C were identical except for colour; investigators and field and supervisory staff were masked to composition of the micronutrient powders until trial completion. Parents knew whether their child was receiving supplementation, but did not know whether the powder contained zinc. Primary outcomes were growth, episodes of diarrhoea, acute lower respiratory tract infection, fever, and incidence of admission to hospital. This trial is registered with ClinicalTrials.gov, number NCT00705445. RESULTS: The trial was done between Nov 1, 2008, and Dec 31, 2011. 947 children were enrolled in group A clusters, 910 in group B clusters, and 889 in group C clusters. Micronutrient powder administration was associated with lower risk of iron-deficiency anaemia at 18 months compared with the control group (odds ratio [OR] for micronutrient powder without zinc=0·20, 95% CI 0·11-0·36; OR for micronutrient powder with zinc=0·25, 95% CI 0·14-0·44). Compared with the control group, children in the group receiving micronutrient powder without zinc gained an extra 0·31 cm (95% CI 0·03-0·59) between 6 and 18 months of age and children receiving micronutrient powder with zinc an extra 0·56 cm (0·29-0·84). We recorded strong evidence of an increased proportion of days with diarrhoea (p=0·001) and increased incidence of bloody diarrhoea (p=0·003) between 6 and 18 months in the two micronutrient powder groups, and reported chest indrawing (p=0·03). Incidence of febrile episodes or admission to hospital for diarrhoea, respiratory problems, or febrile episodes did not differ between the three groups. INTERPRETATION: Use of micronutrient powders reduces iron-deficiency anaemia in young children. However, the excess burden of diarrhoea and respiratory morbidities associated with micronutrient powder use and the very small effect on growth recorded suggest that a careful assessment of risks and benefits must be done in populations with malnourished children and high diarrhoea burdens. FUNDING: Bill & Melinda Gates Foundation.

Frequência de Escherichia coli e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda / The frequency of Escherichia coli and its sensitivity to antimicrobials in children aged under five years admitted to hospital for treatment of acute diarrhea

Determinar a frequência de Escherichia coli diarreiogênica e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda. MÉTODOS: estudo prospectivo tipo corte transversal realizado no Instituto de Medicina Integral Prof. Fernando Figueira, entre janeiro de 2010 e fevereiro de 2011. Foram excluídas as crianças com diagnóstico de imunodeficiência ou usando antimicrobianos. Para cada paciente foi feito uma única coleta de swab retal nas primeiras 24 horas de internação. Os patógenos foram identificados na coprocultura e sorotipagem. Os antibiogramas foram obtidos por disco-difusão. RESULTADOS: 140 crianças foram arroladas, em sua maioria provinham de famílias de baixa renda da Região Metropolitana do Recife. Foram isolados 99 microorganismos: 9 (6,4 por cento) E. coli enteropatogênica (EPEC) e 4 (2,9 por cento) E. coli enteroinvasora (EIEC) e 80 (57,1 por cento) outras E.coli não EPEC, não EIEC, 3 (2,1 por cento) Shigella spp e 3 (2,1 por cento) Salmonella spp. O perfil de sensibilidade aos antimicrobianos demonstrou níveis elevados de resistência à ampicilina e sulfametoxazol-trimetoprima. CONCLUSÕES: a baixa frequência de EPEC observada pode estar associada às condições de saneamento básico favoráveis apresentadas pelos pacientes do estudo. A análise local do perfil da sensibilidade da E. coli aos antimicrobianos reforça a recomendação da Organização Mundial de Saúde para o uso racional dessas drogas visando prevenção da resistência bacteriana...

To determine the frequency of diarrheic Escherichia coli and its sensitivity to antimicrobials in children aged under five years admitted to hospital for treatment of acute diarrhea. METHODS: a prospective cross-sectional study was carried out at the Instituto de Medicina Integral Prof. Fernando Figueira, between January 2010 and February 2011. Children were excluded if they had been diagnosed as immunodeficient or were using antimicrobials. A single rectal swab was taken from each patient during the first 24 hours of hospitalization. The pathogens were identified in the coproculture and serotyping. Antibiograms were obtained using disc-diffusion. RESULTS: 140 children were recruited. Most were from low-income families in the Metropolitan Region of Recife. Ninety-nine micro-organisms were isolated: 9 (6.4 percent) enteropathogenic E. coli (EPEC) and 4 (2.9 percent) enteroinvasive E. coli (EIEC) and 80 (57.1 percent) other E.coli that are neither EPEC nor EIEC, 3 (2.1 percent) Shigella spp and 3 (2.1 percent) Salmonella spp. The profile of sensitivity to antimicrobials showed high levels to resistance to ampicillin and sulfametho-xazol-trimetropime. CONCLUSIONS: the low frequency of EPEC found may be associated with basic sanitary conditions among the patients in the study. The local analysis of the profile of sensitivity of E. coli to antimicrobials corroborates the World Health Organization recommendation that these drugs be used prudently to ensure prevention of resistance in bacteria...

Use of an omega-3 fatty acid-based emulsion in the treatment of parenteral nutrition-induced cholestasis in patients with microvillous inclusion disease.

Microvillous inclusion disease is a congenital intestinal epithelial cell disorder leading to lifelong intestinal failure. In this report, we discuss the use of a fish oil-based lipid emulsion in the treatment of 3 patients with microvillous inclusion disease who developed parenteral nutrition-associated liver disease.

Composición de las soluciones caseras usadas en ninos con diarrea sin deshidratación: Mérida-Venezuela: [revisión] / Composition of home made solutions used in children with diarrhea without dehydration: [review]

La diarrea es una causa principal de morbi-mortalidad en niños y el uso de la terapia de rehidratación oral (uso de suero oral más líquidos caseros) puede prevenir la deshidratación. Identificar las soluciones caseras utilizadas en los niños con diarrea sin deshidratación, analizar su composición bioquímica y proponer las más adecuadas. Se entrevistaron 167 madres, en consultas pediátricas, seleccionadas al azar, durante los años 2004-2006, en Mérida-Venezuela; es un estudio epidemiológico, analítico, prospectivo y concurrente. Se identificaron cinco grupos de soluciones caseras: agua de arroz, sopa de plátano, sopa de cambur (banana), infusiones de hierbas y jugos de frutas. El análisis bioquímico se realizó mediante un pH metro, espectroscopia de absorción atómica (Na y K), argentometría (Cl), osmómetro (osmolaridad), glucosa peroxidasa (glucosa), hidrovolumetría por neutralización (bicarbonato) y bandas de absorción (citrato), procesadas en la Facultad de Ciencias de la Universidad de Los Andes. Todas las soluciones estudiadas tienen un pH ácido, con excepción del suero casero con bicarbonato. las concentraciones de electrolitos fueron mínimas en el agua de arroz, las infusiones de hierbas y los jugos de frutas, mientras que fueron más elevadas en las sopas de plátano y banana. (Na y Cl más elevado). Las osmolaridad fue baja en todas las soluciones y alta en los jugos de frutas. Ninguna de las soluciones reúne las concentraciones planteadas por la OMS, aunque en el niño con diarrea sin deshidratación la sopas de plátano y banana pueden ser utilizadas debido a la buena aceptación y al bajo costo. No se recomiendan los jugos de fruta por su alta osmolaridad.

Diarrhoea continues to be one the main causes of morbidity-mortality in latin american countries due to dehydration. this is why the most important strategy to avoid deaths due to dehydration is oral rehydration therapy (oral rehydration solution plus homemade solutions) which may vary according to each region of the country. To identify the most frequently used homemade solutions for preventing dehydration in children with acute diarrhoea within the community in Mérida, Venezuela; to analyze the biochemical composition of these solutions; to propose the use of the most adequate ones. By means o an epidemiological, analytical, prospective and concurrent study 167 inquiries were performed to mothers who sought medical help in the main assistance centers of the city. these mothers were selected randomly during 2004-2006. five groups of homemade solutions were identified: rice water (golden rice in esther grain or flour), plantain soup with or without chicken, banana soup, herbal infusions and fruit juices. Biochemical analysis was performed by means of: ohmmeters (pH), spectroscopy of atomic absorption (Na and K), argentometry (Cl), osmometer (osmolarity), glucose peroxidase (glucose), hidrovolumetry by neutralization (bicarbonate) and absorption bands (citrate) processed at the Science Faculty of the Universidad de Los Andes. All the homemade liquids have an acidic pH, except solutions with added bicarbonate. electrolytes concentrations were minimum except for the plantain and banana soups, which have a higher sodium and chloride concentration. The osmolarity of most solutions was low, with exception of fruit juices (orange and guava). Conclusions: none of the homemade solutions meet the requirements established by the World Health Organization as an ideal rehydration solution. However, plantain and banana soup may be used in children with diarrhea without dehydration due to their high availability.

Efecto de la educación sobre EDAS, impartido por el personal de salud a madres de niños menores de 5 años del Cantón Ramadas - Provincia Tapacarí (Tercer trimestre del 2008) / Effect of education on EDAS, provided by health personnel to mothers of children under 5 years of Guangzhou Ramadas - Tapacarí Province (third quarter of 2008)

La enfermedad diarreica aguda (EDAS) es la principal causa de morbi-mortalidad en niños menores de 5 años, es un problema que con mayor evidencia expresa las bajas condiciones de vida de la población junto a la crisis económica, déficit de servicios de saneamiento básico, malas prácticas de higiene, alimentación inadecuada y la deficiente promoción de los servicios de salud. El objetivo de esta investigación es conocer el efecto de la educación sobre (EDAS) en las madres de niños menores de 5 años. La investigación se realizó desde el enfoque cuantitativo con una muestra de 121 madres, las cuales representan el 100%. Para la recolección de datos se empleó el cuestionario mediante entrevista personal. Los resultados muestran que el 93% de las madres recibieron educación sobre (EDAS) por el personal de salud, de las cuales el 33% logró realizar un diagnóstico precoz y para tratarlas, el 14% realizó uso del suero de rehidratación oral, el 33% preparó remedios caseros y el 40% acudió al Centro de Salud. Así mismo, se identificó que el efecto de las actividades educativas no muestra resultados favorables; las madres todavía desconocen el empleo de medidas de prevención, lo cual se refleja en el aumento de casos de (EDAS) en menores de cinco años en el cantón de Ramadas de la provincia de Tapacarí del departamento de Cochabamba

Infant morbidity in an Indian slum birth cohort.

OBJECTIVE: To establish incidence rates, clinic referrals, hospitalisations, mortality rates and baseline determinants of morbidity among infants in an Indian slum. DESIGN: A community-based birth cohort with twice-weekly surveillance. SETTING: Vellore, South India. SUBJECTS: 452 newborns recruited over 18 months, followed through infancy. MAIN OUTCOME MEASURES: Incidence rates of gastrointestinal illness, respiratory illness, undifferentiated fever, other infections and non-infectious morbidity; rates of community-based diagnoses, clinic visits and hospitalisation; and rate ratios of baseline factors for morbidity. RESULTS: Infants experienced 12 episodes (95% confidence interval (CI) 11 to 13) of illness, spending about one fifth of their infancy with an illness. Respiratory and gastrointestinal symptoms were most common with incidence rates (95% CI) of 7.4 (6.9 to 7.9) and 3.6 (3.3 to 3.9) episodes per child-year. Factors independently associated with a higher incidence of respiratory and gastrointestinal illness were age (3-5 months), male sex, cold/wet season and household involved in beedi work. The rate (95% CI) of hospitalisation, mainly for respiratory and gastrointestinal illness, was 0.28 (0.22 to 0.35) per child-year. CONCLUSIONS: The morbidity burden due to respiratory and gastrointestinal illness is high in a South Indian urban slum, with children ill for approximately one fifth of infancy, mainly with respiratory and gastrointestinal illnesses. The risk factors identified were younger age, male sex, cold/wet season and household involvement in beedi work.

Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy.

Acute gastroenteritis remains a common illness among infants and children throughout the world. Among children in the United States, acute diarrhea accounts for >1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths/year. In developing countries, diarrhea is a common cause of mortality among children aged <5 years, with an estimated 2 million deaths annually. Oral rehydration therapy (ORT) includes rehydration and maintenance fluids with oral rehydration solutions (ORS), combined with continued age-appropriate nutrition. Although ORT has been instrumental in improving health outcomes among children in developing countries, its use has lagged behind in the United States. This report provides a review of the historical background and physiologic basis for using ORT and provides recommendations for assessing and managing children with acute diarrhea, including those who have become dehydrated. Recent developments in the science of gastroenteritis management have substantially altered case management. Physicians now recognize that zinc supplementation can reduce the incidence and severity of diarrheal disease, and an ORS of reduced osmolarity (i.e., proportionally reduced concentrations of sodium and glucose) has been developed for global use. The combination of oral rehydration and early nutritional support has proven effective throughout the world in treating acute diarrhea. In 1992, CDC prepared the first national guidelines for managing childhood diarrhea (CDC. The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. MMWR 1992;41[No. RR-16]), and this report updates those recommendations. This report reviews the historical background and scientific basis of ORT and provides a framework for assessing and treating infants and children who have acute diarrhea. The discussion focuses on common clinical scenarios and traditional practices, especially regarding continued feeding. Limitations of ORT, ongoing research in the areas of micronutrient supplements, and functional foods are reviewed as well. These updated recommendations were developed by specialists in managing gastroenteritis, in consultation with CDC and external consultants. Relevant literature was identified through an extensive MEDLINE search by using related terms. Articles were then reviewed for their relevance to pediatric practice, with emphasis on U.S. populations. Unpublished references were sought from the external consultants and other researchers. In the United States, adoption of these updated recommendations could substantially reduce medical costs and childhood hospitalizations and deaths caused by diarrhea.

Infecciones por Escherichia coli enteropatógena / Infectious diseases by Enteropathogenic Escherichia coli

Escherichia coli es una bacteria reconocida como uno de los principales agentes causantes de diarrea en humanos. Las diferentes capas de esta bacteria en humanos se clasifican en 5 categorías diferentes: enterotoxigénica (ETEC), enteroinvasiva (EIEC), enterohemorrágica (EHEC), enteroagregativa (EAggEC) y enteropatógena (EPEC). Las cepas del grupo EPEC son responsables de diarrea en niños menores, principalmente de países en desarrollo. El propósito de esta revisión consiste en presentar los conocimientos más recistentes relacionados con la patogénesis del grupo EPEC, así como las contribuciones de investigadores mexicanos en el conocimiento del microorganismo.

Efficacy of traditional rice-lentil-yogurt diet, lactose free milk protein-based formula and soy protein formula in management of secondary lactose intolerance with acute childhood diarrhoea.

Secondary lactose intolerance is often a cause of prolongation of diarrhoeal episodes. As appropriate management of lactose intolerance is elimination of lactose from diet, expansive lactose free formulae are often prescribed in acute childhood diarrhoea without establishing diagnosis of lactose intolerance. Since cheap weaning diets made from locally available cereals have been found effective in management of persistent diarrhoea, we postulated that same weaning diet made of rice lentil and yogurt (K-Y diet) could be effectively used in management of acute childhood diarrhoea associated with secondary lactose intolerance. We compared this K-Y diet with milk protein-based lactose free and soy-protein formula. Thirty children between 3-18 months of age completed dietary trial for 72 h. Of these nine children received K-Y diet (Group A), four children received milk protein-based formula (Group B) and 11 children received soy protein formula (Group C). Stool frequency was significantly reduced in children in Group A (13 +/- 6 on day 1 to 6 +/- 5 on day 3) and in Group B (13 +/- 5 on day 1 to 7 +/- 4 on day 3), but not in Group C (13 +/- 4 on day 1 to 10 +/- 8 on day 3). No significant difference was observed in intake of diet, total calories intake, and fluid intake among the three groups. It is concluded that cheap weaning diet made of locally available cereals and yogurt can be used effectively in management of secondary lactose intolerance associated with acute childhood diarrhoea.