A comparative study of the prevalence of zinc deficiency among children with acute diarrhoea in SouthWestern Nigeria.

BACKGROUND: Zinc deficiency has been associated with increased incidence, severity and duration of childhood diarrhoea. OBJECTIVE: The objective of the study was to determine the prevalence of zinc deficiency among under-five children with acute diarrhoea. METHODS: The study was a comparative cross-sectional study in which serum zinc levels were determined using atomic absorption spectrometry in under-five children with acute diarrhoea and in apparently healthy contols. Two hundred and fifty children with acute diarrhoea and 250 controls were studied at the Wesley Guild Hospital, Ilesa, Nigeria. RESULTS: The diarrhoea patients had a mean ± SD serum zinc level of 78.8 ± 35.6 µg/dl, while the controls had a mean of 107.3 ± 46.8 µg/dl. The mean serum zinc level was significantly lower in the patients than the controls (t = -7.66; p < 0.001). Furthermore, the prevalence of zinc deficiency was significantly higher among the patients (30.4% versus 12.4% in the controls; OR = 3.09; 95% CI = 1.94 - 4.90; χ2 = 24.08; p < 0.001). Low social class was associated with a significantly higher prevalence of zinc deficiency among the patients (p = 0.013). CONCLUSION: Zinc deficiency is significantly associated with diarrhoea among under-five children in the study community. Hence, routine zinc supplementation should be encouraged for the treatment of diarrhoea, and availability should be ensured.

[Influential factors of iron deficient anemia among infants aged 8 months based on a case-control study].

OBJECTIVE: To study the status and influential factors of iron deficient anemia (IDA) among infants aged 8 months in Changsha City.
 Methods: A case-control study was performed in this research. The case group including 105 8-month-old infants definitely diagnosed as IDA based on standardized blood test. Four-times numbers of age- and genger-matched infants without IDA were selected as a control group. Chi-square test and conditional logistic regression was used to analyze the influential factors for IDA.
 Results: The incidence rate of IDA among infants aged 8 months in Changsha City was 14.7%. The risk factors were as follows: mother with anemia in late pregnancy (OR=3.540, 95% CI 1.898 to 6.601), mixed feeding within 6 months old (OR=1.682, 95% CI 1.099 to 2.574), artificial feeding within 6 months old (OR=4.162, 95% CI 1.343 to 12.896), complementary feeding before 6 months old (OR=1.423, 95% CI 1.022 to 1.982), complementary feeding at or after 7 months old (OR=4.415, 95% CI 2.150 to 9.064), recurrent respiratory tract infections within 8 months old (OR=2.878, 95% CI 1.224 to 6.764), and repeated diarrhea within 8 months old (OR=3.710, 95% CI 1.533 to 8.980).
 Conclusion: There is certain incidence rate of IDA among infants aged 8 months in Changsha City. To prevent the IDA among infants, we should treat mothers' anemia during pregnancy, advocate scientific feeding, encourage complete breastfeeding until 6 months old, add complementary food timely and reasonably, treat infants suffering from respiratory or digestive diseases actively.

Perceptions regarding oral rehydration solutions for the management of diarrhea in Guatemalan children: implications for diarrheal management in the Americas.

OBJECTIVE: To describe knowledge and perceptions regarding the use of oral rehydration solution (ORS) for the management of diarrheal diseases among formal and informal health care providers and community caregivers in the Guatemalan department of Santa Rosa, and to recommend strategies to increase ORS use for management of diarrhea in children. METHODS: From July to September 2008, in-depth, semi-structured interviews were conducted with formal health care providers; open-ended interviews were conducted with informal health care providers; and focus group discussions and pile sorting were carried out with community caregivers. RESULT: The study participants attributed episodes of diarrhea in children to culturally recognized or folk ailments (empacho, cuajo, and varillas) that are primarily treated by traditional healers. There were knowledge deficits about 1) dehydration as a manifestation of diarrhea, and 2) management of dehydration, including the use of ORS and the need to continue feedings during diarrheal episodes. Caregivers perceived bottled/ready-made ORS products and the more expensive over-the-counter antidiarrheal medications as superior to ORS packets in the treatment of diarrhea. CONCLUSIONS: In Guatemala, folk etiologies of disease differ from those of the biomedical establishment and influence the decisions made by caregivers when treating ill children, including those related to the use of ORS. Public health campaigns addressing the treatment and management of diarrheal diseases in Santa Rosa should recognize the ailments known as empacho, cuajo, and varillas and target them for ORS use by community caregivers as well as health care providers in both the formal and informal health sectors.

Perceptions regarding oral rehydration solutions for the management of diarrhea in Guatemalan children: implications for diarrheal management in the Americas / Ideas con respecto a las soluciones de rehidratación oral en el tratamiento de la diarrea de los niños guatemaltecos: repercusiones sobre el tratamiento de la diarrea en las Américas

OBJECTIVE: To describe knowledge and perceptions regarding the use of oral rehydration solution (ORS) for the management of diarrheal diseases among formal and informal health care providers and community caregivers in the Guatemalan department of Santa Rosa, and to recommend strategies to increase ORS use for management of diarrhea in children. METHODS: From July to September 2008, in-depth, semi-structured interviews were conducted with formal health care providers; open-ended interviews were conducted with informal health care providers; and focus group discussions and pile sorting were carried out with community caregivers. RESULT: The study participants attributed episodes of diarrhea in children to culturally recognized or folk ailments (empacho, cuajo, and varillas) that are primarily treated by traditional healers. There were knowledge deficits about 1) dehydration as a manifestation of diarrhea, and 2) management of dehydration, including the use of ORS and the need to continue feedings during diarrheal episodes. Caregivers perceived bottled/ready-made ORS products and the more expensive over-the-counter antidiarrheal medications as superior to ORS packets in the treatment of diarrhea. CONCLUSIONS: In Guatemala, folk etiologies of disease differ from those of the biomedical establishment and influence the decisions made by caregivers when treating ill children, including those related to the use of ORS. Public health campaigns addressing the treatment and management of diarrheal diseases in Santa Rosa should recognize the ailments known as empacho, cuajo, and varillas and target them for ORS use by community caregivers as well as health care providers in both the formal and informal health sectors.

OBJETIVO: Describir los conocimientos y las ideas que tienen las personas que prestan atención de salud en el sector convencional, el sector no convencional y los cuidadores de la comunidad con respecto al uso de las soluciones de rehidratación oral en el tratamiento de las enfermedades diarreicas, en el departamento guatemalteco de Santa Rosa y recomendar estrategias encaminadas a aumentar la utilización de estas soluciones en el tratamiento de la diarrea en los niños. MÉTODOS: De julio a septiembre del 2008 se llevaron a cabo entrevistas exhaustivas semiestructuradas a los profesionales de salud y entrevistas con preguntas abiertas a los proveedores no convencionales de atención sanitaria y se organizaron debates en grupos de opinión y ejercicios de ordenamiento de tarjetas con los cuidadores de la comunidad. RESULTADOS: Los participantes en el estudio atribuyeron la causa de los episodios de diarrea en los niños a dolencias culturalmente aceptadas o populares (empacho, cuajo y varillas), que tratan principalmente los curanderos. Se observaron deficiencias en los conocimientos acerca de 1) la deshidratación como una manifestación de la diarrea y 2) el tratamiento de la deshidratación, incluido el uso de las soluciones de rehidratación oral y la necesidad de continuar la alimentación durante los episodios diarreicos. Los cuidadores consideraron las soluciones de rehidratación embotelladas o preparadas y los medicamentos antidiarreicos de venta libre, que son más costosos, como mejores opciones para el tratamiento de la diarrea que las soluciones de rehidratación oral. CONCLUSIONES: En Guatemala, el concepto popular y el de las instituciones biomédicas sobre la causa de las enfermedades es diferente e influye sobre las decisiones que toman los cuidadores al tratar a los niños enfermos, por ejemplo, las relacionadas con el uso de soluciones de rehidratación oral. Las campañas de salud pública que abordan el tratamiento y el manejo de las enfermedades diarreicas en Santa Rosa deben incorporar las dolencias conocidas como empacho, cuajo y varillas y fomentar el uso de las soluciones de rehidratación oral en estos casos, por parte de los cuidadores de la comunidad, los profesionales de salud del sector convencional y los proveedores de atención del sector no convencional.

Anaemia among Egyptian Children between 2000 and 2005: trends and predictors.

Anaemia remains the most prevalent nutritional disorder among women and children in the Middle East and North Africa region. We examined anaemia trends using data from the Egyptian Demographic and Health Surveys. Between 2000 and 2005, the prevalence of anaemia (defined as haemoglobin concentrations <11 g dL(-1) ) increased from 37.04% to over 52% among Egyptian children between 12 months and 36 months of age. We examined the associations of these changes with food consumption, vitamin A administration, recent illness, immunization status, socio-demographic factors and a child's anaemic status. Children under the age of 24 months who had recently been sick and those who resided in Upper Egypt were significantly more likely to be anaemic. Despite significant improvements in water and sanitation facilities, maternal education and asset-based household wealth, there were marked declines in the consumption of nutritive foods and increases in the prevalence of childhood diarrhoea between 2000 and 2005. Placing these analyses in the broader context of Egyptian economic trends suggests that the nutritional basket consumed by Egyptian households between 2000 and 2005 may have shifted towards less nutritive foods with lower costs per calorie, probably in response to economic difficulties and increasing food prices. Shifts in dietary consumption, in conjunction with increases in diarrhoea, are likely contributing to the rapid increase in childhood anaemia in Egypt between 2000 and 2005. National-level fortification efforts may be one way to combat rising levels of anaemia among Egyptian women and children.

Examining the use of oral rehydration salts and other oral rehydration therapy for childhood diarrhea in Kenya.

Reductions in the use of oral rehydration therapy (ORT) in sub-Saharan Africa highlight the need to examine caregiver perceptions of ORT during diarrheal episodes. Qualitative research involving group discussions with childcare providers and in-depth interviews with 45 caregivers of children < 5 years of age who had experienced diarrhea was conducted in one rural and urban site in Kenya during July-December 2007. Diarrhea was considered a dangerous condition that can kill young children. Caregivers preferred to treat diarrhea with Western drugs believed to be more effective in stopping diarrhea than ORT. Inconsistent recommendations from health workers regarding use of oral rehydration solution (ORS) caused confusion about when ORS is appropriate and whether it requires a medical prescription. In the rural community, causal explanations about diarrhea, beliefs in herbal remedies, cost, and distance to health facilities presented additional barriers to ORS use. Health communication is needed to clarify the function of ORT in preventing dehydration.

[Clinical studies of pediatric malabsorption syndromes].

Multiple cases with various types of pediatric malabsorption syndromes were evaluated. The clinical manifestations, laboratory findings, pathophysiology, and histopathological descriptions of each patient were analyzed in an effort to clear the pathogenesis of the malabsorption syndromes and the treatments were undertaken. The cases studied, included one patient with cystic fibrosis, two with lactose intolerance with lactosuria (Durand type), one with primary intestinal lymphangiectasia, two with familial hypobetalipoproteinemia, one with Hartnup disease, one with congenital chroride diarrhea, one with acrodermatitis enteropathica, one with intestinal nodular lymphoid hyperplasia (NLH), five with intractable diarrhea of early infancy and four with glycogenosis type Ia. Each case description and outcome is described below: 1. A 15-year-old Japanese boy with cystic fibrosis presented with severe symptoms, including pancreatic insufficiency, bronchiectasis, pneumothorax and hemoptysis. His prognosis was poor. Analysis of the CFTR genes of this patient revealed a homozygous large deletion from intron 16 to 17b. 2. In the sibling case of Durand type lactose intolerance, the subjects'disaccaridase activity of the small bowel, including lactase, were within normal limits. The results of per oral and per intraduodenal lactose tolerance tests confirmed lactosuria in both. These observations suggested, not only an abnormal gastric condition, but also duodenal and intestinal mucosal abnormal permeability of lactose. 3. In the case of primary intestinal lymphangiectasia, the subject had a lymphedematous right arm and hand, a grossly coarsened mucosal pattern of the upper gastrointestinal tract (identified via radiologic examination) and the presence of lymphangiectasia (confirmed via duodenal mucosal biopsy). The major laboratory findings were hypoalbuminemia, decreased immunoglobulin levels and lymphopenia resulting from loss of lymph fluid and protein into the gastro-intestinal tract. 4. In two cases of heterozygous familial hypobetalipoproteinemia, serum total cholesterol and betalipoprotein levels were very low. The subjects presented with symptoms and signs of acanthocytosis and fat malabsorption. Further, one subject had neurological abnormalities such as mental retardation and severe convulsions. Treatment with MCT formula diet corrected the lipid malabsorption. 5. A 5-year-old girl presented with pellagra-like rashes, mental retardation and cerebellar ataxia. An oral tryptophan (Trp) and dipeptide (Trp-Phe) loading test were conducted and the renal clearance of amino acids was also evaluated in this patient and in controls. Following the oral Trp loading test, plasma levels of Trp indicated a lower peak in the case, reaching a maximum at 60 minutes. On the other hand, the oral dipeptide (Trp-Phe) loading test in the Hartnup patient showed the peak Trp plasma level was the same as the control subjects. The renal clearance of neutral amino acids in this case increased to levels 5 to 35 times normal. 6. In the case of congenital chloride diarrhea, the subject had secondary lactose intolerance, dehydration, hyponatremia, hypokalemia, hypochloremia, hyperreninemia and metabolic alkalosis. The chloride content of her fecal fluid was very high. The concentrations were 89-103 mEq/l. In contrast, her urine was chloride-free. The subject's growth and development improved after treatment with lactose free formura and oral replacement of the fecal loses of water, NaCl and KCl. Unfortunately, the patient died of a small bowel intussusception. The kidney histopathological finding was juxtaglomerular hyperplasia by a necropsy. 7. In the case of acrodermatitis enteropathica, the subject had characteristic skin lesions, low serum zinc levels and ALPase activity. An oral ZnSO4 loading test and intestinal mucosal histology by a peroral biopsy were conducted. The serum zinc peak level was 2 hours after the oral ZnSO4 loading test. Infant formula alone could not maintain normal serum zinc ranges. Light microscopic studies of the intestinal villous architecture showed a normal pattern. However, ultrastructual examination of several epithelial cells revealed numerous intracellular vesicles. After zinc therapy, these changes were decreased. The lesions were postulated as the secondary result of zinc deficiency. 8. A 12-year-old girl presented with hypogammaglobulinemia, recurrent infections, chronic diarrhea and intestinal NLH. A barium meal and follow-through examination showed multiple nodules throughout the stomach and intestine. The nodules, all uniform in size, were 2 mm diameter. The barium enema did not show NLH in the colon. Mucosal biopsy of the stomach and jejunum revealed the typical histology of NLH in the lamina propria. Also, achlorhydria was present in this patient and her serum gastrin levels were very high; 315-775 pg/ml. 9. In 4 cases of intractable diarrhea in early infancy (by Avery G B), a jejunal biopsy showed shortening villi and nonspecific enterocolitis. Some patients were found with only low lactase or low lactase and sucrase levels. An electron microscope analysis of the small bowel in 2 cases showed alterations: increased pinocytosis in microvillus membranes and lysosomes by endocytosis of undigested macromolecular substances. I postulated that the stated evidence was causative of this clinical profile. 10. I frequently observed diarrhea as a clinical manifestation in glycogenosis type Ia and lipid malabsorption in one case. The light and electron photomicrographs showed intestinal absorption cells with the glycogen deposits in the inferior devision of nuclei.

Terapia de rehidratación oral. Situación actual / Oral rehydration therapy. Current situation

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Impact of zinc supplementation in malnourished children with acute watery diarrhoea.

A double-blind, randomized, controlled clinical trial was conducted on 80 malnourished children with acute dehydrating diarrhoea to evaluate the efficacy of oral supplementation of zinc as an adjunct therapy to oral rehydration solution (ORS). After decoding it was observed that 44 children received zinc sulphate (177 mg/kg/day in three divided doses equivalent to 40 mg elemental zinc) in a syrup form and 36 children received only syrup placebo. Clinical parameters and microbiological findings of stool samples were comparable in the two groups at the time of enrollment. All the children (100 per cent) in the zinc supplemented group and 32 (89 per cent) children in the placebo group recovered within 5 days of hospitalization (p = 0.04). The zinc supplemented group had a significantly shorter duration of diarrhoea (70.4 +/- 10.0 vs. 103.4 +/- 17.1 h; p = 0.0001), passed less liquid stool (1.5 +/- 0.7 vs. 2.4 +/- 0.7kg; p=0.0001), consumed less oral rehydration solution (2.5 +/- 1.0 vs. 3.6 +/- 0.8 litre; p = 0.0001) and other liquids (867.0 +/- 466.1 vs. 1354.7 +/- 675.6 ml; p = 0.0001) as compared to the placebo group. Our findings suggest that zinc supplementation as an adjunct therapy to ORS has beneficial effects on the clinical course of dehydrating acute diarrhoea.

[Clinical and experimental study on zhixie buye mixture in treating infantile diarrhea complicated with dehydration].

OBJECTIVE: To observe the therapeutic effect of Zhixie Buye mixture (ZXBYM) on infantile diarrhea patient with mild and middle degree of dehydration. METHODS: The controlled observation method was adopted in the clinical and experimental study. RESULTS: There was no significant difference in the treatment of dehydration between the ZXBYM group and ORS group (P > 0.05), while it was more effective for ZXBYM to eliminate the symptoms such as vomiting and abdominal distension (P < 0.01). In addition, it was confirmed that the ion concentration of sodium, potassium, chlorine, glucose and osmotic pressure in the mixture was similar to those in ORS. Animal experiment showed that it has the effect of rat intestine peristalsis suppression and water absorption promotion in colon for ZXBYM. And there was statistical difference in antidiarrhea effect between the mixture and ORS (P < 0.01). CONCLUSION: The ZXBYM is an effective mixture in the treatment of diarrhea with dehydration. It has a good prospect of development and application.

Ação do colostro humano na adesão de Escherichia coli enteroagregativa a células HEp-2 / Action of the human colostrum in adhesion of enteroaggregative Escherichia coli to HEp-2 cells

Escherichia coli enteroagregativa (EAggEC) está associada a casos de diarréia infantil, especialmente em crianças de baixo nível socioeconômico. Diversos estudos epidemiológicos recentes apontam EAggEC como um importante agente de diarréia persistente que pode estar associada a desnutrição crônica. Estudos clínicos e epidemiológicos demonstram que o aleitamento materno efetivamente protege lactentes de diarréias e outras doenças infecciosas. IgA secretória (sIgA) do leite humano inibe fortemente a adesão in vitro de E. coli enteropatogênica (EPEC) a células HEp-2 cells, bem como a invasão dessas células por E. coli enteroinvasora (EIEC). Essa capacidade inibidora está associada com a presença de anticorpos reativos com componentes antigênicos da superfície bacteriana...

Neonatal hypocalcaemia associated with rotavirus diarrhoea.

UNLABELLED: We observed an association between rotavirus diarrhoea and hypocalcaemia in several patients and therefore started a prospective evaluation with measurement of calcium levels in all patients with rotavirus infection during a period of 8 months. We report on 54 infants with rotavirus gastro-enteritis. Serum concentrations of sodium, potassium, and total and ionized calcium were measured on admission. If hypocalcaemia was detected, total and ionized calcium were measured every day until recovery. Calcium was supplemented as calcium gluconate which was added to milk. Out of 54 newborns with rotavirus gastro-enteritis, 20 developed hypocalcaemia. All these newborns had severe diarrhoea. Seven infants were admitted because of convulsions, but EEG and ultrasonographic examination of the brain revealed no abnormalities. Once the infants' clinical condition and the consistency and frequency of the stool had improved, calcium concentrations increased and remained within the reference range without supplementation. CONCLUSION: Rotavirus gastro-enteritis seems to be a cause of neonatal hypocalcaemia.

Impact of zinc supplementation on persistent diarrhoea in malnourished Bangladeshi children.

To evaluate the impact of zinc supplementation on the clinical recovery and body weight of children with persistent diarrhoea, a randomized, double-blind, controlled trial was conducted in 190 children with persistent diarrhoea aged between 3 and 24 months. Children were randomly allocated to receive either zinc (20 mg d(-1)) syrup with multivitamin (2 x RDA) or multivitamin alone in three divided daily doses for 2 weeks. The trial was conducted in a diarrhoeal disease hospital in Dhaka, Bangladesh. Duration until clinical recovery (d), impact on body weight and serum zinc level after 2 weeks of zinc supplementation were recorded. The duration of illness was significantly reduced (33%) with zinc supplementation among children who were underweight (< or =70% wt/age, p = 0.03). Supplemented male children also had a significant reduction (27%) in duration for recovery compared with unsupplemented children (p = 0.05). From baseline to convalescence, zinc-supplemented children maintained their serum zinc concentration (13.4 vs 13.6 micromol l(-1)), whereas unsupplemented children had a decrease in serum zinc after the 2 weeks of diarrhoea (13.6 vs 11.8 micromol l(-1),p < 0.03). The mean body weight of the children in the supplemented group was maintained (5.72 vs 5.70 kg, p = 0.62) during hospitalization, unlike that of the control group, in which there was a reduction in body weight (5.75 vs 5.67 kg, p = 0.05). Five children in the unsupplemented group and one child in the zinc-supplemented group died during the 2 weeks of supplementation (p = 0.06). Zinc supplementation in persistent diarrhoea significantly reduced the length of the recovery period in malnourished children and prevented a fall in body weight and serum zinc concentration, indicating that zinc is a beneficial therapeutic strategy in this high-risk childhood illness.

Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea.

OBJECTIVE: To evaluate the impact of zinc supplementation on the clinical course, stool weight, duration of diarrhoea, changes in serum zinc, and body weight gain of children with acute diarrhoea. DESIGN: Randomised double blind controlled trial. Children were assigned to receive zinc (20 mg elemental zinc per day) containing multivitamins or control group (zinc-free multivitamins) daily in three divided doses for two weeks. SETTING: A diarrhoeal disease hospital in Dhaka, Bangladesh. PATIENTS: 111 children, 3 to 24 months old, below 76% median weight for age of the National Center for Health Statistics standard with acute diarrhoea. Children with severe infection and/or oedema were excluded. MAIN OUTCOME MEASURES: Total diarrhoeal stool output, duration of diarrhoea, rate of weight gain, and changes in serum zinc levels after supplementation. RESULTS: Stool output was 28% less and duration 14% shorter in the zinc supplemented group than placebo (p = 0.06). There were reductions in median total diarrhoeal stool output among zinc supplemented subjects who were shorter (less than 95% height for age), 239 v 326 g/kg (p < 0.04), and who had a lower initial serum zinc (< 14 mmol/l), 279 v 329 g/kg (p < 0.05); a shortening of mean time to recovery occurred (4.7 v 6.2 days, p < 0.04) in those with lower serum zinc. There was an increase in mean serum zinc in the zinc supplemented group (+2.4 v -0.3 mumol/l, p < 0.001) during two weeks of supplementation, and better mean weight gain (120 v 30 g, p < 0.03) at the time of discharge from hospital. CONCLUSIONS: Zinc supplementation is a simple, acceptable, and affordable strategy which should be considered in the management of acute diarrhoea and in prevention of growth faltering in children specially those who are malnourished.

Factors determining recovery during nutritional therapy of persistent diarrhoea: the impact of diarrhoea severity and intercurrent infections.

The recovery pattern and outcome were analysed in 261 consecutive children (age 6-36 months) with persistent diarrhoea who underwent inpatient nutritional rehabilitation with a rice-lentil (Khitchri) and yoghurt-based diet. Overall, 217 (83%) recovered successfully, as judged by a reduction in stool output and weight gain for a consecutive 3 d. Failures were more commonly febrile at admission [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.1-4.8] and a greater number had culture-proven sepsis (Fisher's exact test, p < 0.001). Logistic regression analysis identified significantly increased risk of treatment failure with several admission characteristics, including stool frequency > 5 d(-1) (OR 2.9, 95% CI 1.6-5.2), vomiting (OR 2.5, 95% CI 1.1-5.7) and sepsis (OR 2.8, 95% CI 1.1-7.5). Survival analysis revealed significantly longer time-to-recovery among children with stool frequency > 5 d(-1) at admission (p < 0.001), suspected sepsis necessitating intravenous antibiotics (p < 0.001) or oral candidiasis (p < 0.05). These findings suggest that severity of diarrhoea and coexisting systemic infections are key determinants of the response to nutritional therapy in children with persistent diarrhoea.

[A baobab solution for the prevention and treatment of acute dehydration in infantile diarrhea]. / Une solution de pain de singe pour la prévention et le traitement de la déshydratation aiguë due aux diarrhées infantiles.

OBJECTIVE: The purpose of this study was to compare the clinical efficacy of a local solution based on "pain de singe", fruit of baobab (Adansonia digitata), and the WHO standard solution in the treatment of children with acute diarrhea and resulting mild to moderate dehydration. METHODOLOGY: A prospective clinical trial comparing the local solution to the standard WHO solution was conducted; in children of 6 months or older (mean age = 16.6 +/- 8.8 months), 79 received the WHO solution and 82 the local solution, and were followed for a period ranging from 4 to 48 hours. Evolution of diarrhea and weight gain were evaluated as variables of interest. RESULTS: WHO solution was found to be superior, but not statistically significant in term of duration of diarrhea and weight gain. DISCUSSION: The pain de singe based solution presents additional advantages: nutritional, economic and cultural; we recommend it to promote use of TRO at home.

Tratamiento nutricional de la diarrea aguda / Nutritional treatment of the acute diarrhea

En este artículo se revisan una serie de aspectos con relación a la Diarrea Aguda: etiopatogenia, fisiopatogenia, conplicaciones, principalmente las relacionadas con la desnutrición, tratamiento nutricional, al igual que los mecanismos preventivos de la desnutrición como consecuencia de la Diarrea

Fallen fontanelle: culture-bound or cross-cultural?

Rather than bound to one culture, fallen fontanelle has been labeled as an illness or recognized as a symptom through time and space. The condition may be called siriasus, sitibundum, fontanellae collapsus, el apostema cálido del cerebro, Blatfallen, Blattschiessen, entzündung des Gehirns und der Gehirnhäute der Kleinen Kinder, coup de soleil, sorte de maladie causée par l'inflammation des membranes du cerveau, head-mould-shot, mollera caída, desmollerado, gual, split skull, sutt, nhova, kubabula, chipande, phogwana and dehydration. Defining features of this condition as well as prevention and treatment have corresponded to the specific cultural setting and ethnographic present. Fallen fontanelle (or fontanel) is "a culturally interpreted symptom rather than culture-bound" (Low 1985). The methodological perspective is an ethnohistorical recounting of change in the meaning of this symptom.