Zinc and Vitamin Supplementation in an Under-5 Indigenous Population of Guatemala: Influence of Lay Health Promoters in Decreasing Incidence of Diarrhea.

BACKGROUND: Malnutrition is an urgent problem in the developing world, especially for children under 5 years of age. The article describes the utilization of a standard of practice designed to prevent illness in a malnourished, under-5 indigenous population and reinforced by weekly basic health messages taught by lay community health promoters. METHOD: The two villages were chosen for observation after administration of the standard of care among the Maya-Kíché, the most numerous Mayan group in Guatemala. The standard of practice, 20 mg of daily oral zinc, was administered for 10 days in the home and followed by daily vitamin supplementation that continued throughout the 3 months of the project. All patients received four monthly clinic visits, with one of the village groups receiving weekly health promoter visits. RESULTS: Data evaluated after the quality improvement project showed significant differences in adherence to the zinc regimen (χ(2) = 3.677, p ≤ .05) as well as lower rates of diarrheal illnesses (χ(2) = 5.850, p ≤ .05), with both of these improved in the health promoter group. DISCUSSION: This study suggests that the training and implementation of para-health professionals from the lay community in response to specific health care needs could be considered a best practice in developing countries. IMPLICATIONS: Public health professionals are key to health promoter training and direction, and their importance in the global setting cannot be understated.

Utilidad de las proteínas de pollo y de soja en ratas nutridas o desnutridas con diarrea inducida por lactosa / Utility of chicken and soybean protein in well-nourished or undernourished rats with lactose-induced diarrhea

En el tratamiento nutricional de la diarrea infantil se han utilizado con éxito preparaciones líquidas que contienen pollo combinado con cereales y/o tubérculos, que se preparan en la institución de hospitalización o en la casa. En un estudio anterior, se comparó la efectividad de fórmulas con proteínas de pollo o aislado de soja en el tratamiento de la diarrea infantil. El objetivo de este trabajo fue estudiar en ratas con o sin diarrea, la utilización de las proteínas y la disponibilidad de nutrientes de dietas preparadas con pollo o aislado proteico de soja, para determinar si los resultados obtenidos en los niños eran comparables a los obtenidos en ratas. Dado que la diarrea y la desnutrición frecuentemente están presentes de manera simultánea, también se estudiaron grupos de animales con o sin diarrea previamente desnutridos. Los resultados mostraron que durante la diarrea las ratas desnutridas fueron igualmente eficientes que las nutridas en utilizar los nutrientes presentes en las dietas con pollo o soja, por lo que no experimentaron un deterioro nutricional mayor que las nutridas. Adicionalmente, la severidad de la diarrea fue similar en las ratas asignadas a las dietas con pollo o soja. Asimismo, las ratas con diarrea consumieron, crecieron, absorbieron y retuvieron menos de los macronutrientes dietarios que las ratas control. Sin embargo, este efecto de la diarrea fue similar en las ratas que consumieron proteína de soja o de pollo. Como estos resultados coinciden con los obtenidos previamente en niños con diarrea aguda, se concluye que la proteína de soja es tan efectiva como la de pollo en el manejo nutricional de la diarrea y que la diarrea producida con lactosa en ratas es un modelo apropiado para el estudio de las consecuencias nutricionales de la misma.

In the nutritional treatment of diarrhea, good results have been obtained using liquid formulas with chicken meat together with cereals and/or starchy vegetables, prepared at home or at the clinic. In a previous study, formulas prepared with chicken meat or isolated soybean protein were tested in the treatment of infantile diarrhea. In order to determine if the results obtained in children could be reproduced in rats, the objective of the present study was to evaluate the effectiveness of the same diets in the nutritional treatment of well-nourished as well as undernourished rats with lactose induced diarrhea. The results showed that all the rats with diarrhea absorbed and retained less of the dietary nutrients and consequently, grew less than their counterparts without diarrhea. However, the absorption and retention measured in the nourished as well as in the undernourished rats were similar, indicating that a short period of malnutrition previous to the diarrhea episode, did not affect rats' absorption capacity. In addition, similarly to the results previously obtained in children, the rats with lactose induced diarrhea utilised equally well the dietary nutrients present in the chicken as well as in the soybean protein based diets. These results confirmed the value of isolated soybean protein in the nutritional treatment of diarrhea and showed that lactose induced diarrhea in rats is an appropriate model to study the nutritional consequences of diarrhea.

Diarrea funcional como causa de diarrea crónica / Functional diarrhea as cause of chronic diarrhea

La diarrea funcional se presenta con frecuencia en la práctica pediátrica, y generalmente no se asocia a alteraciones nutricionales, pero sí a esquemas dietéticos incorrectos. Se actualiza su importancia clínica, se hace énfasis en la patogenia, diagnóstico y en los métodos de tratamiento. Consideramos que es la causa más frecuente de diarrea crónica inespecífica y que el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con esta enfermedad en la infancia deben ser tratados en la atención primaria(AU)

The functional diarrhea is frequent in the pediatric practice and in general it is not associated with nutritional alterations, but to incorrect dietary schemes. Its clinical significance is updated and its pathogenesis, diagnosis and treatment methods are emphasized. Authors considered that the functional diarrhea is the more frequent cause of unspecific chronic diarrhea and the questioning directed according the Rome criteria is very useful for its diagnosis. Most of patients presenting with this disease during childhood must to be treated in primary care services(AU)

Diarrea funcional como causa de diarrea crónica / Functional diarrhea as cause of chronic diarrhea

La diarrea funcional se presenta con frecuencia en la práctica pediátrica, y generalmente no se asocia a alteraciones nutricionales, pero sí a esquemas dietéticos incorrectos. Se actualiza su importancia clínica, se hace énfasis en la patogenia, diagnóstico y en los métodos de tratamiento. Consideramos que es la causa más frecuente de diarrea crónica inespecífica y que el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con esta enfermedad en la infancia deben ser tratados en la atención primaria

The functional diarrhea is frequent in the pediatric practice and in general it is not associated with nutritional alterations, but to incorrect dietary schemes. Its clinical significance is updated and its pathogenesis, diagnosis and treatment methods are emphasized. Authors considered that the functional diarrhea is the more frequent cause of unspecific chronic diarrhea and the questioning directed according the Rome criteria is very useful for its diagnosis. Most of patients presenting with this disease during childhood must to be treated in primary care services

Hidratación oral con una solución a base de harina de plátano precocida con electrolitos estandarizados / Oral rehydratation with a plantain flour-based solution precooked with standardized electrolytes

Objetivo. El objetivo del presente trabajo fue determinar si una solución de hidratación oral a base de harina de plátano precocida con electrolitos, además de ser efectiva para tratar la deshidratación, tiene propiedades antidiarreicas. Materiales y métodos. Se incluyeron 101 niños con edades entre 1 y 41 meses con diarrea de menos de una semana y deshidratación leve, y sin complicaciones asociadas. El grupo 1 (54 niños) recibió sales de rehidratación oral de la Organización Mundial de la Salud (SRO/OMS); el grupo 2 (47 niños) recibió solución con concentraciones de electrolitos similares pero que, en lugar de la glucosa, contiene 50 g de harina de plátano precocida (sales de rehidratación oral/plátano (SRO/plátano). Resultados. Se hidrató con éxito el 94,4 por ciento de los niños en el grupo SRO/OMS, y el 91,5 por ciento(p=0,70) del grupo SRO/plátano. El tiempo necesario para lograr la hidratación fue de 5,8 horas (DE=±3,0) en el grupo SRO/OMS y de 6,2 horas (DE:±3,7) en el grupo SRO/plátano (p=0,31). El gasto fecal hasta alcanzar la hidratación en el grupo SRO/OMS fue de 7,5 g/kg por hora (DE=±7,6), y en el grupo SRO/plátano de 7,05 g/kg por hora (DE=±9,4) (p=0,78). No hubo diferencia significativa en el sodio plasmático. El período de observación para el grupo SRO/OMS fue de 22,3 horas (DE=±5,3), y de 22,7 horas (DE=±4,7) para el grupo SRO/plátano. El gasto fecal durante el período de observación fue de 5,7 g/kg por hora (DE=±4,7) para el grupo SRO/OMS y de 6,3 g/kg por hora (DE=±7,9) para el grupo SRO/plátano (p=0,67). La proporción de niños que necesitaron líquidos endovenosos durante las primeras veinticuatro horas fue de 11,1 por ciento en el grupo SRO/OMS y de 8,5 por ciento en el grupo SRO/plátano (RR=1,31; IC 95 por ciento: 0,39 a 4,35). Conclusiones. La solución a base de harina de plátano es efectiva y segura para corregir la deshidratación. No se pudo demostrar en este estudio el efecto antidiarreico de la solución a base de harina de plátano

Tratamento nao intervencionista da diarreia persistente / Non interventionist treatment on persistent diarrhea

Avaliar uma terapeutica nao intervencionista, sem emprego de medicacao e, preferencialmente, com manutencao da alimentacao para o tratamento da diarreia persistente...

[Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea]. / Creencias y conocimientos de un grupo de médicos sobre el manejo de la alimentación del niño con diarrea aguda.

OBJECTIVE: To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. MATERIAL AND METHODS: A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. RESULTS: The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. CONCLUSIONS: The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Diarreia persistente: revisao dos principais aspectos fisiopatologicos, fatores de risco e implicacoes terapeuticas / Persistent diarrhea: review of physiopatogenic feature, risk factors and therapeutic

Objetivo : revisar a literatura sobre a diarreia persistente em relacao aos fatores de risco e terapeutica. Fontes pesquisadoras : bases de dados MEDLINE e LILACS, de 1988 a 1999. Sintese dos dados : a diarreia persistente apresenta como principais fatores...

Randomized clinical trial of soy formula with and without added fiber in antibiotic-induced diarrhea.

OBJECTIVE: The objective of this study was to examine the effects of soy formulas with and without added soy fiber in children who developed diarrhea while receiving antibiotics. DESIGN: In a masked, randomized parallel study, older infants and toddlers were fed commercial soy formulas with or without added soy fiber for 10 days on occurrence of diarrhea during the administration of antibiotics. Subjects were stratified by feeding (formula versus cow's milk). The primary variables were duration of diarrhea, stool characteristics, and intake. Secondary variables were weight and spit-up. RESULTS: All 45 children who completed the 10-day study received >30% of their caloric intake from formula. Fiber intake from other foods did not differ between groups and averaged 0.5 g/day. Total median fiber intake of the group fed the formula with added fiber was 6.53 g/day. The mean duration of diarrhea was 25.1 +/- 5.2 hours for children fed the formula with added fiber and 51.6 +/- 10.7 hours for those fed the regular formula (P =.0013). CONCLUSION: The duration of antibiotic-induced diarrhea in children fed the soy formula with added soy fiber was significantly reduced.

Use of undiluted whole cow's milk is effective for the routine treatment of children with acute diarrhea and severe dehydration.

A comparison is made between two groups of children aged 1-24 months and admitted to a teaching University Hospital due to acute diarrhea and severe dehydration. One group (n = 119) received a diluted cow's milk formula and the other (n = 109) a full-strength formula. Duration of diarrhea was similar: In the group that received full-strength milk weight gain was greater during diarrhea (5.03 vs. 1.80 g/kg/day, P < 0.01) and during the hospital stay (5.39 vs. 2.33 g/kg/day, P < 0.001). Weight for height z-scores and weight for height as percentage of median improved during the hospital stay only in the group that received the full-strength formula. Full-strength cow's milk seems to be an adequate routine regimen even for children with acute diarrhea that must be treated for severe dehydration. In developing countries diarrhea and dehydration are a disease of small children. As rates of exclusive breast feeding are low, mainly in the urban setting, cow's milk is the main and sometimes the only food available. Lactose-free formulae are priced out of reach of the poor people and in Latin America there is no accepted tradition for use of fermented milk products. Our study is an indication that use of undiluted cow's milk may be effective for the routine treatment of acute diarrhea in children that must be treated as inpatients due to severe dehydration.

Efficacy of milk versus yogurt offered as part of a mixed diet in acute noncholera diarrhea among malnourished children.

We compared the clinical outcome of acute diarrhea in 96 malnourished boys (aged 4 to 47 months) receiving full-strength milk compared with yogurt offered as part of a mixed diet. All had weight for height less than or equal to 80% of the National Centre for Health Statistics median. They were randomly assigned to receive milk formula (MF; 67 cal/100 ml) or yogurt formula (YF; prepared from the same milk formula) at the rate of 120 ml/kg body weight in seven divided feedings. Stool-reducing substances (> 1%) were detected more frequently in the MF group, and the differences were significant for day 3 of the study (p = 0.04). However, the geometric mean (95% confidence interval) of the total stool weights (gm/kg) during 0 to 72 hours (MF 128.8 [103, 161.4]; YF 110.9 [87, 142.2]) was comparable (p = 0.37) as was the median (range) duration of diarrhea (hours) (MF 45 [4, 183]; YF 52 [7, 173] p = 0.94). The treatment failure rates in the MF (8.2%) and YF (6.3%) groups were also similar (p = 0.67). The children consuming milk had higher median percent weight gain at the end of 72 hours of the study (p = 0.04) and at recovery (p = 0.02). Routine substitution of yogurt as small frequent feedings as an addition for semisolid food to malnourished children with acute diarrhea does not achieve any significant clinical benefit versus milk.

Use of undiluted whole cow's milk is effective for the routine treatment of children with acute diarrhea and severe dehydratation

A comparison is made between two groups of children aged 1-24 months and admitted to a teaching University Hospital due to acute diarrhea and severe dehydration. One group (n = 119) received a diluted cow's milk formula and the other (n = 109) a full-strength formula. Duration of diarrhea was similar: In the group that received full-strength milk weight gain was during diarrhea (5.03 vs. 1.80 g/kg/day, P<0.01) and during the hospital stay (5.39 vs 2.33 g/kg/day; P<0.001). Weight for height z-scores weight for height as percentage of median improved during the hospital stay only in the group that received the full-strength formula. Full-strength cow's milk seems to be an adequate routine regimen even for children with acute diarrhea that must be treated for severe dehydration. In developing contries diarrhea and dehydration are a disease of small children. As rates of exlcusive breast feeding are low, mainly in the urban setting, cow's milk is the main and sometimes the only food available. Lactose-free formulae are priced out of reach of the poor people and in Latin America there is no accepted tradition for use of fermented milk products. Our study is an indication that use of undiluted cow's milk may be effective for the routine treatment of acute diarrhea in children that must be treated as inpatients due to severe dehydration.

Terapéutica dietética con fórmulas sin lactosa en niños hospitalizados con diarrea aguda / Free-lactose nourishment for in-bed children who were hospitalized because of acute diarrhea

Se realizó un estudio prospectivo en 124 niños con edad máxima de 5 años, internados por diarrea aguda que se agrparon en 3 grupos. El A se alimentó con leche con lactosa, el B con leche de soya y el C con leche sin lactosa. El promedio de días de hospitalizaicón fue de 5.6 para el grupo A, 3.5 para el B y 3.4 para el c. Se concluye que las fórmulas alimentarias sin lactosa deben emplearse en casos de desnutrición, de intolerancia a los disacáridos, de ratovirus como agente causal y en algunos casos afectados por Shigella y Eschirichia

Nutrición durante la enfermedad diarreica infantil / Appropiate feeding during diarrhea in children

Recientes investigaciones han examinado el momento apropiado para alimentar al niño que sufre diarrea aguda y los alimentos que ofrecen ventajas nutricionales y acortan la duración y severidad natural del proceso diarreico. Esta revisión presenta aspectos clínicos y conclusiones de ensayos controlados. Los datos disponibles sugieren que durante la enfermedad diarreica se debe proporcionar alimentación continua, con alimentos de fácil digestión y absorción, continuar con lactancia al pecho materno en caso de que el niño la reciba. En pacientes alimentados con fórmulas lácteas (no humanas) la gran mayoría podrá continuarla; no es necesario la dilución rutinaria de la leche o el uso de fórmulas sin lactosa si el paciente recibie terapia de hidratación oral apropiada con la fórmula de la Organización Mundial de la Salud y alimentos complementarios como cereales y vegetales

Use of soy fiber in acute diarrhea in infants and toddlers.

Soy fiber has been shown to reduce the duration of watery stools during acute diarrhea caused by bacterial and viral pathogens in underdeveloped countries. A randomized blinded clinical trial was conducted with middle-class American children to assess the efficacy of soy fiber-supplemented infant formula. Stool characteristics, intake, and weight were recorded. Infants > 6 months of age (n = 44) fed soy fiber-supplemented formula (Isomil DF) had a significantly shorter estimated median duration of diarrhea (9.7 hours vs. 23.1 hours) than those fed soy formula (Isomil). The use of fiber-supplemented soy formula may reduce the duration of diarrheal symptoms in U.S. infants more than 6 months of age with acute diarrhea.