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.

[Acute infantile diarrhea. Nursing treatment]. / Diarrea aguda infantil. Cuidados enfermeros.

Acute diarrhea is a common cause of sickness and hospitalization of children throughout the world. Handling children who have acute gastroenteritis includes the use of oral rehydration solutions combined with a timely reintroduction to a complete regular diet, which satisfies the energy and nutritional requirements according to the age and nutritional history of the patient under care. Children who suffer severe diarrheas might require hospitalization, but the majority of these cases can be treated in outpatient clinics or at home. For very few cases it is necessary to resort to the use of intravenous serum therapy. Parents should be aware of the risks which gastroenteritis poses for their children, and be familiar with the use of oral rehydration solutions. These solutions should be kept on hand in all homes which have children in them. Nursing personnel's role in teaching parents about how to deal with acute diarrhea or gastroenteritis van be the key to prevention and precocious, timely treatment of complications due to acute diarrhea in children.

Diarrea aguda infantil. Cuidados enfermeros / Acute Infantile Diarrhea. Nursing Treatment

La diarrea aguda es causa común de enfermedad y hospitalización infantil en todo el mundo. El manejo de los niños con gastroenteritis aguda incluye el uso de soluciones de rehidratación oral, junto con la reintroducción temprana de una alimentación completa, que satisfaga los requerimientos de energía y nutrientes según la edad e historia dietética del paciente. Los niños con diarreas severas pueden precisar hospitalización, pero la mayoría de ellos pueden ser tratados ambulatoriamente o en el domicilio. En contadas ocasiones es preciso recurrir a la sueroterapia intravenosa. Los padres deberían conocer los riesgos que una gastroenteritis supone para sus hijos, y estar familiarizados con el uso de las soluciones de rehidratación oral. Éstas deberían estar presentes en cualquier hogar con niños. La educación a los padres por parte del personal de enfermería puede ser la clave para conseguir la prevención y el tratamiento precoz de las complicaciones de la diarrea aguda infantil(AU)

Acute diarrhea is a common cause of sickness and hospitalization of children throughout the world. Handling children who have acute gastroenteritis includes the use of oral rehydration solutions combined with a timely reintroduction to a complete regular diet, which satisfies the energy and nutritional requirements according to the age and nutritional history of the patient under care. Children who suffer severe diarrheas might require hospitalization, but the majority of these cases can be treated in outpatient clinics or at home. For very few cases it is necessary to resort to the use of intravenous serum therapy. Parents should be aware of the risks which gastroenteritis poses for their children, and be familiar with the use of oral rehydration solutions. These solutions should be kept on hand in all homes which have children in them. Nursing personnel’s role in teaching parents about how to deal with acute diarrhea or gastroenteritis van be the key to prevention and precocious, timely treatment of complications due to acute diarrhea in children(AU)

The role of the pediatric home healthcare nurse.

The acuity and number of children with life-threatening, life-limiting, and chronic conditions has increased dramatically over the past decade. The pediatric home care nurse needs a special body of knowledge and repertoire of tools to accurately assess, intervene, manage, evaluate, and provide resources to this most vulnerable population. Inherent in caring for these children is the need to support the family, nurturing the parents who care for chronically ill children at home.

Enfermedad diarreica aguda: atención de Enfermería: unidad de Terapia Intensiva, Bayamo, 2004 / Acute diarrhea disease: nursing Care: intensive Care Unit: Bayamo 2004

Se realizó un estudio retrospectivo y descriptivo de 21 pacientes ingresados con el diagnóstico de Enfermedad Diarreica Aguda en la Unidad de Cuidados Intensivos del Hospital Pediátrico General Milanés Tamayo de Bayamo, Granma, de enero a marzo del 2004 con el objetivo, de determinar el comportamiento de los pacientes ingresados por enfermedades diarreicas agudas, se evaluaron las variables, edad, procedencia, características de la deposiciones, estado de los pacientes al ingreso, los problemas asociados, estadía, y las acciones de la enfermería. En los menores de tres meses se presentó el mayor por ciento (66,8 por ciento), procediendo del servicio de urgencia el (52,4 por ciento), predominando las deposiciones acuosas con el 85,7 por ciento, ingresaron graves el 66,7 por ciento, ningún paciente falleció por esta causa, los trastornos hidroelectrolíticos y ácido básico representaron el 71,6 por ciento de los casos, quienes tuvieron una estadía corta. Las acciones de enfermería se plantearon en todos los pacientes, la observación de los signos de deshidratación (85,7 por ciento) fue la más enunciada, los cuidados de enfermería influyeron en la evolución satisfactoria de los pacientes, aunque se deben trazar las acciones más específicas como está establecido(AU)

A retrospective-descriptive study was carried out to 21 patients with the diagnosis of Acute Diarrhea Disease in Intensive Care Unit of General Milanes Pediatric hospital from Bayamo, Granma from January to March 2004 to determine the behaviour of patients admitted for Acute Diarrhea Disease, variables of age, Origin, evacuation characteristics stages of the admitted patients, associated problems, hospital stay, and nurse attentions were evaluated. In children under 3 months it is presented the greater percentage (66,8 per cent) when the /52,4 per cent) comes from the Emergency Service prevailing the aqueous evacuation with the 86,1 per cent, the 66,7 per cent of the inpatients presented serious conditions, no patients died for this disease, the hidroelectrolyte and basic acid disorders represented the 71,6 per cent of cases which had a short hospital stay. Nurse actions were traced in all patients, the observation of dehydration signs (86,7 per cent) was the most enunciated, nurse care influenced in the satisfactory evolution of patients, although the most specific actions should be designed as it is established(EU)

Enfermedad Diarreica Aguda: atención de enfermería: unidad de Terapia Intensiva: Bayamo 2004

Se realizó un estudio retrospectivo y descriptivo de 21 pacientes ingresados con El diagnóstico de Enfermedad Diarreica Aguda en la Unidad de Cuidados Intensivos del Hospital Pediátrico General Milanés de Bayamo, Granma, de enero a marzo del 2004 con el objetivo, de determinar el comportamiento de los pacientes ingresados por enfermedades diarreicas agudas, se evaluaron las variables, edad, procedencia, características de las deposiciones, estado de los pacientes al ingreso, los problemas asociados, estadía, y las acciones de enfermería. En los menores de tres meses se presentó el mayor por ciento (66,8 por ciento), procediendo del servicio de urgencia el (52,4 por ciento), predominando las deposiciones acuosas con el 85,7 por ciento, ingresaron graves el 66,7 por ciento, ningún paciente falleció por esta causa, los trastornos hidroelectrolíticos y ácido-básicos representaron el 71,6 por ciento de los casos, quienes tuvieron una estadía corta. Las acciones de enfermería se plantearon en todos los pacientes, la observación de los signos de deshidratación (85,7 por ciento) fue la más enunciada, los cuidados de enfermería influyeron en la evolución satisfactoria de los pacientes, aunque se deben trazar las acciones más específicas como está establecido(AU)

La crianza como objetivo de Salud Comunitaria / Parenting as an object of community health: Marcia Caravallo

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Grandma ahead of her time: traditional ways of diarrhoea management in Lesotho.

The study was aimed at learning about home management of infant and young child diarrhoea in Lesotho. Focus groups and individual interviews were conducted with mothers, grandmothers and nurses during two phases of field work in three geographically different locations. It was found that home management of diarrhoea traditionally had emphasised feeding. While medical advice in the past recommended that, except for breast feeding, food should be withheld during diarrhoea, mothers, grandmothers and even nurses had been reluctant to follow this advice. Mothers and grandmothers saw feeding during diarrhoea as so essential that they would make special efforts to feed a child with diarrhoea. Since most foods contain protein and carbohydrates which stimulate intestinal fluid absorption, feeding during diarrhoea, besides maintaining nutrition, will help maintain hydration. When such beneficial feeding practices are protected and supported there is less need to promote new practices and less risk of producing harmful effects.

Acute childhood diarrhoea and maternal time allocation in the northern central Sierra of Peru.

Interventions to improve child health depend, at least implicitly, on changing maternal knowledge and behaviour and a reallocation of maternal time. There have been few studies, however, of the time cost involved in the adoption of new health technologies and even fewer that examine changes in maternal activities in response to child illness. The present study examines maternal daytime activities and investigates changes that occur when children are ill. We examine the impact of acute childhood diarrhoea episodes on the activity patterns of the mother/caretaker in this setting. The results show that mothers alter their usual activity patterns only slightly in response to acute diarrhoea episodes in their children. They continue to perform the same variety of activities as when the children are healthy, although they are more likely to perform them with the child 'carried' on their back. There is some indication that diarrhoea perceived to be more severe did result in the mother acting as caretaker more frequently. These findings have important implications for health interventions that depend on changing the amount of maternal or caretaker time spent for child health technologies, but the implications may vary depending on the reasons for the observed lack of changes in caretaker activities.

PIP: During the daytime in the rural village of Macashca in the Callejon de Huaylas, Peru, data collecters conducted 30 minute interval spot check observations on the activities of 45 children aged 4-36 months and their mothers/caretakers to examine the effect of acute childhood diarrhea episodes on the activities of the mothers/caretakers. The mothers/caretakers took more than 2 hours/day to prepare meals and 0.13 hours/day to collect fuel and water. Mothers were the caretakers for about 70% of all observations. Overall, time spent on child care duties increased only slightly during acute diarrhea episodes. It increased markedly for children aged 12-18 months, however (230 vs. 415 minutes/day; p = 0.006). When mothers perceived diarrhea to be severe, the amount of time spent in caretaker activities increased (72% vs. 62% during health; p = 0.1). Time spent on productive activities (e.g., gardening, food preparation, and work for wages) did not change greatly during acute diarrhea episodes. Possible explanations why mothers did not change their activity patterns during acute diarrhea episodes include: lack of flexibility to change their activity patterns; diarrhea may not be perceived as a threat; and lack of knowledge of, or access to, diarrheal treatments other than herbal tea. These findings demonstrate the need for public health specialists to consider the amount of time spent on child health technologies when designing health interventions. Realistic assessments of the practice and efficacy of traditional caretaker patterns during diarrheal episodes should be conducted to design feasible, culturally appropriate, effective case management programs.

Doce mil trescientos niños con diarrea

Se presentan los datos de 12.300 pacientes atendidos en la consulta de diarreas de la Unidad de Capacitación para el Tratamiento de la Diarrea del Hospital Universitario San Vicente de Paúl de Medellín, durante un período de cinco años. De los pacientes, 56.8 por ciento fueron hombres, 78 por ciento fueron menores de dos años y 43 por ciento menores de un año, 69 por ciento de los niños fueron eutróficos, 24 por ciento presentaron desnutrición leve y 7 por ciento desnutrición avanzada; 90.8 por ciento de los niños tuvieron diarrea aguda, el resto diarrea persistente; 84.3 por ciento tuvieron diarrea acuosa, 10.4 por ciento diarrea disentérica, y 5.2 por ciento consultaba sólo por vómito; 58 por ciento de los niños habían sido atendidos previamente en forma ambulatoria por lo menos una vez por médico; 60 por ciento de los niños recibían suero para rehidratación oral (SRO) con 90 mmol de sodio por litro. Casi 40 por ciento de los niños, cuando consultaron recibían antibióticos, 16 por ciento recibían antidiarreicos e igual proporción antiparasitarios, 18 por ciento habían recibido antieméticos, 53.9 por ciento se encontraron hidratos, 44.4 por ciento presentaron algún grado deshidratación y 1.8 por ciento tuvo deshidratación grave.

Dieta con o sin lactosa en niños con enfermedad diarreica aguda: un meta-análisis de la literatura

La eficacia de las dietas libres de lactosa en forma rutinaria en niños menores de tres años con enfermedad diarreica aguda, en comparación con dietas con lactosa, no ha sido demostrada en forma consistente y significativa a pesar de múltiples estudios realizados. Para determinar si esta diferencia existe, se diseñó un meta-análisis que nos permitió reunir cuantitativamente los resultados de 15 experimentos clínicos controlados, con un total de 1.364 pacientes, seleccionados por su adecuada calidad metodológica, que intentaban responder la hipótesis planteada. Los parámetros evaluados fueron: 1. Duración de la diarrea en días o enhoras medida como la diferencia (tiempo con lactosa-tiempo sin lactosa). 2. Falla terapéutica medida por el RRI (Odds radio: Con lactosa/Sin lactosa). y 3. La ganancia ponderal teniendo en cuenta variación en el peso post-tratamiento respecto al ingreso. El análisis indicó que no hay diferencias estadísticamente significativas en cuanto a la duración de la diarrea en días (0,03 días con IC 95 por ciento -0.4 a +0,3). Sin embargo, al anlizar los estudios que informaron la duración de la diarrea en horas, sugieren que la dieta con lactosa puede incrementar en algunas horas su duración (+12,8 horas con IC 95 por ciento +4,1 a +21,5). En cuanto al análisis por falla terapéutica, sugiere que en conjunto los niños que reciben lactosa tienen un riesgo aproximadamente 2 veces mayor que los que no la reciben (RRI 1,91 con IC 95 por ciento 1,28 a 2,86). Los resultados sugieren que el empleo rutinario de dietas sin lactosa en niños con enfermedad diarreica aguda (EDA) puede producir resultados diferentes según la variable empleada para medir la efectividad. La diferencia obtenida en duración por horas no tiene importancia clínica. La diferencia obtenida en cuanto a falla terapéutica está a favor de la utilización de fórmulas libres de lactosa.