Severe illness in African children with diarrhoea: implications for case management strategies.

ABSTRACT

PIP: Researchers prospectively studied 264 children aged less than 5 years with diarrhea who were admitted to the Bouake Regional Hospital Center in the Ivory Coast between June 10 and August 11, 1991, to identify clinical disorders associated with severe diarrhea. They compared data on the 196 children with non-severe diarrhea with data on 68 children with severe diarrhea. All but three of the children were breast fed. The severely ill children were more likely than the non-severely ill children to have dehydration (45% vs. 11%; p 0.01), severe wasting (22% vs. 7%; p 0.01), anemia (29% vs. 13%; p = 0.01), bacteremia (26% vs. 9%; p 0.01), and malarial parasitemia (27% vs. 14%; p = 0.02). 68% of the blood isolates had nontyphoidal Salmonella spp. 6% of children had HIV-1 or HIV-2 infection. The most common pathogens in the stool specimens were rotavirus (41 cases), Campylobacter jejuni (22), Shigella spp. (21), and Salmonella spp (10). These findings indicate a need for a more comprehensive approach to assessment and management of children with diarrhea that secures immediate recognition of bacteremia, anemia, wasting, malaria, and dehydration.