PREVENTION
AND MANAGEMENT OF PROLONGED CHILDHOOD DIARRHEA
Zulfiqar Ahmed Bhutta
The Husein Lalji Dewraj Professor of Paediatrics
The Aga Khan University & Medical Centre, Karachi, Pakistan
Despite
major advances in the oral rehydration therapy and management of diarrheal
disorders in childhood, there has been little reduction in the incidence of
diarrhea. In particular, the HIV and AIDS pandemic in Africa threatens to
reverse all the gains made by the child survival programs. In particular,
the association of prolonged and persistent diarrhea with HIV infection is
well recognized. In non-HIV endemic areas, prolonged episodes of diarrhea
are frequently seen in combination with lactation failure, inappropriate
and early introduction of breast milk substitutes especially animal milk,
and unhygienic nutritionally inadequate complementary foods. It is also
evident that poor management of acute diarrheal episodes, also predispose
to prolongation of the diarrheal episodes. Such episodes of prolonged diarrhea,
especially if greater than 14 days duration called persistent diarrhea, are
associated with malnutrition and disproportionately high mortality.
Apart
from close attention to preventive strategies such as encouragement of
early and exclusive breastfeeding and appropriate management of acute
diarrheal episodes, the major advances in the management of prolonged
episodes of diarrheal relate to nutritional management of diarrhea, usually
by easily digested and available traditional cereal-based diets. In several
community and hospital-based studies, this approach to the dietary
management of diarrhea has been shown to result in significant improvement
in nutritional outcomes and recovery from diarrhea. Recent data on
micronutrient especially zinc supplementation, in children with diarrhea or
those at-risk of diarrhea, indicates that zinc supplementation
significantly reduces the duration of diarrhea as well as prevents against
subsequent episodes of prolonged diarrhea. These findings, coupled with the
potential benefit of zinc and vitamin A supplementation on childhood
mortality and growth, indicate the need for closer liaison between public
health nutrition interventions and diarrheal disease control programs.