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  • Title: Diarrhoeal disease morbidity and home treatment practices in Egypt.
    Author: Jousilahti P, Madkour SM, Lambrechts T, Sherwin E.
    Journal: Public Health; 1997 Jan; 111(1):5-10. PubMed ID: 9033217.
    Abstract:
    Diarrhoeal disease is a major cause of death in children in the developing world. In developing countries a quarter of infant and childhood mortality is related to diarrhoea. The World Health Organization started the Diarrhoeal Disease Control Programme (CDD) in 1980 with the objective to decrease diarrhoeal mortality and morbidity among young children in developing countries. The aim of this study was to measure the prevalence and incidence of diarrhoeal diseases among young children and to assess the quality of home case management of diarrhoeal cases. Particular emphasis was put on the assessment of drug use during diarrhoea. The survey included also the assessment of breast feeding practices. Geographically the survey was limited to two governorates, Dakahlia and Gharbia, in lower Egypt, which have the largest population (7.12 million) and were thought to be representative of lower Egypt. The total sample size was 11032. Seasonally adjusted diarrhoea incidence was 3.6 episodes per child under five years of age per year. This means a minimum estimate of 30 million cases annually in Egypt. Although the majority of the caretakers knew of Oral Rehydration Salts (ORS), only 22% of cases with diarrhoea in the last 24 h received ORS. 54% of cases had received drugs, and many of the children with diarrhoea received more than one drug. The source of drug prescription was most often a private doctor and the use of drugs was common among government doctors and health workers. The high proportion of cases treated with drugs, other than ORS, is the major problem in diarrhoeal home case management in Egypt. The message of ORS has penetrated into the general population well, but the practices of health professionals have not changed. To improve the situation further, training of health workers in correct case management is needed. Paediatric forms of symptomatic antidiarrhoeal drugs should also be withdrawn from the market. In August 1992, interviews were conducted with 9711 caretakers, usually mothers, living in Kakahlia and Gharbia governorates, Egypt, so researchers could determine the prevalence and incidence of diarrheal diseases among 11,032 children aged under 5 years and examine the quality of home treatment practices among 958 children who had had diarrhea in the previous 24 hours. The point prevalence of diarrhea for the previous 24 hours was 8.7% (958 children). 4.1% of these diarrhea cases had had persistent diarrhea (14 days in duration). 3.8% had had blood in the stool. Only 2 of the 36 children with blood in the stool had received an antibiotic or an antiparasitic drug. 21.9% had received oral rehydration solution (ORS). 77.1% of their caretakers prepared ORS correctly. The mean quantity of ORS was 351 ml/child, probably too little for effective rehydration. 95.8% of caretakers of all cases of diarrhea in the last 24 hours were familiar with ORS. The 2-week diarrheal incidence rate was 20.4%. The seasonally adjusted incidence rate was 3.6 episodes/child/year. Rural areas had higher incidence and prevalence rates than urban areas (2-weeks incidence, 22.7% vs. 16.9%; point prevalence, 10% vs. 6.6%). 96.3% of lactating mothers continued to breast feed during their child's diarrhea episode. 69.8% of diarrhea cases receiving solid or semi-solid foods before the illness received the same amount during the diarrhea episode. Only 24.4% of cases who received fluids other than breast milk before diarrhea received more fluids during diarrhea. 54.2% of all cases were given at least one drug during the diarrhea episode; more than 50% of these were given more than one drug. 17.6% received ORS and drugs. Only 5% received ORS alone. A private physician and a government physician or health worker, respectively, prescribed a drug for 50% and 23.3% of cases who were given drugs. A pharmacy provided 90.4% of the drugs. The continued breast feeding rate (i.e., any breast feeding in last 24 hours) was 78.2% among children aged 12-15 months and 48.9% among those aged 20-23 months. Training of health workers in correct case management is needed.
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