Islam Shoeb Bin, Ahmed Tahmeed, Mahfuz Mustafa, Mostafa Ishita, Alam Mohammed Ashraful, Saqeeb Kazi Nazmus, Sarker Shafiqul Alam, Chisti Mohammod Jobayer, Alam Nur Haque
a Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research , Bangladesh.
b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh.
Paediatr Int Child Health. 2018 May;38(2):87-96. doi: 10.1080/20469047.2017.1315911. Epub 2017 May 5.
Persistent diarrhoea (PD) is poorly recognised and it requires proper assessment and early intervention to ensure effective treatment. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has been managing children with PD for more than two decades. This review focuses on different aspects of the management of PD in a hospital setting.
To estimate the prevalence, socio-demographic and clinical characteristics, treatment outcome and hospital course in under-5 children with persistent diarrhoea (PD).
The hospital records of all children under 5 years admitted with PD to Dhaka Hospital of the International Centre for Diarrhoeal Disease Research between January 2012 and December 2013 were reviewed. Data were retrieved from the hospital's electronic database.
Of 8638 children under 5 years of age admitted with diarrhoea, 551 (6.4%) had PD and one-third had developed PD during their hospital stay. The incidence of PD was highest (228, 41.4%) in summer (April-June). Half (51%) of the children with PD had dehydration on admission. Fifty-seven (10.3%) had never been breastfed, 138 (25.1%) were severely wasted and 21 (3.8%) had bipedal oedema. Following the steps of a dietary algorithm, 224 (40.6%) patients responded to a milk-based low-lactose diet, 235 (42.6%) to a lactose-, sucrose- and milk-free diet, 48 (8.7%) to a comminuted chicken and glucose-based diet, 41 (7.4%) to exclusive breastfeeding, and 3 (0.5%) required a partially hydrolysed, semi-elemental diet. Major stool pathogens were Campylobacter species (23/59, 39%), Salmonella (10/59, 16.9%) and Shigella (10/59, 16.9%). The overall recovery rate from PD was 95.6% (527/551) and the duration of treatment until resolution of diarrhoea was 6 (3-9) days. The case-fatality rate was 2% (11/551).
Persistent diarrhoea remains an important public health problem in children under-5 in Bangladesh. Algorithm-based dietary management with simple clinical guidelines was effective in most cases. This treatment is appropriate in low-income settings where resources are limited.
持续性腹泻（PD）的认知程度较低，需要进行适当评估和早期干预以确保有效治疗。孟加拉国腹泻病国际研究中心（icddr,b）对患有PD的儿童进行管理已超过二十年。本综述聚焦于医院环境中PD管理的不同方面。
评估5岁以下持续性腹泻（PD）儿童的患病率、社会人口统计学和临床特征、治疗结果及住院病程。
回顾了2012年1月至2013年12月期间在国际腹泻病研究中心达卡医院因PD入院的所有5岁以下儿童的医院记录。数据从医院电子数据库中获取。
在8638名因腹泻入院的5岁以下儿童中，551名（6.4%）患有PD，其中三分之一在住院期间患上PD。PD发病率在夏季（4月至6月）最高（228例，41.4%）。一半（51%）的PD儿童入院时伴有脱水。57名（10.3%）儿童从未进行过母乳喂养，138名（25.1%）严重消瘦，21名（3.8%）出现双下肢水肿。按照饮食算法步骤，224名（40.6%）患者对以牛奶为基础的低乳糖饮食有反应，235名（42.6%）对无乳糖、无蔗糖和无牛奶饮食有反应，48名（8.7%）对碎鸡肉和葡萄糖饮食有反应，41名（7.4%）对纯母乳喂养有反应，3名（0.5%）需要部分水解的半要素饮食。主要粪便病原体为空肠弯曲菌属（23/59，39%）、沙门氏菌（10/59，16.9%）和志贺氏菌（10/59，16.9%）。PD的总体恢复率为95.6%（527/551），腹泻缓解前的治疗持续时间为6（3 - 9）天。病死率为2%（11/551）。
持续性腹泻在孟加拉国5岁以下儿童中仍然是一个重要的公共卫生问题。基于算法的饮食管理结合简单临床指南在大多数情况下是有效的。这种治疗方法适用于资源有限的低收入环境。
