Follow-up of children discharged from hospital after treatment for diarrhoea in urban Bangladesh.

To determine the subsequent mortality of urban children in Bangladesh after an episode of diarrhoea we visited 74 children aged 2 to 5 years in their homes four months after they had received treatment for diarrhoea at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). Parents and health workers were questioned about their perceptions of the nutritional status of the children at this time. Although 43% of the children were severely malnourished and 28% were moderately malnourished at the time of presentation to ICDDR,B only two deaths (3%) had occurred in the cohort during follow-up. No deaths were noted for the severely malnourished two year old group, which contrasts with the high post-discharge mortality (33%) in similarly malnourished two year old Bangladeshi children living in rural areas (p = 0.004) at the time of follow-up parents were significantly (p = 0.02) less likely than health workers to recognize malnutrition in the children. We suggest that there may be substantial rural-urban differences in the survival of children after receiving treatment for diarrhoea. Further, we note that parental under-recognition of malnutrition may impede the nutritional rehabilitation that is necessary to avert much of the morbidity and mortality that ensues after an episode of diarrhoea.