del Aguila R, Brown K H
Instituto de Investigación Nutricional, Lima, Perú.
Bol Oficina Sanit Panam. 1993 Oct;115(4):291-300.
This study investigated the practices followed by physicians in the clinical, therapeutic, and dietary management of children under the age of 5 with diarrhea. A total of 148 physicians were observed while they provided outpatient services at various public and private health institutions in two areas of Peru. They were also interviewed to assess their theoretical knowledge about the proper management of diarrhea in children. The physicians treated 222 children under 5 with diarrhea. It was observed that in taking their clinical histories the physicians ascertained the duration of the problem, the number of bowel movements, their consistency, and the presence of fecal mucus or blood in 175 (79%), 158 (71%), 140 (63%), and 153 (69%) cases, respectively. Antibiotics were prescribed for 130 children (58%), and 102 (46%) were not given any oral rehydration therapy (ORT). The oral rehydration salts (ORS) were recommended to only 40 (18%) of the children. On the other hand, during the interviews only 38 physicians (26%) indicated that they prescribe drugs for diarrhea, while 110 (74%) said that they recommend ORT. Fewer than half the mothers received recommendations regarding the type of food that they should give their children during the diarrhea episode. The results reveal a sizable discrepancy between theory and practice in the medical management of childhood diarrhea, which means that it is necessary to instill in physicians the importance of assessing and treating children with diarrhea according to a uniform and systematic scheme that includes careful therapeutic and dietary guidance.
本研究调查了医生在临床、治疗和饮食方面对5岁以下腹泻儿童的管理方法。在秘鲁两个地区的各类公立和私立医疗机构中，共有148名医生在提供门诊服务时接受了观察。他们还接受了访谈，以评估他们关于儿童腹泻正确管理的理论知识。这些医生共治疗了222名5岁以下腹泻儿童。观察发现，在询问临床病史时，医生分别在175例（79%）、158例（71%）、140例（63%）和153例（69%）病例中确定了问题的持续时间、排便次数、大便性状以及是否存在粪便黏液或血液。130名儿童（58%）被开了抗生素，102名儿童（46%）未接受任何口服补液疗法（ORT）。仅向40名（18%）儿童推荐了口服补液盐（ORS）。另一方面，在访谈中，只有38名医生（26%）表示他们会为腹泻开药方，而110名医生（74%）表示他们会推荐ORT。不到一半的母亲收到了关于腹泻期间应给孩子吃何种食物的建议。结果显示，在儿童腹泻的医疗管理方面，理论与实践之间存在相当大的差异，这意味着有必要向医生灌输根据统一和系统的方案评估和治疗腹泻儿童的重要性，该方案包括仔细的治疗和饮食指导。
