SEVERE ILLNESS IN AFRICAN CHILDREN WITH DIARRHEA - IMPLICATIONS FOR CASE-MANAGEMENT STRATEGIES

To identify clinical disorders associated with severe illness in Afric an children with diarrhoea, we studied a group of under-5-year-olds wi th diarrhoea who had been brought to a large public hospital in centra l Cote d'lvoire, The general condition of children with diarrhoea was assessed and classified according to criteria recommended by WHO, and then used as a nonspecific indicator of severity. Of the 264 children with diarrhoea who were enrolled in the study, 196 had nonsevere illne ss and 68 severe illness. Children with severe illness were significan tly more likely than those with nonsevere illness to be dehydrated (45 % versus 11%), moderate-to-severely wasted (47% versus 29%), bacteraem ic (26% versus 9%), severely anaemic (haemoglobin level <6 g/dl; 15% v ersus 6%), have Plasmodium falciparum parasitaemia (27% versus 14%), a nd have two or more of these five conditions (60% versus 14%). Nontyph oidal Salmonella spp. were present in 68% of the blood isolates but we re not associated with sero-positivity to human immunodeficiency virus (HIV). The study demonstrates the need for a more comprehensive appro ach to assessment and management of children with diarrhoea that ensur es prompt recognition of bacteraemia, anaemia, wasting and malaria, as well as dehydration. Simple nonspecific observational criteria, such as those recommended by WHO for assessing and classifying general cond ition, are useful for identifying children with diarrhoea who are at h igh risk of having life-threatening clinical disorders, and can readil y be used by health workers whose clinical training and access to diag nostic laboratory facilities are both limited.