EPIDEMIOLOGY AND MANAGEMENT OF PERSISTENT DIARRHEA IN CHILDREN OF DEVELOPING-COUNTRIES

Diarrhoea that begins acutely but lasts longer than two weeks is defin ed to be persistent. Revised estimates in developing countries includi ng India showed that acute diarrhoea accounts for 35 per cent, dysente ry 20 per cent and non-dysenteric persistent diarrhoea (PD) for 45 per cent of total diarrhoeal deaths. PD also often changes marginal malnu trition to more severe forms. Factors that increase the risk of acute diarrhoea becoming persistent have been identified in India and other developing countries. These include antecedent malnutrition, micronutr ient deficiency particularly for zinc and vitamin A, transient impairm ent in cell mediated immunity, infection with entero aggregative Esche richia coli and cryptosporidium, sequential infection with different p athogens and lack of exclusive breast feeding during the initial four months of life particularly use of bovine milk. Several issues regardi ng the management of persistent diarrhoea in hospitalized children in India have been resolved. Diets providing modest amounts of milk mixed with cereals are well tolerated, In those who fail on such diets prov iding carbohydrate as a mixture of cereals and glucose ol sucrose hast en recovery. The role of antimicrobial agents and individual micronutr ients in PD is currently being investigated. A management algorithm ap propriate for India and other developing countries has been developed and found to substantially reduce case fatality in hospital settings t o about 2-3 per cent. Recent epidemiological and clinical research rel ated to persistent diarrhoea is also reviewed.