PERSISTENT CHILDHOOD DIARRHEA - PATTERNS, PATHOGENESIS AND PREVENTION

With improved management of acute episodes of infectious diarrhoea, in creased attention is now being given to persistent diarrhoea and its n utritional consequences and associated mortality. Risk factors for the development of persistent diarrhoea include young age, malnutrition, impaired immune function, recent introduction of milk feedings, prior antimicrobial therapy and infection with pathogenic strains of Escheri chia coli. Descriptive epidemiology indicates that 3-20% of episodes o f acute diarrhoea in children in developing countries become persisten t and cause about one-third to one-half of all deaths from diarrhoea. Environmental factors may be very important in causing persistent diar rhoea: these include undernutrition combined with the impact of living in highly contaminated environments and their effects on gastrointest inal microecology. Development of effective preventive strategies will depend on improved understanding of causes and pathogenesis of persis tent diarrhoea.