Management of childhood diarrhea and use of oral rehydration salts in a suburban west African community

In a household survey in Guinea-Bissau, 319 episodes of diarrhea in childre n were followed by interviews every second day with the aim of investigatin g perceived morbidity and subsequent actions taken. The majority of the mot hers had good knowledge of oral rehydration salts (ORS). However, only 58% of the episodes were treated with ORS and the amount given was insufficient . Mothers with no knowledge of ORS did not use it during the observed attac k of diarrhea regardless of contact with a health center, which suggests th at maternal knowledge is an important determinant of whether health personn el provide ORS. Children with diarrhea considered to be caused by teething were less likely to receive ORS in the acute phase (risk ratio = 0.6, 95% c onfidence interval [CI] = 0.50.9). Univariate analyses showed that the use of ORS was related to number of reported symptoms, the mother being the car e taker, consultations, previous use of ORS, good knowledge of ORS, and hav ing ORS sachets at home. Multivariate Cox regression analyses showed that t he presence of ORS sachets at home at the onset of diarrhea was the stronge st predictor of use (hazard ratio = 3.3, 95% CI = 1.9-3.6). Improved health education should focus more on the quantity of ORS needed, early signs of dehydration, treatment of teething diarrhea, and breast feeding, and addres s mothers who have no prior knowledge of ORS. Management of diarrhea may be improved by a more liberal distribution of ORS sachets.