A Study Of Some Factors Influencing The Outcome Of Acute Childhood Diarrhoea At The Paediatric Observation Ward Of Kenyatta National Hospital

Abstract

Factors affecting the outcome of acute childhood diarrhoea in children below five years during ward stay and after one week of discharge were studied.

Over 90% of children studied were aged below two years, with a peak age in the 6 - 11 months age group. Out of ~,total of 105 children, 61 were males and 44 were females.

52.3% of the children studied had normal nutrition, 24.7% were underweight, 8.6% had kwashiorkor, 4.8% had marasmus and 9.6% had marasmic-kwashiorkor.

Rotavirus detection and cultures for enteropathogenic organisms was done for all the children. Rotavirus was detected in the stool of 21 children, accounting for 51% of all the isolates at admission. EPEe was the most commonly isolated entero-bacteria with twelve occuring as single infections and four as mixed infections, giving a total of 16(38% of total isolates). Other stool agents isolated included shigella, salmonella and campylobacter; these accounted for 4.9%, 3.8% and 0.9% respectively of the tot~l isolates. V. cholera organisms were not isolated.

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Malnourished children had a worse outcome compared to children with normal nutrition in terms of duration of diarrhoea and mortality. Duration of diarrhoea also tended to increase with age.

Children with Rotavirus had a mild illness with a mean

duration of diarrhoea of 7.6 days. Isolation of EPEC was associated with prolongation of diarrhoea - the mean duration being 15.5 days in wellnourished children and 16.7 days in malnourished children.

Children with Rotavirus were successfully rehydrated with oral rehydration solution alone. 76% of children requiring intravenous hyration had EPEC isolated in their stool. Supplimental feeding after the initial four hour rehydration period advocated was noted to be insignificant. This occured both for breasfed children and children on other diets.

Thirty three children returned for review one week after discharge from the ward. One child had Rotavirus persisting in stool, one had salmonella and two had EPEC persisting. Causative agents

isolated for the first time at review were seen in eight of the reviewed children. One patient had Rotavirus, five had EPEC and two had salmonella. Isolation of salmonella and EPEC at review was associated with use of antibiotics while on the ward.