Evaluation of an algorithm for persistent/ chronic diarrhea in children at a community hospital adjoining slums in Agra, north India
Related Experiment Video
Updated: Jul 18, 2026
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
1Department of Pediatrics, Shanti Mangalick Hospital, Agra (UP), India. pankajparul8@rediffmail.com
Insights
A simplified algorithm effectively managed children with persistent or chronic diarrhea in a community hospital setting. This approach proved successful and cost-effective for pediatric outpatient care, warranting further multi-center validation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Management Algorithms
- Community Health
Background:
- Persistent and chronic diarrhea pose significant challenges in pediatric care, especially in resource-limited settings.
- Effective outpatient management strategies are crucial for improving child health outcomes and reducing healthcare costs.
Purpose of the Study:
- To evaluate a simplified algorithm for managing children with persistent/chronic diarrhea in a community hospital.
- To assess the algorithm's effectiveness, cost, and identify common causes of diarrhea in the studied population.
Main Methods:
- Prospective enrollment of 50 clinically stable children (6 months-5 years) with persistent/chronic diarrhea managed as outpatients.
- Detailed history, physical examination, and management using a pre-tested simplified algorithm.
- Symptom monitoring via questionnaire at 15 days, 1 month, and 3 months; cost analysis performed.
Main Results:
- 42% of children presented with persistent diarrhea; 14% showed lactose malabsorption.
- 71.8% of treated children responded well to standard medications (albendazole, metronidazole, cotrimoxazole) with supplements.
- Abdominal tuberculosis and elevated anti-tissue transglutaminase antibodies were identified in 6% and 8% of cases, respectively.
Conclusions:
- The evaluated algorithm successfully managed children with chronic diarrhea in an outpatient setting.
- The average cost per managed case was low (US$10).
- Multi-center validation of similar algorithms is recommended to confirm these findings.
Abstract:
The objective of this study was to evaluate an algorithm for the management of children with persistent/chronic diarrhea at a community level hospital. The study was carried out in the pediatric OPD of a 150 bed trust hospital catering to children from poor, rural and urban slums. Fifty clinically stable children (6 months-5 years old, mean = 19.7 months) with persistent or chronic diarrhea refusing admission, being managed on an outpatient basis, were enrolled prospectively. A detailed history and physical examination were done for each child to ascertain the cause of diarrhea. They were managed using a pre-tested simplified algorithm and monitored for symptom improvement using a questionnaire 15 days, 1 month and 3 months after initiation of therapy. The average cost for treatment of each child was also calculated. Twenty-one (42%) children had persistent diarrhea. Seven (14%) infants with a typical history of lactose malabsorption responded to a trial of WHO feeding protocols or lactose/sucrose free milk. Four (8%) infants had chronic non-specific diarrhea. A total of 71.8% (28/39) of children were treated satisfactorily with albendazole or metronidazole and Cotrimaxazole along with hematinics and multivitamins. Three (6%) children were diagnosed with abdominal tuberculosis. Four (8%) had raised anti-tissue tranglutaminase antibodies (age 18-34 months). The algorithm used was successful in managing all the children with chronic diarrhea. The average cost per managed case was US$10. Further, multi-center evaluations of similar algorithms are needed to validate the observations in the present study.
