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Assessing diarrhoea-induced dehydration at the community level
1Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205.
Insights
Diarrhoea in young children is common in Mozambique. Fever, vomiting, and changes in drinking habits are key indicators of dehydration, aiding in early detection and treatment.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Diarrhoea remains a leading cause of mortality in children under five globally.
- Accurate assessment of dehydration is crucial for effective management and prevention of severe outcomes.
- The World Health Organization (WHO) provides standardized guidelines for dehydration assessment.
Purpose of the Study:
- To evaluate the prevalence of diarrhoea in young children in Nampula, Mozambique.
- To assess the sensitivity and specificity of various signs and symptoms reported by caregivers and observed during physical examination for detecting dehydration in children with diarrhoea.
- To compare findings with similar studies in diverse settings.
Main Methods:
- A community-based study involving children under five years with diarrhoea in Nampula, Mozambique.
- Assessment of 12 WHO-defined dehydration signs/symptoms, plus observed thirst and reported fever.
- Comparison of caregiver-reported symptoms with physical examination findings.
Main Results:
- The point prevalence of diarrhoea was 13.1%.
- High sensitivity for dehydration was associated with: ≥4 stools, altered drinking habits (more/less than usual), and reported fever in 24h.
- High specificity for dehydration was observed with: decreased urine output, vomiting, and ≥10 stools in 24h.
- Combinations of symptoms like fever/vomiting or vomiting/altered drinking/fever showed varying sensitivity and specificity.
Conclusions:
- Specific symptoms and caregiver reports can aid in identifying dehydration in children with diarrhoea.
- Fever, vomiting, and changes in fluid intake are important indicators for assessing dehydration severity.
- Findings highlight the need for context-specific validation of dehydration assessment tools in diverse populations.
Abstract:
A community based study of children under 5 years of age in Nampula, Mozambique, assessed children with diarrhoea for the 12 signs and symptoms of dehydration listed in the World Health Organization's Diarrhoea Treatment Chart and for the additional indicators of observed thirst and reported fever. The point prevalence of diarrhoea was 13.1%. The signs and symptoms of dehydration reported by carers were compared with signs detected on physical examination at the time of the interview. The presence of four or more stools, a history of drinking either more or less than usual, and reported fever in the preceding 24 h had the highest sensitivities. Individual symptoms with the highest specificity were decreased urine output, vomiting, and the passing of 10 or more stools during the 24 h preceding the interview. The combination of fever or vomiting had a sensitivity of 68.3% and a specificity of 55.9%, whereas a combination of vomiting or drinking more than usual or fever had a sensitivity of 87.8% and a specificity of 34.1%. These findings are compared with the results of similar studies conducted in different clinical and cultural settings.