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Early child health in Lahore, Pakistan: VII. Diarrhoea
A Mahmud1, F Jalil, J Karlberg
1Department of Paediatrics, King Edward Medical College, Lahore, Pakistan.
Insights
Infant diarrhea is common in developing communities, with over 3 episodes per child annually. Management varies by socioeconomic status, with oral rehydration salts (ORS) use higher in wealthier families.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Infantile diarrhoeal disease poses a significant health challenge in developing and urbanizing regions.
- Prospective data on diarrhea incidence and management in diverse socioeconomic settings is crucial for effective interventions.
Purpose of the Study:
- To gather reliable prospective data on the incidence, home management, and duration of infantile diarrhoeal disease.
- To analyze diarrhea patterns across different urbanization levels and socioeconomic groups in Lahore.
Main Methods:
- Prospective follow-up of 1,476 infants from birth to 2 years across four distinct communities in Lahore.
- Data collection on diarrhea episodes, age-specific incidence, seasonality, and management practices, including oral rehydration salts (ORS) and antibiotic use.
Main Results:
- Average of 3.6 diarrhea episodes per child annually, with higher incidence in village and peri-urban slum settings.
- Peak incidence observed in infants aged 9-10 months, with no significant sex difference.
- Oral rehydration salts (ORS) use was highest (53%) in the upper-middle (Um) class, while antibiotics were used in 75% of all episodes.
Conclusions:
- Diarrheal disease remains a substantial public health issue in rapidly urbanizing communities.
- Socioeconomic status significantly influences diarrhea management practices, highlighting disparities in access to care.
- Targeted public health strategies are needed to improve diarrhea management, particularly in lower socioeconomic and rural areas.
Abstract:
This study was carried out to obtain reliable prospective data on the incidence, home management and duration of infantile diarrhoeal disease in a developing and rapidly urbanizing community. Fourteen hundred and seventy six infants from 4 different communities of Lahore, representing different stages of urbanization, were followed prospectively from birth to 2 years of age. Each child had an average of 3.6 episodes of diarrhoea during one year; 4.3 episodes per child per year in the village, 4.4 in the periurban slum, 3.4 in the urban slum and 1.4 in the upper middle (Um) class control group. The maximum incidence of diarrhoeal episodes occurred in children between 9-10 months of age. No sex difference was found. The seasonal variation showed a peak incidence during April-June. Bloody diarrhoea, in 3-5% of the episodes, was predominantly seen in winter months and in older infants. The maximum use of ORS was seen in the Um class (53%). Antibiotics were used in 75% of all diarrhoeal episodes maximally in the Um class, and morphine derivatives in 1% of all cases. The overall incidence of persistent diarrhoea was 14% of all acute cases, being highest in the village (18%), followed by the periurban slum (14%), Um class (10%) and urban slum (8%) with peak incidence occurring in June and July. Our results confirm the magnitude of the problem of diarrhoea.(ABSTRACT TRUNCATED AT 250 WORDS)