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Severe illness in African children with diarrhoea: implications for case management strategies
1International Health Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30306, USA.
Insights
Severe illness in African children with diarrhoea is linked to dehydration, malnutrition, bacteraemia, severe anaemia, and malaria. WHO criteria effectively identify high-risk children for better management.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrhoea is a leading cause of mortality in African children.
- Accurate assessment of illness severity is crucial for timely intervention.
Purpose of the Study:
- To identify clinical disorders associated with severe diarrhoea in children under five in Cote d'Ivoire.
- To evaluate the utility of WHO general condition criteria for identifying severe cases.
Main Methods:
- A cross-sectional study of 264 children under five with diarrhoea at a public hospital.
- Assessment of general condition using WHO criteria to classify severity.
- Clinical and laboratory evaluation for dehydration, wasting, bacteraemia, anaemia, and malaria.
Main Results:
- Children with severe diarrhoea were significantly more likely to be dehydrated, wasted, bacteraemic, severely anaemic, and have malaria.
- 60% of severe cases had at least two of these five conditions, compared to 14% of non-severe cases.
- Nontyphoidal Salmonella was common in blood isolates but not linked to HIV.
Conclusions:
- WHO general condition criteria are useful for identifying African children with severe diarrhoea at high risk of life-threatening disorders.
- A comprehensive approach is needed to manage diarrhoea, recognizing bacteraemia, anaemia, wasting, and malaria alongside dehydration.
- Simple observational criteria can aid health workers with limited resources in identifying at-risk children.
Abstract:
To identify clinical disorders associated with severe illness in African children with diarrhoea, we studied a group of under-5-year-olds with diarrhoea who had been brought to a large public hospital in central Cote d'Ivoire. The general condition of children with diarrhoea was assessed and classified according to criteria recommended by WHO, and then used as a nonspecific indicator of severity. Of the 264 children with diarrhoea who were enrolled in the study, 196 had nonsevere illness and 68 severe illness. Children with severe illness were significantly more likely than those with nonsevere illness to be dehydrated (45% versus 11%), moderate-to-severely wasted (47% versus 29%), bacteraemic (26% versus 9%), severely anaemic (haemoglobin level <6 g/dl; 15% versus 6%), have Plasmodium falciparum parasitaemia (27% versus 14%), and have two or more of these five conditions (60% versus 14%). Nontyphoidal Salmonella spp. were present in 68% of the blood isolates but were not associated with seropositivity to human immunodeficiency virus (HIV). The study demonstrates the need for a more comprehensive approach to assessment and management of children with diarrhoea that ensures prompt recognition of bacteraemia, anaemia, wasting and malaria, as well as dehydration. Simple nonspecific observational criteria, such as those recommended by WHO for assessing and classifying general condition, are useful for identifying children with diarrhoea who are at high risk of having life-threatening clinical disorders, and can readily be used by health workers whose clinical training and access to diagnostic laboratory facilities are both limited.