Diarrhoeal disease morbidity and home treatment practices in Egypt

Diarrhoeal disease is a major cause of death in children in the developing world. In developing countries a quarter of infant and childhood mortality is related to diarrhoea. The World Health Organization started the Diarrhoeal Disease Control Programme (CDD) in 1980 with the objective to decrease diarrhoeal mortality and morbidity among young children in developing countries. The aim of this study was to measure the prevalence and incidence of diarrhoeal diseases among young children and to assess the quality of home case management of diarrhoeal cases. Particular emphasis was put on the assessment of drug use during diarrhoea. The survey included also the assessment of breast feeding practices. Geographically the survey was limited to two governorates, Dakahlia and Gharbia, in lower Egypt, which have the largest population (7.12 million) and were thought to be representative of lower Egypt. The total sample size was 11032. Seasonally adjusted diarrhoea incidence was 3.6 episodes per child under five years of age per year. This means a minimum estimate of 30 million cases annually in Egypt. Although the majority of the caretakers knew of Oral Rehydration Salts (ORS), only 22% of cases with diarrhoea in the last 24 h received ORS. 54% of cases had received drugs, and many of the children with diarrhoea received more than one drug. The source of drug prescription was most often a private doctor and the use of drugs was common among government doctors and health workers. The high proportion of cases treated with drugs, other than ORS, is the major problem in diarrhoeal home case management in Egypt. The message of ORS has penetrated into the general population well, but the practices of health professionals have not changed. To improve the situation further, training of health workers in correct case management is needed. Paediatric forms of symptomatic antidiarrhoeal drugs should also be withdrawn from the market.