Diarrhoea in children in Papua New Guinea

National data for diarrhoeal disease in children can only be used as a very rough guide to morbidity and mortality, since they are based on incomplete reporting. Furthermore, when only one diagnosis per attendance, admission or cause of death is recorded, the true importance of diarrhoea as a cause of morbidity and mortality may be obscured. This may in part explain discrepancies between figures recorded in national and hospital statistics and those recorded in detailed studies of diarrhoeal admissions. While there appear to be quite marked differences in the relative importance of diarrhoea in different parts of the country, and while diarrhoeal disease is less of a scourge than in some other parts of the world, it is nevertheless a major cause of attendance at health facilities, the second or third most common cause of admission to many of the hospitals in the country, and a significant and often preventable cause of death. Limited studies of diarrhoeal aetiology indicate the major importance of rotavirus, Shigella and enteropathogenic and enterotoxigenic Escherichia coli. The control of diarrhoeal diseases in children is based not only on early and appropriate treatment, but also on preventive strategies. These include breastfeeding (which has saved the lives of many thousands of Papua New Guinean children and which is once again under threat), ensuring good host defence by good nutrition, immunization and early treatment of childhood illness, and ensuring satisfactory sanitation and hygiene. Increasing fluid intake to prevent dehydration remains the most important part of the early management of acute diarrhoeal disease. In the management of children with dehydration, UNICEF glucose-based oral rehydration therapy is widely available but not used as well as it should be. There are significant advantages in cereal-based oral rehydration solutions, and the use of such solutions, locally prepared, should be encouraged. Breastfeeding should be continued during episodes of diarrhoea, unless there is the specific contraindication of lactose intolerance. In all events the child's nutritional intake should be maintained and if possible increased during episodes of diarrhoea. There are specific indications for the use of antibiotics in the management of children with diarrhoea. They should not be used, and may be harmful, in the absence of these indications. Persistent diarrhoea--lasting more than 14 days--is associated with a high mortality and severe malnutrition. It is therefore important that children whose diarrhoea is prolonged for more than 7 days are managed appropriately, using the standard guidelines.