Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden
Date
2013-08-30
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Health & Medical Publishing Group
Abstract
Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World
Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy
(ORT) in the Western Cape Province of South Africa are not well described.
Objectives. To document pre-hospital home and primary care management of diarrhoea, and certain risk factors and complications of
diarrhoea.
Methods. We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital, Parow,
Cape Town, between 1 February 2007 and 31 May 2008. Caregivers were interviewed, and demographic, clinical and laboratory variables
were collected.
Results. We recruited 142 children, median age 8.9 months. A third had moderate malnutrition. Twenty–four (16.9%) were HIV-exposed,
with 9 (6.3%) HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores
(WAZ) were significantly lower in HIV-infected than in HIV-exposed, uninfected children (p=0.02). Eighty per cent of caregivers gave
ORT and 35.2% stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely
complied with IMCI guidelines.
Conclusions. Most caregivers do give ORT, but advice given at primary care level is often suboptimal. Many hospitalised children with
diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition, and HIV exposure
appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies, prehospital
management and nutritional rehabilitation.
Description
CITATION: Cooke, M. L., Nel, E. D. & Cotton, M. F. 2013. Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden. South African Journal of Child Health, 7(3):84-87, doi:10.7196/SAJCH.472.
The original publication is available at http://www.sajch.org.za
The original publication is available at http://www.sajch.org.za
Keywords
Diarrhea in infants -- Care, Oral rehydration therapy for infants, Children of HIV-positive persons -- Risk factors, HIV-positive infants -- Risk factors, Malnutrition in infants -- South Africa -- Western Cape
Citation
Cooke, M. L., Nel, E. D. & Cotton, M. F. 2013. Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden. South African Journal of Child Health, 7(3):84-87, doi:10.7196/SAJCH.472.