Bill and Melinda Gates Annual Letter 2019 (5) Management of acute childhood diarrhoea (3)

19 February, 2019

Dear friends, when I was young paediatrician in Europe I was taught to 'keep the affected organ resting', therefore to avoid any food uncluding fluid in a child with dyarrhea. In Africa I reviewed this (wrong) knowledge.

It is true that some mothers are reluctant to give fluid to a child with dyarrhea, my way to convince them is the following: "there is 'dirty' in the bowels of the child, we should wash it out, therefore give water/fluid to him/her. More water/fluid you'll give and more dirty will get out, until the bowel will be cleaned and dyarrhea off."

I do the same 'trick' for cough: dirty in the lungs, cough helps to clean them, to stop cough wont help for dirty will remain in. Mothers do learn to be patient and accept cough as a 'remedy' and not as a 'illness'. I learnt this attitude from 'Where there is no doctor', I recommend it to be always on the table of my colleagues/prescribers.

Indeed cough and dyarrhea in children are by far the first cause of ill health, in Tanzania 84% of children 'affected' by cough & dirrhoea and attending public or private ambulatories receive an antibiotic, plus a cough syrup.

Thanks

Massimo

Dodoma

HIFA Profile: Massimo Serventi is a long-standing Pediatrician working in Africa since 1982. He currently works on a volunteer basis in an excellent missionary/credited hospital in north Uganda, St. Mary's Hospital-Lacor-GULU. He has worked for several NGOs in 6 African/2 Asian countries. His interests include clinical and community pediatrics, adherence to clinical guidelines and school education as the major determinant of good health.

Email: massimoser20 AT gmail.com