Dear CHIFA colleagues,
This paper concludes: 'A large gap exists between diarrheal treatment recommendations and their application by healthcare workers and caregivers in the community. Opportunities exist for improvement in case management for children with moderate-to-severe diarrhea in low-resource settings, and these improvements could reduce mortality and malnutrition. Site-specific sensitization interventions may be needed to improve adherence to WHO diarrhea management guidelines. Implementation-based interventions should consider local knowledge, behavior, and infrastructure.'
The paper revealed low compliance with WHO guidelines within the home and also within the healthcare facility.
It was unclear, however, whether WHO guidelines were actually available in the home or in the healthcare facility, and, if they were available, whether they were appropriately adapted for family caregivers and health workers.
Citation and abstract below.
CITATION: Deichsel EL, Keita AM, Verani JR, Powell H, Jamka LP, Hossain MJ, Jones JCM, Omore R, Awuor AO, Sow SO, Sanogo D, Tapia MD, Neuzil KM, Kotloff KL. Management of Diarrhea in Young Children in Sub-Saharan Africa: Adherence to World Health Organization Recommendations During the Global Enteric Multisite Study (2007-2011) and the Vaccine Impact of Diarrhea in Africa (VIDA) Study (2015-2018). Clin Infect Dis. 2023 Apr 19;76(76 Suppl 1):S23-S31. doi: 10.1093/cid/ciac926. PMID: 37074440; PMCID: PMC10116557. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10116557/
ABSTRACT
Background
Reducing diarrhea-related morbidity and mortality is a global priority, particularly in low-resource settings. We assessed adherence to diarrhea case management indicators in the Global Enteric Multisite Study (GEMS) and Vaccine Impact of Diarrhea in Africa (VIDA) study.
Methods
GEMS (2007–2010) and VIDA (2015–2018) were age-stratified case-control studies of moderate-to-severe diarrhea (MSD) in children aged <5 years. In this case-only analysis, we included children enrolled in The Gambia, Kenya, and Mali. A case with no dehydration received adherent care at home if they were offered more than usual fluids and at least the same as usual to eat. Children with diarrhea and some dehydration are to receive oral rehydration salts (ORS) in the facility. The recommendation for severe dehydration is to receive ORS and intravenous fluids in the facility. Adherent care in the facility included a zinc prescription independent of dehydration severity.
Results
For home-based management of children with MSD and no signs of dehydration, 16.6% in GEMS and 15.6% in VIDA were adherent to guidelines. Adherence to guidelines in the facility was likewise low during GEMS (some dehydration, 18.5%; severe dehydration, 5.5%). The adherence to facility-based rehydration and zinc guidelines improved during VIDA to 37.9% of those with some dehydration and 8.0% of children with severe dehydration.
Conclusions
At research sites in The Gambia, Kenya, and Mali, suboptimal adherence to diarrhea case management guidelines for children aged <5 years was observed. Opportunities exist for improvement in case management for children with diarrhea in low-resource settings.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
