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pubmed:abstractText |
Methods of inpatient management of children with diarrhoeal diseases (DD) in 1978 and in 1980 were compared to assess the use of oral rehydration salts (ORS) and a national antidiarrhoeal programme (NAP). Inpatient notes of 369 children admitted with DD were reviewed. The management of DD differed significantly but the clinical outcome was similar, with the exception of the case-fatality rate. All deaths occurred within the first 24 h of admission, indicating that this difference was attributable to improved management of DD in the community rather than changes in the inpatient treatment regime.
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pubmed:otherAbstract |
PIP: Researchers examined the clinical case notes of 224 and 145 children admitted for diarrheal disease in 1978 and in 1983 respectively to Vaiola Hospital near Nuku'alofa, Tonga to determine any effects of the national antidiarrheal program on inpatient management. Most of the children were 2 years old. 64.4% of the 2 year old children on admission ranked below the 50th weight percentile compared to 37.5% in 1978 (p.002). On discharge, however, there was no significant difference. 28.6% of cases received intravenous fluids (IVF) in 1978 while only 2.1% did in 1983 (p.001). Further only 40% of the oral rehydration therapy (ORT) cases in 1978 received oral rehydration solution (ORS). Most ORT cases (45%) received water and the remaining cases (15%) received fruit juice or milk. In 1983, all ORT cases received ORS in larger amounts than in 1978 (p.001). In 1978, health practitioners withheld a normal diet from 78.6% of the children for 1-4 days and reintroduced it slowly. On the other hand, in 1983, they permitted all children to have a normal diet on admission (p.001). They restricted the diet, however, for 27.1% because of suspected lactose intolerance. Even though health practitioners correctly did not prescribe antidiarrheals in 1983, they continued to prescribe antibiotics in the absence of other acute infections and at a higher rate than 1978 (9.5% va. 22.9%; p.001). The case fatality rate significantly fell between 1978-1983 from 6.3%-.7% (p.005). This study showed that the national campaign was effective in changing inpatient management in clinical outcome of the 2 treatments. This suggests that improvements in morbidity and mortality were attributable to diarrhea management in the community.
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