Acute Gastroenteritis in Children of the World: What Needs to Be Done?

Abstract

The incidence of gastroenteritis has greatly reduced due to improved hygiene conditions in developing countries and the use of rotavirus vaccine. Still thousands of children, however, die from gastroenteritis, most of them in poor countries. Yet gastroenteritis management is simple, inexpensive, and effective and is largely the same all over the world. Universal guidelines for gastroenteritis guide the management and include simple interventions put forward early in the course of the disease. Treatment includes rehydration, continuing oral feeding, and anti-infective drugs in selected clinical conditions related to the symptoms or to host-related risk, and possible additional drug treatment to reduce the duration and severity of symptoms. There may be minor geographical differences in the treatment applied due to health care organizations that do not substantially change the standard universal recommendations. Prevention is recommended with sanitation interventions and rotavirus universal immunization. Implementation of those interventions through educational initiatives and local programs in target areas are needed. A series of recommendations for interventions, education, and research priorities are included here with the aim of reducing the burden of gastroenteritis, to be pursued by scientists, physicians, policy makers, and stakeholders involved. They include the need of recommendations for the management of gastroenteritis in malnourished children, in those with chronic conditions, in neonates, and in emergency settings. A reference system to score dehydration, the definition of optimal composition of rehydration solution and the indications for anti-infective therapy are also included. Rotavirus immunization should be actively promoted, and evidence-based guidelines should be universally implemented. Research priorities are also indicated.

Figure 1

Barriers to immunization against rotavirus. Although the single major barrier is “cost,” underscoring the severity of acute gastroenteritis (AGE) by caregivers, health authorities, and even by physician is also a major barrier. Hence, knowledge rather than cost is a target of actions to ensure widespread universal immunization. Organizational issues are an additional barrier, very much related to the need of keeping the vaccine viable under temperature control, and the need of administering the vaccine within a narrow time window early after birth. From ref (20), modified.

Figure 2

Algorithm for the management of acute gastroenteritis (AGE). The algorithm shows indications providing clear information on what to do in the presence of red flags. Prolonged diarrhea is considered as a complication requiring investigations. Oral rehydration solution should always be regarded as the key intervention to start with in all cases. From ref (34), modified.