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. 2023 Apr 19;76(76 Suppl 1):S23-S31.
doi: 10.1093/cid/ciac926.

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)

Emily L Deichsel  1 , Adama Mamby Keita  2 , Jennifer R Verani  3 , Helen Powell  1 , Leslie P Jamka  1 , M Jahangir Hossain  4 , Joquina Chiquita M Jones  4 , Richard Omore  5 , Alex O Awuor  5 , Samba O Sow  2 , Doh Sanogo  2 , Milagritos D Tapia  1 , Kathleen M Neuzil  1 , Karen L Kotloff  1
Affiliations

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)

Emily L Deichsel et al. Clin Infect Dis. .

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.

Keywords: Africa; IMCI guidelines; WHO; diarrhea management.

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Conflict of interest statement

Potential conflicts of interest. K. L. K. reports consultation fees and travel support from PATH and the University of Washington related to diarrheal diseases and grant support to her institution from the National Institute of Allergy and Infections Diseases, Institut Pasteur, and the Bill & Melinda Gates Foundation. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Adherence to WHO IMCI home management guidelines by WHO dehydration level, site, and study (GEMS, 2007–2011 and VIDA, 2015–2018). Abbreviations: GEMS, Global Enteric Multisite Study; VIDA, Vaccine Impact of Diarrhea in Africa study; WHO, World Health Organization.
Figure 2.
Figure 2.
Adherence to WHO IMCI facility-based management guidelines by WHO dehydration level, site, and study (GEMS, 2007–2011 and VIDA, 2015–2018). Abbreviations: GAM, The Gambia; GEMS, Global Enteric Multisite Study; IV, intravenous; KEN, Kenya; MAL, Mali; ORS, oral rehydration salts; VIDA, Vaccine Impact of Diarrhea in Africa study; WHO, World Health Organization.
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References

    1. Institute for Health Metrics and Evaluation . GBD compare. Seattle, WA: University of Washington, 2022.
    1. Moore SR, Lima NL, Soares AM, et al. . Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children. Gastroenterology 2010; 139:1156–64. - PMC - PubMed
    1. Troeger C, Colombara DV, Rao PC, et al. . Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years. Lancet Glob Health 2018; 6:e255–69. - PMC - PubMed
    1. Boschi-Pinto C, Labadie G, Dilip TR, et al. . Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on. BMJ Open 2018; 8:e019079. - PMC - PubMed
    1. World Health Organization . Global strategy on human resources for health: workforce 2030. Geneva, Switzerland: WHO, 2016.

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