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Amu EO, Olatona FA, Adeyemi BO, Adegbilero-Iwari OE. Childhood diarrhoea in southwestern Nigeria: Predictors of low osmolarity ORS and zinc use among mothers. J Taibah Univ Med Sci 2022; 17:1006-1013. [PMID: 36212577 PMCID: PMC9519615 DOI: 10.1016/j.jtumed.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/08/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Diarrhoea is a leading cause of mortality among children in resource-limited countries. However, very scarce literature exists regarding the factors influencing the awareness and use of low osmolarity oral rehydration salts (Lo-ORS) and zinc supplementation in the management of childhood diarrhoea among mothers of children under 5 years of age in southwestern Nigeria. This study, performed in Lagos, Nigeria, aimed to address this lack of knowledge. Methods Through a cross-sectional survey design, 336 mothers of children under 5 years of age were selected through a multi-stage sampling procedure. Data were collected with a pretested, semi-structured interviewer administered questionnaire and analysed in SPSS version 23. Descriptive and inferential statistical techniques were used for data analysis. Results A total of 10.4% of the mothers were aware of Lo-ORS, whereas 6.5% had ever used it; 53.3% were aware of zinc supplementation, whereas 42% had ever used it. Awareness was influenced by educational level (AOR: 2.017; 95% CI: 1.123–3.626) and the age of the child (AOR: 2.257; 95% CI: 1.237–4.117) for Lo-ORS, and by average monthly income (AOR: 1.582; 95% CI: 1.144–2.187) for zinc supplementation. The utilisation level was associated with educational level (p = 0.039) and awareness (p < 0.001) for Lo-ORS, and with marital status (p = 0.018) and awareness (p < 0.001) for zinc supplementation. Conclusion Awareness and use of Lo-ORS was poorer than that of zinc supplementation among the mothers. Efforts to promote awareness regarding these treatments among mothers and health workers should be intensified to promote their use and help bridge the gap between policy change and effectiveness.
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Affiliation(s)
- Eyitope O. Amu
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | - Foluke A. Olatona
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria
| | - Barbara O. Adeyemi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria
| | - Oluwaseun E. Adegbilero-Iwari
- Department of Community Medicine, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Corresponding address: Department of Community Medicine, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria.
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Li YT, Xu H, Ye JZ, Wu WR, Shi D, Fang DQ, Liu Y, Li LJ. Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: A systematic review with meta-analysis. World J Gastroenterol 2019; 25:4999-5016. [PMID: 31543689 PMCID: PMC6737314 DOI: 10.3748/wjg.v25.i33.4999] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diarrhea is a major infectious cause of childhood morbidity and mortality worldwide. In clinical trials, Lactobacillus rhamnosus GG ATCC 53013 (LGG) has been used to treat diarrhea. However, recent randomized controlled trials (RCTs) found no evidence of a beneficial effect of LGG treatment.
AIM To evaluate the efficacy of LGG in treating acute diarrhea in children.
METHODS The EMBASE, MEDLINE, PubMed, Web of Science databases, and the Cochrane Central Register of Controlled Trials were searched up to April 2019 for meta-analyses and RCTs. The Cochrane Review Manager was used to analyze the relevant data.
RESULTS Nineteen RCTs met the inclusion criteria and showed that compared with the control group, LGG administration notably reduced the diarrhea duration [mean difference (MD) -24.02 h, 95% confidence interval (CI) (-36.58, -11.45)]. More effective results were detected at a high dose ≥ 1010 CFU per day [MD -22.56 h, 95%CI (-36.41, -8.72)] vs a lower dose. A similar reduction was found in Asian and European patients [MD -24.42 h, 95%CI (-47.01, -1.82); MD -32.02 h, 95%CI (-49.26, -14.79), respectively]. A reduced duration of diarrhea was confirmed in LGG participants with diarrhea for less than 3 d at enrollment [MD -15.83 h, 95%CI (-20.68, -10.98)]. High-dose LGG effectively reduced the duration of rotavirus-induced diarrhea [MD -31.05 h, 95%CI (-50.31, -11.80)] and the stool number per day [MD -1.08, 95%CI (-1.87, -0.28)].
CONCLUSION High-dose LGG therapy reduces the duration of diarrhea and the stool number per day. Intervention at the early stage is recommended. Future trials are expected to verify the effectiveness of LGG treatment.
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Affiliation(s)
- Ya-Ting Li
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hong Xu
- Department of Orthopedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Zhong Ye
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wen-Rui Wu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ding Shi
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Dai-Qiong Fang
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yang Liu
- Department of Orthopedics, Clinical Sciences, Lund, Lund University, Lund 22185, Sweden
| | - Lan-Juan Li
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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do Carmo MS, Santos CID, Araújo MC, Girón JA, Fernandes ES, Monteiro-Neto V. Probiotics, mechanisms of action, and clinical perspectives for diarrhea management in children. Food Funct 2019; 9:5074-5095. [PMID: 30183037 DOI: 10.1039/c8fo00376a] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infectious diarrhea is the second most common cause of morbidity and mortality in children under 5 years of age in the underdeveloped areas of the world. Conventional treatment consists of rehydration, which may be coupled with antimicrobial agents in more severe bacterial infections or with antiprotozoal agents. In the last few decades, research on the use of probiotic strains, such as Lactobacillus rhamnosus GG ATCC 53013 (LGG), Lactobacillus reuteri DSM 17938 and Saccharomyces boulardii, has gained much attention to prevent and treat diarrheal diseases. However, they are rarely used in the clinical routine, perhaps because there are still gaps in the knowledge about the effective benefit to the patient in terms of the reduction of the duration of diarrhea and its prevention. Furthermore, only a few probiotic strains are safely indicated for usage in pediatric practice. This review summarizes the current knowledge on the antimicrobial mechanisms of probiotics on distinct enteropathogens and their role in stimulating host defense mechanisms against intestinal infections. In addition, we highlight the potential of probiotics for the treatment and prevention of diarrhea in children. We conclude that the use of probiotics is beneficial for both the treatment and prevention of diarrhea in children and that the identification of other candidate probiotics might represent an important advance to a greater reduction in hospital stays and to prevent infectious diarrhea in a larger portion of this population.
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Affiliation(s)
- Monique Santos do Carmo
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brazil
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Nitazoxanide in Acute Rotavirus Diarrhea: A Randomized Control Trial from a Developing Country. J Trop Med 2017; 2017:7942515. [PMID: 28331496 PMCID: PMC5346365 DOI: 10.1155/2017/7942515] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/17/2016] [Indexed: 02/05/2023] Open
Abstract
Background. Acute diarrhea is one of the leading causes of childhood mortality, with rotavirus being an important pathogen. Nitazoxanide, an antiparasitic agent, has been shown to inhibit rotavirus. Objective. This double-blind, randomized trial was designed to study the role of nitazoxanide in acute rotavirus diarrhea. Methods. Of 174 children (12 months to 5 years) with acute diarrhea, 50 rotavirus positive cases were randomized. The intervention group received syrup nitazoxanide twice daily (100 mg in 12–47 months, 200 mg in ≥4 yr) for 3 days along with standard treatment of diarrhea. Duration of diarrhea was the primary outcome measure. Results. The median duration (hrs) of diarrhea (54 versus 80; 95% CI: –26 [–13.2 to –38.8]) and hospitalization (68 versus 90; 95% CI: –22 [–12.98 to –31.02]) was significantly shorter in the nitazoxanide group. No significant difference was seen in the median duration (hrs) of fever or vomiting or the proportion of children requiring parenteral rehydration. There was no report of any adverse events. Conclusions. Oral nitazoxanide is effective and safe in the management of acute rotavirus diarrhea in Indian children (CTRI REF/2016/10/012507).
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Das S, Gupta PK, Das RR. Efficacy and Safety of Saccharomyces boulardii in Acute Rotavirus Diarrhea: Double Blind Randomized Controlled Trial from a Developing Country. J Trop Pediatr 2016; 62:464-470. [PMID: 27283364 DOI: 10.1093/tropej/fmw032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the efficacy and safety of Saccharomyces boulardii (SB) in acute childhood rotavirus diarrhea. METHODS Children (3 months to 5 years) with WHO-defined acute watery diarrhea and stool rotavirus positive (n = 60) were randomized into intervention (n = 30) and control (n = 30) groups. The intervention group received SB (500 mg/day) for 5 days. RESULTS The median duration (hours) of diarrhea was significantly shorter in the intervention group (60 vs. 89; 95% CI: -41.2 to - 16.8). A significantly shorter duration of hospitalization (74 vs. 91; 95% CI: -33.46 to - 0.54) was also seen in the intervention group, but no significant difference was seen for fever and vomiting. There was also no difference between the two groups in the proportion of children requiring parenteral rehydration and persistence of diarrhea lasting beyond day 7. There was no report of any adverse events. CONCLUSIONS The present trial showed that SB is effective and safe in acute rotavirus diarrhea.
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Affiliation(s)
- Susrut Das
- Department of Pediatrics, Tata Main Hospital, Jamshedpur 831001, India
| | | | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
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Bhatt GC, Jain S, Das RR. Zinc supplementation as an adjunct to standard therapy in childhood nephrotic syndrome - a systematic review. World J Clin Pediatr 2016; 5:383-390. [PMID: 27872827 PMCID: PMC5099591 DOI: 10.5409/wjcp.v5.i4.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/27/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the role of zinc as add on treatment to the “recommended treatment” of nephrotic syndrome (NS) in children.
METHODS All the published literature through the major databases including Medline/Pubmed, Embase, and Google Scholar were searched till 31st December 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved papers concerning the role of zinc in childhood NS were reviewed by the authors, and the data were extracted using a standardized data collection tool. Randomized trials (RCTs) comparing zinc vs placebo was included. Effect of zinc was studied in both steroid sensitive and steroid dependent/frequent relapsing NS. The primary outcome measure was the risk of relapse in 12 mo. The secondary outcome measures were mean relapse rate per patient in 12 mo, mean relapse rate per patient in 6 mo, risk of infection associated relapse in 12 mo, cumulative dose of steroids in two groups, mean length of time to next relapse, adverse effects of therapy, and change in serum zinc levels.
RESULTS Of 54 citations retrieved, a total of 6 RCTs were included. Zinc was used at a dose of 10-20 mg/d, for the duration that varied from 6-12 mo. Compared to placebo, zinc reduced the frequency of relapses, induced sustained remission/no relapse, reduced the proportion of infection episodes associated with relapse with a mild adverse event in the form of metallic taste. The GRADE evidence generated was of “very low-quality”.
CONCLUSION Zinc may be a useful additive in the treatment of childhood NS. The evidence generated mostly was of “very low-quality”. We need more good quality RCTs in different country setting as well different subgroups of children before any firm recommendation can be made.
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Das RR, Sankar J, Naik SS. Efficacy and safety of diosmectite in acute childhood diarrhoea: a meta-analysis. Arch Dis Child 2015; 100:704-12. [PMID: 25784748 DOI: 10.1136/archdischild-2014-307632] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/23/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We evaluated the role of diosmectite as an add-on treatment to the 'recommended treatment' of acute diarrhoea in children. METHODS We searched all published literature through the major databases: Medline via Ovid, PubMed, CENTRAL, Embase and Google Scholar till May 2014. Randomised clinical trials comparing diosmectite versus placebo were included (PROSPERO registration: CRD42014013783). MAIN OUTCOME MEASURES The primary outcome measures were duration of acute diarrhoea (h), and day-to-day cure rates (%). The secondary outcome measures were stool output (volume), stool output (frequency) and adverse events. RESULTS Of 384 citations retrieved, a total of 13 randomised clinical trials (2164 children, 1-60 months old) were included in the meta-analysis. A dose of 3-6 grams per day of diosmectite was given for a duration from 3 days until recovery. Compared with placebo, diosmectite significantly decreased the duration of acute diarrhoea (mean difference, -23.39; 95% CI -28.77 to -18.01), and increased the cure rate (%) at day 5 (OR, 4.44; 95% CI 1.66 to 11.84), without any increases in the risk of adverse events. Diosmectite was effective in all types of acute childhood diarrhoea except dysentery. Because, most of the trials were open-label, and there was a high possibility of publication bias, the GRADE evidence generated was of 'low quality'. CONCLUSIONS Diosmectite may be a useful additive in the treatment of acute childhood diarrhoea. As the evidence generated was of 'low quality', future research is needed with higher quality designs before any firm recommendations can be made. TRIAL REGISTRATION NUMBER PROSPERO registration: CRD42014013783.
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Affiliation(s)
- Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushree Samiksha Naik
- Department of Obstetrics & Gynecology, SCB Medical College & Hospital, Cuttack, India
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