© 1993 by Oxford University Press
research-article |
Persistent Diarrhoea: Management in Algorithmic Approach Using a Low-cost Rice-based Diet in Severely Malnourished Bangladeshi Children
* Department of Paediatrics, Bangladesh institute of Child Health, Dhaka Shishu Hospital Sher-e-Bangla Nagar, Dhaka, Bangladesh
** Clinical Sciences Division, International Centre for Diarrhoeal Disease Research Bangladesh. Dhaka, Bangladesh
*** Dhaka Shishu Hospital Sher-e-Bangla Nagar, Dhaka, Bangladesh
Correspondence: Dr. S. K. Roy, Scientist, Clinical Sciences Division, ICDDR, Dhaka, Bangladesh
Easy and successful dietary management of persistent diarrhoea has been a long desired goal. Finding an efficient diet which is economically feasible, and easy to prepare in poor homes of developing countries, has not been easy. A dietary algorithm was followed to test the clinical efficacy of an inexpensive and easy to prepare diet made up with rice powder, egg white, glucose, and soya oil. We studied a cohort of 100 severely malnourished children aged between 3 and 36 months with persistent diarrhoea in Dhaka Shisu (children's) Hospital, Bangladesh, during 1990. Initially on a milk-based diet, 26 children (26 per cent) improved while on a subsequent rice-based diet; 65(88 per cent) of the remaining 74 children improved within a week, with a mean recovery period of 4 days. Patients who did not improve with the rice-based diet were weaned earlier than those who improved. Nine patients failed to improve on the rice-based diet. They were given a soya formula, and only two improved. The remaining seven patients finally improved when a comminuted chicken diet was given. Eight patients died in the hospital with secondary infections of septicaemia and bronchopneumonia. This study offers a simple and effective algorithm on the management of persistent diarrhoea and also demonstrates the success of a rice-based diet, showing promising and feasible means of management of persistent diarrhoea in patients with severe malnutrition.