Management of Childhood Diarrhoea at the Household Level: A Population-Based Survey in North-East Brazil

By Barros, F. C.; Victora, C. G. et al. | Bulletin of the World Health Organization, January-February 1991 | Go to article overview

Management of Childhood Diarrhoea at the Household Level: A Population-Based Survey in North-East Brazil


Barros, F. C., Victora, C. G., Forsberg, B., Maranhao, A. G. K., Stegeman, M., Gonzalez-Richmond, A., Martins, R. M., Neuman, Z. A., McAuliffe, J., Branco, J. A., Jr., Bulletin of the World Health Organization


The management of childhood diarrhoea at the household level was studied in a population-based survey in four states in north-east Brazil. Of a representative sample of 6524 children under 5 years of age, 982 (15. 1 %) had diarrhoea on the day of the interview or had had diarrhoea at some time during the previous 15 days. A total of 66% of the children were not taken for treatment, while government health services were used by 14%, private doctors by 1%, and traditional healers (rezadeiras) by 24%.

Oral rehydration therapy was given to 24.3% of the children as follows: solutions of oral rehydration salts (ORS) were received by 6.8%, salt-and-sugar solutions by 14.7%, and solutions of commercial ORS brands by 4.3%. Although 95% of the caretakers knew about rehydration solutions, only 18% prepared them correctly, the most common error being the use of insufficient water.

Of the rehydration solutions used, 39% had a sodium concentration that was potentially dangerous (> 120 mmol/l), and 8% had a sodium concentration that was very low. Of those solutions prepared using ORS, 38% had too high a sodium concentration, while 14% of the salt-and-sugar solutions prepared using either the scoop-and-pinch" approach or a plastic spoon were too concentrated. However, potentially the most dangerous were the salt-and-sugar solutions prepared using nonstandard recipes. More than half of these had an unacceptably high sodium concentration or osmolarity. Introduction National programmes for the control of diarrhoeal diseases have been operational in many countries for the last 10 years. Such programmes have usually focused on case management and in many instances have been successful in introducing oral rehydration therapy (ORT) to the communities they serve. Recent reports have indicated, however, that there are considerable difficulties in teaching the public how to prepare correctly oral rehydration solutions.' There are also indications that earlier surveys and studies overestimated the use of ORT, and that the high usage levels after promotion campaigns have been difficult to sustain 1).

In order to collect data on the use and preparation of oral rehydration solutions in a community that had been exposed to health education on proper case management of diarrhoea, we carried out a household survey in north-east Brazil in April 1989. The study was preceded by the following efforts to disseminate knowledge about ORT: health workers from governmental and nongovernmental organizations were trained how to prepare and use oral rehydration solutions; a campaign for the use of home-made salt-and-sugar solutions (SSS) in the treatment of diarrhoea was launched; and instructions on the preparation of the solutions, using either a pinch of salt and a scoop of sugar or a special plastic spoon for measuring the quantities of sugar and salt to be mixed in a glass of water, were broadcast daily on radio and television for several months preceding the survey. At the same time, the use of prepackaged oral rehydration salts (ORS), based on the WHO formulation, was also promoted on radio and television, and by the public health services. Efforts were made by the government to make ORS available in all public health facilities in the survey area, and several commercial brands of ORS were also sold in private drug stores and pharmacies.

Methodology

The nine states in north-east Brazil (total population, 41.3 million) were divided into four groups based on population size and geographical distribution. One state from each group was selected at random, and 10 municipalities were chosen at random in each state. Subsequently, eight sectors were selected randomly in each municipality and 30 households in each sector were surveyed using a standard technique that has been described previously.' If any child aged under 5 years had diarrhoea on the day of the survey or had had an episode of diarrhoea that started in the 15 days preceding the survey, a caretaker of the child was interviewed on the characteristics of the episode, how it had been managed, and whether the caretaker knew about ORT. …

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