Diarrhoea case management in low- and middle-income countries: an unfinished agenda
Diarrhoea case management in low- and middle-income countries: an unfinished agenda
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DOI：
10.2471/blt.06.030866
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发表时间：
2007-01-01
期刊：
影响因子：
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通讯作者：
Allebeck, Peter
中科院分区：
文献类型：
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作者：
Forsberg, Birger Carl;Petzold, Max G;Allebeck, Peter
目的 确定 1986 年至 2003 年期间腹泻管理是否有所改善，这一时期为促进有效的儿童病例管理做出了巨大努力。 方法 我们分析了 1986 年至 2003 年 40 个低收入和中等收入国家的 107 次人口统计和健康调查的家庭数据，并评估了腹泻儿童的补液、液体量和食物摄入量指标的趋势。对各项指标的总体趋势进行了统计分析。 结果发现，口服补液疗法（ORT）的使用（每年 0.39%）和增加液体摄入量（每年 1.02%）方面取得了一定进展，与预期的全面覆盖相比，2003 年的使用率仍然较低。尽管大多数国家的使用率有所提高，但一些国家没有取得任何进展。我们估计，每年，低收入和中等收入国家有 3.07 亿儿童没有接受 ORT，3.56 亿儿童没有获得增加液体量，而在 21 世纪初，有 2.27 亿儿童既没有接受 ORT，也没有增加液体量。 结论 低收入和中等收入国家的许多儿童没有接受适当的腹泻治疗，这一发现表明解决儿童生存这一未完成议程的紧迫性。在对现有方法和活动进行严格审查后，需要提高腹泻控制的有效性，以帮助有死于腹泻病风险的儿童的照顾者。必须做出重大努力，扩大活动范围，以改善病例管理并减少因腹泻造成的儿童死亡。
Objective To ascertain whether diarrhoea management improved during 1986-2003, a period when significant efforts were made to promote effective case management in children.Methods We analysed household data from 107 Demographic and Health Surveys in 40 low- and middle-income countries from 1986 to 2003 and assessed trends in indicators of rehydration, fluid quantity and food intake in children with diarrhoea. A statistical analysis was made of the overall trend for each indicator.Findings Modest progress was made with regard to the use of oral rehydration therapy (ORT) (0.39% per year) and increased fluid intake (1.02% per year), and use rates remained low in 2003, when compared with desired full coverage. Although use rates improved in the majority of countries, no progress was made in several countries. We estimate that, annually, 307 million children in low- and middle-income countries did not receive ORT, 356 million did not get increased amounts of fluids, and at the beginning of the 21st century, 227 million children got neither ORT nor increased amounts of fluids.Conclusion The finding that many children in low- and middle-income countries do not receive proper treatment for diarrhoea points to the urgency in addressing this unfinished agenda in child survival. The effectiveness of diarrhoea control needs to be improved after critical review of established approaches and activities to reach caregivers of children at risk of dying from diarrhoeal diseases. Significant efforts must be made to scale up activities to improve case management and reduce childhood deaths from diarrhoea.