Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review.
Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review.
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DOI：
10.1186/s12889-015-2127-1
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发表时间：
2015-08-18
影响因子：
4.5
通讯作者：
Newby H
中科院分区：
文献类型：
--
作者：
Carter E;Bryce J;Perin J;Newby H
儿童腹泻管理中的有害做法与负面健康结果有关，并与世卫组织治疗指南相冲突。这些做法包括在腹泻发作期间限制液体、母乳和/或食物摄入，以及不正确地使用现代药物。我们对自1990年以来发表的英语文献进行了系统回顾，以评估这四种有害做法的记录流行率，以及与低收入和中等收入国家有害做法相关的信念，动机和背景因素。我们电子检索了PubMed、Embase、奥维德全球健康和WHO全球健康图书馆。报告与四种有害习俗中至少一种有关的信念、动机或背景的流行率或实质性调查结果的出版物均被纳入，而不论研究设计或抽样人口的代表性如何。在纳入审查的114篇文章中，79篇报告了至少一种有害做法的普遍性，35项研究报告了有害做法的信念、动机或背景。大多数研究依赖于国家以下一级的人口样本，许多研究仅限于小样本。研究设计、研究人群和有害做法的定义因研究而异。报告的有害做法流行率在研究人群中差异很大，我们无法确定不同地区，国家或时间段的明确定义模式。护理人员报告说，腹泻管理做法是基于其他人（卫生工作者、亲属、社区成员）的建议，以及他们自己对某些腹泻治疗方法疗效的观察或理解。另一些人报告说，他们遵循传统上对特定妇科疾病的病因和治疗方法的信念。现有证据表明，腹泻治疗中的有害做法在一些疟疾相关死亡率高的国家很常见。这些做法可能会减少对儿童腹泻病的正确管理，导致治疗失败，持续的营养不足和腹泻死亡率增加。本文献综述中发现的采样、测量和报告缺乏一致性，这突出表明需要使用标准测量和报告方法记录有害做法，以持续降低腹泻死亡率。本文的在线版本（doi：10.1186/s12889-015-2127-1）包含补充材料，可供授权用户使用。
Harmful practices in the management of childhood diarrhea are associated with negative health outcomes, and conflict with WHO treatment guidelines. These practices include restriction of fluids, breast milk and/or food intake during diarrhea episodes, and incorrect use of modern medicines. We conducted a systematic review of English-language literature published since 1990 to assess the documented prevalence of these four harmful practices, and beliefs, motivations, and contextual factors associated with harmful practices in low- and middle-income countries. We electronically searched PubMed, Embase, Ovid Global Health, and the WHO Global Health Library. Publications reporting the prevalence or substantive findings on beliefs, motivations, or context related to at least one of the four harmful practices were included, regardless of study design or representativeness of the sample population. Of the 114 articles included in the review, 79 reported the prevalence of at least one harmful practice and 35 studies reported on beliefs, motivations, or context for harmful practices. Most studies relied on sub-national population samples and many were limited to small sample sizes. Study design, study population, and definition of harmful practices varied across studies. Reported prevalence of harmful practices varied greatly across study populations, and we were unable to identify clearly defined patterns across regions, countries, or time periods. Caregivers reported that diarrhea management practices were based on the advice of others (health workers, relatives, community members), as well as their own observations or understanding of the efficacy of certain treatments for diarrhea. Others reported following traditionally held beliefs on the causes and cures for specific diarrheal diseases. Available evidence suggests that harmful practices in diarrhea treatment are common in some countries with a high burden of diarrhea-related mortality. These practices can reduce correct management of diarrheal disease in children and result in treatment failure, sustained nutritional deficits, and increased diarrhea mortality. The lack of consistency in sampling, measurement, and reporting identified in this literature review highlights the need to document harmful practices using standard methods of measurement and reporting for the continued reduction of diarrhea mortality. The online version of this article (doi:10.1186/s12889-015-2127-1) contains supplementary material, which is available to authorized users.