Management of shigellosis in undernourished children

Tens of thousands of Rwandan refugees were believed to have died from dysentery in the Goma camps in 1994/95. Above Goma, Eastern Zaire

Summary of published paper1

Acute Shigellosis can be one of the major causes of mortality in emergencies. Between 46-63,000 Rwandan refugees were believed to have died from dysentery (Shigella dysenteria type 1) in the Goma camps in Eastern Zaire during 1994/5. World-wide, it is estimated that shigellosis accounts for about 15% of diarrhoea-associated deaths in children below 5 years of age.

To date there have been few reports on the impact of dietary interventions on the clinical course of acute shigellosis. Current management of the disease is primarily focused on antibiotic therapy with less emphasis on nutritional management. A recent randomised clinical trial examined the role of an energy-dense diet on the clinical outcome of malnourished children with acute dysentery due to shigellosis. Seventy five children aged 12-48 months with acute dysentery randomly received either a milk-cereal formula with an energy density of 4960 kJ/l (1185 kcal/l2) (test group) or a milk-cereal formula with energy of 2480 kJ/l (593 kcal/l) (control group) for 10 days in hospital. In addition the standard hospital diet was offered to all children and all received an appropriate antibiotic for 5 days.

It is estimated that shigellosis amounts for about 15% of diarrhoea associated deaths under 5 years of age. Mother and child, Goma Eastern Zaire

There was no difference between the two groups in resolution of fever, dysenteric stools and stool frequency. However, vomiting was more frequently observed among the test group children during the first five days. There was a statistically significant increase in the mean weight for age in the test group compared to the control group after the 10 days of dietary intervention. In addition there was a statistically significant resolution of rectal prolapse in the test group after five days of dietary intervention. The observed difference in proportion of children with a rectal prolapse is most likely to be related to the nutritional improvement in the test group.

In conclusion, this study indicated that supplementation with a high energy diet did not have any adverse effect on the clinical course of acute shigellosis, led to improved weight gain and reduced the incidence of rectal prolapse in malnourished children.

Show footnotes

1Effect of an energy-dense diet on the clinical course of acute shigellosis in undernourished children: Mazumder .R et al. British Journal of Nutrition (2000) vol 84, pp 775-779 2 1kcal = 4.184kJ

More like this

FEX: Vitamin A Supplementation in Treatment for Acute Shigellosis

Summary of published paper Shigellosis is one of the most severe forms of infection to affect the intestine. The infection is associated with malnutrition, growth stunting and...

FEX: Carbon Dioxide Production in Acutely Ill Malnourished Children

Summary of published paper1 A recent study set out to test the hypothesis that the rate of carbon dioxide production is less in marasmic children with acute infection when...

FEX: Study of the Risk Factors for the Development of Nutritional Oedema in North Kivu, DRC

By Mark Myatt and Frances Mason Mark Myatt is a consultant epidemiologist and senior research fellow at the Division of Epidemiology, Institute of Opthalmology, University...

FEX: Clinical Trial of BP100 vs F100 Milk for Rehabilitation of Severe Malnutrition

Child eating BP100 in Freetown TFC. By Carlos Navarro-Colorado and Stéphanie Laquière Carlos Navarro-Colorado is a medical doctor, with a MSc Epidemiology. He has ten years...

FEX: Inadequate Refugee Rations: Is this a Result of Planning?

Published Lancet letters Two recent letters to the LANCET draw attention to two separate situations in which emergency food may have been used to promote longer term political...

FEX: Suspected toxic ingestion outbreak in central Afghanistan

By Gerald Martone, International Rescue Committee (IRC) Gerald Martone is the Director of Emergency Response at the International Rescue Committee's Headquarters in New York....

FEX: Caring for Unaccompanied Children under Difficult Circumstances

by Jean Long, Ros O'Loughlin, Annalies Borrel Jean Long and Ros O'Loughlin worked for Concern in Kisingani (DRC) in the fall of 1997, establishing the programme described...

FEX: Anthropometric predictors of mortality in undernourished adults in southern Sudan

Summary of published research1 Location: South Sudan What we know: Acute adult undernutrition tends to occur in prolonged severe famines. There is a lack of evidence on which...

FEX: Antibiotics as part of the management of severe acute malnutrition

Summary of published research1 Mothers receive instruction on how to adminster antibiotics Location: Malawi What we know already: There is a high prevalence of clinically...

en-net: CMAM and routine medicine

Based on WHO guideline, all severe acute malnourished children admitted to therapeutic programme are supposed to receive antibiotic whether or not they show any sign and...

FEX: Impact of Dietary Zinc Supplementation on PEM

Summary of published research1 Zinc deficiency is one of several trace element deficiencies that may play a pivotal role in the development of Protein Energy Malnutrition...

FEX: Fortified spreads v CSB in supplementary feeding in Malawi

A child eating fortified spread made using skimmed milk Summary of published research1 A study conducted in rural Malawi has compared the recovery rates of moderately wasted...

FEX: Sale of Food Aid as Sign of Distress not Excess

Summary of Published Paper In February 1996, WFP reduced rations for refugees in Uvira, Zaire by 20% when visiting donors noted that food aid, primarily maize and oil, was...

FEX: Comparison of the Efficacy of a Solid Ready-to-Use Food and a Liquid, Milk- Based Diet in Treating Severe Malnutrition

Kwashiorkor case, before and after management using RUTF (oedema resolved). Nutritional Rehabilitation Centre (Dispensaire Saint Martin), Senegal 2001 Summary of published...

FEX: WHO/UNICEF/WFP/UNHCR informal consultation on moderate malnutrition management in U5’s

Summary of meetinga The World Health Organisation (WHO) convened a meeting in Geneva (September 30th - October 3rd, 2008) with the overall aim of answering the question, 'What...

FEX: Feasibility and effectiveness of preventing child malnutrition with local foods in Kenya

Summary of research1 One of the researchers (Rebecca Ashton) weighs a child The findings of a study to establish the operational feasibility and effectiveness of using locally...

FEX: Nutritional Status of HIV+ Pre-School Children in South Africa

Summary of unpublished research Nursing health professional doing clinical investigation at Livningstone Hospital By Liana Steenkamp, Dr Jill von der Marwitz, and Charlene...

FEX: Lessons Learned From Complex Emergencies

Published paper1 Children being fed in MFS-H feeding programme Another paper in the same series in the LANCET reviewed the lessons learned from complex emergencies over the...

FEX: Assessing the intervention on infant feeding in Gaza 2008

By Susan Thurstans and Vicky Sibson Susan Thurstans has been part of the emergency response team for nutrition with Save the Children UK since January 2009 and previously...

FEX: Impact of Emergency SFP in Guinea-Bissau

A team of researchers recently investigated the effect of an SFP on malnourished children in Guinea-Bissau who were returning to their homes after having been displaced within...

Close

Reference this page

Management of shigellosis in undernourished children. Field Exchange 13, August 2001. p5. www.ennonline.net/fex/13/management