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.
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: Recovery rate of children with moderate acute malnutrition treated with ready-to-use supplementary food (RUSF) or improved corn-soya blend (CSB+)
Summary of research * Location: Cameroon. What we know: A wide range of nutritional products are currently used to treat MAM; there is no definitive consensus on the most...
FEX: Efficacy of a community-embedded RUTF programme to treat childhood malnutrition in Kapanga, DRC
By Ivan R. Molton, Rukang Chikomb, Marie Chilembe, Alice Rowe, Rodolph Rowe and Chingambu Tshiseng Ivan Molton is an Associate Professor in the Department of Rehabilitation...
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: 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....
en-net: inpatient SAM management
hi.. in Jordan, the CMAM program is integrated into primary healthcare...thus, only children with urgent complications are referred for secondary healthcare services. F-100...
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: 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...
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: 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: 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: Dietary Treatment of Severe Malnutrition in Adults
Summary of a Published Paper Somalia - Standing in the mud near the edge of the Sabelle River a boy watches the arrival of the villagers from a neighbouring Bulomano 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...
FEX: CSB versus fortified spread in wasted HIV infected adults in Malawi
Summary of published research1 Eating ready-to-use fortified spread in Malawi The prevalence of wasting, defined as a Body Mass Index (BMI) <18.5, in adults with advanced...
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: Fortified blended flour supplements displace plain cereals in feeding of young children
View this article as a pdf Research snapshot1 Growth faltering often occurs during the period of complementary feeding, from six to 20 months of age, when the child is...
FEX: Responding to the crisis in Congo-Zaire: emergency Feeding of Rwandan Refugees May-July 1997
Author:Susanne Jaspars, is an independent Consultant in Nutrition. This article was based on her experiences while working for CARE UK as a Food Policy Consultant. The...
FEX: Kwashiorkor – reflections on the ‘revisiting the evidence’ series
View this article as a pdf Lisez cet article en français ici By Merry Fitzpatrick, Gerard Bryan Gonzales, Alexandra Rutishauser-Perera and André Briend Merry...
Reference this page
Management of shigellosis in undernourished children. Field Exchange 13, August 2001. p5. www.ennonline.net/fex/13/management
(ENN_3511)