Promoting Appropriate Management of Diarrhea: A Systematic Review of Literature for Advocacy and Action: UNICEF-PHFI Series on Newborn and Child Health, India.
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Date
2012-08
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Abstract
Background: Scaling up of evidence-based management and prevention of childhood diarrhea is a public health priority in India, and
necessitates robust literature review, for advocacy and action.
Objective: To identify, synthesize and summarize current evidence to guide scaling up of management of diarrhea among under-five
children in India, and identify existing knowledge gaps.
Methods: A set of questions pertaining to the management (prevention, treatment, and control) of childhood diarrhea was identified
through a consultative process. A modified systematic review process developed a priori was used to identify, synthesize and summarize,
research evidence and operational information, pertaining to the problem in India. Areas with limited or no evidence were identified as
knowledge gaps.
Results: Childhood diarrhea is a significant public health problem in India; the point (two-weeks) prevalence is 9-20%. Diarrhea accounts
for 14% of the total deaths in under-five children in India. Infants aged 6-24 months are at the highest risk of diarrhea. There is a lack of
robust nation-wide data on etiology; rotavirus and diarrheogenic E.coli are the most common organisms identified. The current National
Guidelines are sufficient for case-management of childhood diarrhea. Exclusive breastfeeding, handwashing and point-of-use water
treatment are effective strategies for prevention of all-cause diarrhea; rotavirus vaccines are efficacious to prevent rotavirus specific
diarrhea. ORS and zinc are the mainstay of management during an episode of childhood diarrhea but have low coverage in India due to
policy and programmatic barriers, whereas indiscriminate use of antibiotics and other drugs is common. Zinc therapy given during
diarrhea can be upscaled through existing infrastructure is introducing the training component and information, education and
communication activities.
Conclusion: This systematic review summarizes current evidence on childhood diarrhea and provides evidence to inform child health
programs in India.
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Keywords
Communication barriers, Diarrhea, National Health Programs, Operations Research, Oral rehydration therapy, Zinc
Citation
Shah Dheeraj, Choudhury Panna, Gupta Piyush, Mathew Joseph L, Gera Tarun, Gogia Siddhartha, Mohan Pavitra, Panda Rajmohan, Menon Subhadra. Promoting Appropriate Management of Diarrhea: A Systematic Review of Literature for Advocacy and Action: UNICEF-PHFI Series on Newborn and Child Health, India. Indian Pediatrics. 2012 August; 49(8): 627-649.