Diagnosis and management of dysentery by community health workers

Lancet. 1988 Sep 3;2(8610):552-5. doi: 10.1016/s0140-6736(88)92669-4.


To develop guidelines for community health workers in the treatment of patients with diarrhoea, diarrhoea prevalence was actively surveyed for a year in a remote rural community of 915,000 persons, and the enteric pathogens and clinical features associated with diarrhoeal illness were determined in a sample of 300 patients. Bloody diarrhoea accounted for 39% of all diarrhoea episodes and 62% of diarrhoea-associated deaths. 51 (50%) of 101 patients with a history of bloody diarrhoea had Shigella infection, compared with 31 (16%) of 199 patients with other types of diarrhoea. A history of bloody diarrhoea was as predictive of the presence of shigella infection (positive predictive value 50%, negative predictive value 86%) as more complex prediction schemes incorporating other clinical features or stool microscopic examination. In the area of Bangladesh where the study was done reduction of diarrhoea-related morbidity and mortality will depend on control and treatment of shigellosis, and community health workers have been instructed to provide antibiotics for patients with a history of bloody dysentery.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anti-Infective Agents, Urinary / therapeutic use
  • Bacteria / isolation & purification
  • Bangladesh
  • Child, Preschool
  • Community Health Workers*
  • Drug Combinations / therapeutic use
  • Dysentery / diagnosis*
  • Dysentery / epidemiology
  • Dysentery / therapy
  • Dysentery, Bacillary / diagnosis
  • Dysentery, Bacillary / epidemiology
  • Dysentery, Bacillary / therapy
  • Female
  • Fluid Therapy
  • Humans
  • Infant
  • Nalidixic Acid / therapeutic use
  • Rural Population
  • Specimen Handling
  • Sulfamethoxazole / therapeutic use
  • Time Factors
  • Trimethoprim / therapeutic use
  • Trimethoprim, Sulfamethoxazole Drug Combination


  • Anti-Infective Agents, Urinary
  • Drug Combinations
  • Nalidixic Acid
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Trimethoprim
  • Sulfamethoxazole