To identify clinical disorders associated with severe illness in African children with diarrhoea, we studied a group of under-5-year-olds with diarrhoea who had been brought to a large public hospital in central Cote d'Ivoire. The general condition of children with diarrhoea was assessed and classified according to criteria recommended by WHO, and then used as a nonspecific indicator of severity. Of the 264 children with diarrhoea who were enrolled in the study, 196 had nonsevere illness and 68 severe illness. Children with severe illness were significantly more likely than those with nonsevere illness to be dehydrated (45% versus 11%), moderate-to-severely wasted (47% versus 29%), bacteraemic (26% versus 9%), severely anaemic (haemoglobin level <6 g/dl; 15% versus 6%), have Plasmodium falciparum parasitaemia (27% versus 14%), and have two or more of these five conditions (60% versus 14%). Nontyphoidal Salmonella spp. were present in 68% of the blood isolates but were not associated with seropositivity to human immunodeficiency virus (HIV). The study demonstrates the need for a more comprehensive approach to assessment and management of children with diarrhoea that ensures prompt recognition of bacteraemia, anaemia, wasting and malaria, as well as dehydration. Simple nonspecific observational criteria, such as those recommended by WHO for assessing and classifying general condition, are useful for identifying children with diarrhoea who are at high risk of having life-threatening clinical disorders, and can readily be used by health workers whose clinical training and access to diagnostic laboratory facilities are both limited.
PIP: Researchers prospectively studied 264 children aged less than 5 years with diarrhea who were admitted to the Bouake Regional Hospital Center in the Ivory Coast between June 10 and August 11, 1991, to identify clinical disorders associated with severe diarrhea. They compared data on the 196 children with non-severe diarrhea with data on 68 children with severe diarrhea. All but three of the children were breast fed. The severely ill children were more likely than the non-severely ill children to have dehydration (45% vs. 11%; p 0.01), severe wasting (22% vs. 7%; p 0.01), anemia (29% vs. 13%; p = 0.01), bacteremia (26% vs. 9%; p 0.01), and malarial parasitemia (27% vs. 14%; p = 0.02). 68% of the blood isolates had nontyphoidal Salmonella spp. 6% of children had HIV-1 or HIV-2 infection. The most common pathogens in the stool specimens were rotavirus (41 cases), Campylobacter jejuni (22), Shigella spp. (21), and Salmonella spp (10). These findings indicate a need for a more comprehensive approach to assessment and management of children with diarrhea that secures immediate recognition of bacteremia, anemia, wasting, malaria, and dehydration.