National data for diarrhoeal disease in children can only be used as a very rough guide to morbidity and mortality, since they are based on incomplete reporting. Furthermore, when only one diagnosis per attendance, admission or cause of death is recorded, the true importance of diarrhoea as a cause of morbidity and mortality may be obscured. This may in part explain discrepancies between figures recorded in national and hospital statistics and those recorded in detailed studies of diarrhoeal admissions. While there appear to be quite marked differences in the relative importance of diarrhoea in different parts of the country, and while diarrhoeal disease is less of a scourge than in some other parts of the world, it is nevertheless a major cause of attendance at health facilities, the second or third most common cause of admission to many of the hospitals in the country, and a significant and often preventable cause of death. Limited studies of diarrhoeal aetiology indicate the major importance of rotavirus, Shigella and enteropathogenic and enterotoxigenic Escherichia coli. The control of diarrhoeal diseases in children is based not only on early and appropriate treatment, but also on preventive strategies. These include breastfeeding (which has saved the lives of many thousands of Papua New Guinean children and which is once again under threat), ensuring good host defence by good nutrition, immunization and early treatment of childhood illness, and ensuring satisfactory sanitation and hygiene. Increasing fluid intake to prevent dehydration remains the most important part of the early management of acute diarrhoeal disease. In the management of children with dehydration, UNICEF glucose-based oral rehydration therapy is widely available but not used as well as it should be. There are significant advantages in cereal-based oral rehydration solutions, and the use of such solutions, locally prepared, should be encouraged. Breastfeeding should be continued during episodes of diarrhoea, unless there is the specific contraindication of lactose intolerance. In all events the child's nutritional intake should be maintained and if possible increased during episodes of diarrhoea. There are specific indications for the use of antibiotics in the management of children with diarrhoea. They should not be used, and may be harmful, in the absence of these indications. Persistent diarrhoea--lasting more than 14 days--is associated with a high mortality and severe malnutrition. It is therefore important that children whose diarrhoea is prolonged for more than 7 days are managed appropriately, using the standard guidelines.
PIP: The incidence of diarrhea tends to vary among Papua New Guinea's various populations and it remains unclear to what extent the country's children are plagued by such diseases. Controlling diarrheal diseases in children involves early and appropriate treatment, as well as prevention. Breast feeding, good nutrition, immunization, the early treatment of childhood illness, and maintaining proper sanitation and hygiene all help prevent the development of diarrheal disease. Fluid intake must be increased in children with diarrhea in order to prevent dehydration. This increase in fluid consumption is the most important part of the early management of acute diarrheal disease. While UNICEF's glucose-based oral rehydration therapy is widely available to manage dehydrated children, it is inadequately used. The use of locally prepared, cereal-based oral rehydration solutions should be encouraged. Furthermore, breast feeding should be continued during episodes of diarrhea unless there is a specific contraindication of lactose intolerance. The child's nutritional intake should nonetheless be maintained and, if possible, increased during episodes of diarrhea. Antibiotics should not be used to treat diarrhea in children unless there are specific indications for such use. Diarrheal episodes which last more than 14 days are associated with high mortality and severe malnutrition. It is therefore important for children with diarrhea of longer than 7 days to be managed appropriately according to standard guidelines.