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Dietary Management of Young Children with Acute Diarrhoea
A Practical Manual for District Programme Managers
D.B. Jelliffe and E.F.P. Jelliffe
1991, 29 pages [E, F, R; S from PAHO]
ISBN 92 4 154428 7
Sw.fr. 8.-/US $7.20; in developing countries: Sw.fr. 5.60
Order no. 1152316
Sets out principles and practices designed to guide the correct early feeding of young children suffering from acute diarrhoea. Addressed to district programme managers, the book advocates an approach to management that combines feeding practices, backed by the latest scientific knowledge, with efforts to uncover cultural beliefs that may either support or impede successful management.
The book opens with a brief review of findings relevant to the dietary management of acute diarrhoea as a means of preventing malnutrition. The second chapter offers a guide to the selection of foods during and after diarrhoea, emphasizing the importance of issuing medical advice in keeping with an awareness of traditional beliefs and practices that may influence acceptance. A chapter on prevention concentrates on dietary measures, for infants and during weaning, that can decrease the likelihood of swallowing harmful bacteria or viruses and increase resistance to infection. The book concludes with a tabular guide to the dietary management of diarrhoea according to four stages, moving from diarrhoea without obvious dehydration to convalescence.
"... an eminently sensible and easily understood
Catering and Health
"... the essence of nutrition and health ... a
strictly practical, valuable manual of instruction..."
Nutrition and Health
Guidelines for Cholera Control
1993, vi + 61 pages [C, E, F, S*]
ISBN 92 4 154449 X
Sw.fr. 15.-/US $13.50; in developing countries: Sw.fr. 10.50
Order no. 1150398
Sets out the facts and advice needed to guide public health actions in response to an outbreak of cholera. Noting that the introduction of cholera into a country cannot be prevented, the book stresses the many things that can be done to prepare the health services, educate the general public, save the lives of patients, and prevent the further spread of an outbreak. The objective is to help managers of national diarrhoeal disease control programmes and non-governmental agencies to make the most effective decisions, whether concerning the selection of medical supplies or the emergency response to an epidemic. Throughout, emphasis is placed on the importance of safe water, scrupulous personal hygiene, and careful food preparation as the most effective preventive measures. Readers are also alerted to public health interventions, such as vaccination, mass chemoprophylaxis, and cordon sanitaire, which are ineffective, wasteful, and therefore to be discouraged.
The opening chapters describe what national programmes should do to be prepared for an outbreak of cholera, outline the actions to take at the earliest stage of an outbreak, and provide guidelines for the management of patients, including advice on the use of oral rehydration therapy and antibiotics. The remaining chapters cover measures for preventing the spread of an outbreak, the epidemiological investigation of an outbreak, the role of the laboratory, and long-term preventive activities.
The second part, which consists of five annexes, provides brief advice on the construction of a ventilated improved pit latrine, followed by a detailed step-by-step guide to the management of cholera patients, a selection of sample health education messages, and nine rules for safe food preparation to prevent cholera. The book concludes with guidelines describing a simple and rapid method for the isolation and identification of Vibrio cholerae O1 in diarrhoeal stools.
Integrated Management of Childhood Illness: A WHO/UNICEF Initiative
Bulletin of the World Health Organization, Vol. 75,
1997, Supplement 1
1997, 128 pages [E, with summaries in F]
ISBN 92 4 068750 5
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 0037501
Reports the design and findings of field studies conducted during the development of the new WHO/UNICEF strategy for the integrated management of childhood illness (IMCI). The strategy responds to the fact that 70% of the 11 million childhood deaths that occur each year in the developing world are due to five conditions: pneumonia, diarrhoea, measles, malaria and malnutrition. Central to the strategy's implementation are a set of clinical guidelines for integrated case management at first-level health facilities and an 11-day course for training health workers to use the guidelines correctly.
The research reported in this volume is part of an ongoing effort to ensure that the IMCI clinical guidelines and training course evolve in line with solid scientific evidence concerning their effectiveness. The volume opens with an overview of the technical basis for the guidelines, which aim to help health workers reach quick and accurate decisions based on clinical signs and symptoms. Two subsequent papers report on field evaluations of the guidelines in Africa, one in an area with seasonal malaria and the second in an area with high malaria transmission. In both studies, health workers using the guidelines as the basis for case management performed well when compared with paediatricians, whose clinical diagnosis was supported by laboratory investigations and radiology.
The training course was evaluated in two studies, which were designed to determine how well the course trained workers to assess, classify, and treat ill children, and to suggest improvements in the course material and teaching procedures. Other studies investigated the extent to which use of the guidelines resulted in the accurate assessment and classification of cases, and correct referral to hospital. The remaining studies considered whether specific clinical signs used in the guidelines were adequate for reaching a correct diagnosis of protein-energy malnutrition and moderate or severe anaemia. The final paper summarizes lessons from these studies, which confirm that use of the guidelines enables health workers in first-level facilities to manage a very high proportion of clinical problems quickly and correctly. Use of the guidelines and the training course in individual countries requires adaptation to specific epidemiological situations and health system environments. WHO has developed a detailed guide to facilitate this process.
The Management and Prevention of Diarrhoea
1993, v + 50 pages [C, E, F, R, S]
ISBN 92 4 154454 6
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1153230
The third edition of a practical guide for teaching health workers how to assess diarrhoea and dehydration, treat cases effectively, and convince community members to adopt preventive practices. Didactic in its approach, the manual uses simple language supported by abundant charts, tables, checklists, and illustrations to help readers absorb information and acquire the full range of essential skills.
The book opens with a clear explanation of what diarrhoea is, why dehydration is so dangerous, and how a child with diarrhoea should and should not be treated. The second section, devoted to home treatment, elaborates three basic rules for helping mothers and other family members treat diarrhoea in the home. Of particular practical value are sections designed to teach health workers how to assess and treat patients. Instructions for assessment are presented through a list of questions to ask, conditions to investigate, and signs to observe, followed by a detailed assessment chart and illustrative examples of how the chart works in practice. The section on treatment provides step-by-step instructions for the preparation of a solution from oral rehydration salts, and sets out three detailed plans, correlated with columns in the assessment chart, for the treatment of diarrhoea, dehydration, and severe dehydration. The guide also outlines the treatment of dysentery and cholera, and discusses what health workers can do to help prevent diarrhoea by making community members aware of preventive practices and encouraging their adoption. A checklist of essential points to remember concludes the book.
"... clear and simple ... a very useful book for
family practice in developing countries..."
The Rational Use of Drugs in the Management of Acute Diarrhoea in Children
1990, iv + 71 pages [C, E, F, S from PAHO]
ISBN 92 4 156142 4
Sw.fr. 14.-/US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1150355
Provides authoritative information essential to those concerned with improving the rational use of drugs in the management of acute diarrhoea in infants and young children and with tackling the immense problems posed by the prescribing of clinically useless and potentially dangerous drugs. The book gathers the information needed to argue against the widespread use of medicines that have no established clinical benefits, are frequently harmful, and may delay or replace effective treatment measures.
Drugs judged effective are dealt with concisely in a table listing four first-choice antimicrobials, and six alternatives, useful in the management of cholera, shigella dysentery, amoebiasis, and giardiasis. Apart from these cases of specific etiology, readers are informed that antidiarrhoeal drugs and antiemetics should never be used for children, as none has any proven practical value and some are frankly dangerous. This statement is substantiated through a review of data on eleven antidiarrhoeal drugs widely used in paediatric practice. The book concludes that none of these preparations has any documented benefits, some actually prolong diarrhoea, and others have been shown to produce severe and sometimes fatal side-effects. The book further concludes that the continued production, promotion, and sale of these preparations for paediatric practice cannot be justified.
"...offers objective assessments of drugs that
are widely misused ... will be important everywhere, but vitally so in developing
Readings on Diarrhoea
1992, vii + 147 pages [C, E, F; S from PAHO]
ISBN 92 4 154444 9
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 1150386
A collection of eight teaching units conveying essential information about the pathophysiology, clinical features, diagnosis, epidemiology, treatment and prevention of diarrhoea in children. Addressed to medical students undergoing clinical training in paediatrics, the manual aims to equip students with all the knowledge needed to assess patients, plan treatment, and prevent deaths through proper case management. Information, which is specific to conditions in developing countries, ranges from an explanation of the clinical features seen in different forms of dehydration, through advice on how to communicate with mothers, to a discussion of the role of feeding in the management of diarrhoea. Recommended lines of action draw their authority from published research and extensive WHO experience in programmes for the treatment and prevention of diarrhoea.
The first two teaching units provide fundamental information about the epidemiology, clinical types of diarrhoea, causative agents, modes of transmission, pathophysiology, and implications for treatment. Subsequent units explain how the clinical assessment of patients should be performed and interpreted, discuss ways of teaching mothers to treat diarrhoea at home, describe clinical measures for the treatment of dehydrated patients, and discuss the special procedures to be followed during the treatment of dysentery, persistent diarrhoea, and diarrhoea associated with other illnesses. The remaining units cover the nutritional management of diarrhoea in children, including those suffering from severe malnutrition, and explain how physicians can promote prevention, particularly through the education of mothers and other family members. Each unit concludes with a list of exercises. Further practical information is presented in a series of annexes, which include illustrated, step-by-step instructions for intravenous rehydration and nasogastric rehydration.