Pediatric Nutrition in Practice

170 Das  Bhutta

Goal 4 by impacting diarrhea-related mortality;
these, according to the priority ratings, included
rotavirus immunization, the promotion of ORS
and a reduction in inappropriate medical inter-
ventions (hospitalizations, microbiological in-
vestigations, dietary modifications, and unnec-
essary drug administration).

Nutrition in Acute and Persistent Diarrhea

There is some debate about the optimum diet or

dietary components for quick recovery in chil-

dren with diarrhea; however, the current WHO

guidelines strongly recommend continued feed-

ing alongside the administration of ORS and zinc

therapy. Recent evidence suggests that among

Ta b l e 1. Key interventions for diarrhea and potential effects

Intervention Effect estimate

WASH 48, 17, and 36% risk reductions for diarrhea with hand washing with soap,
improved water quality, and excreta disposal, respectively
Breastfeeding education and
effects on breastfeeding rates

EBF rates increase by 43% at 1 day, 30% till 1 month, and 90% from
1 – 6 months; rates of no breastfeeding decrease by 32% at 1 day, 30% till
1 month, and 18% from 1 – 6 months
Preventive zinc supplementation 18% reduction in diarrhea-related mortality
Vaccines for rotavirus 74% reduction in very severe rotavirus infections and 47% reduction in
rotavirus hospitalizations
Vaccines for cholera 52% effective against cholera infection; vibriocidal antibodies
increase by 124%
Vaccines for Shigella 28% effective against S. flexneri infection and 53% against S. sonnei
Vaccines for enterotoxigenic
Escherichia coli

Increase in serum IgA and IgG seroconversion rates by 170 and 500%,
respectively
ORS and recommended home fluids 69% reduction in diarrhea-specific mortality
Dietary management
of diarrhea

Lactose-free diets reduce the duration of diarrhea treatment failure
significantly by 47%
Probiotics 14% reduction in diarrhea duration, 11% reduction in stool frequency on day
2, and 19% reduction in hospitalizations, although statistically nonsignificant
Therapeutic zinc
supplementation

66% reduction in diarrhea-specific mortality, 23% reduction in
diarrhea hospitalizations, and 19% reduction in diarrhea prevalence
Antiemetics for gastroenteritis 54% reduction in the incidence of vomiting and hospitalizations and 60%
reduction in intravenous fluid requirement rates
Antibiotics for cholera 63% reduction in clinical failure rates and 75% reduction in
bacteriological failure rates
Antibiotics for Shigella 82% reduction in clinical failure rates and 96% reduction in
bacteriological failure rates
Antibiotics for cryptosporidiosis 52% reduction in clinical failure rates and 38% reduction in
parasitological failure rates
Community-based interventions 153% increase in the use of ORS and manifold rise in the use of zinc in
diarrhea; 76% decline in the use of antibiotics for diarrhea
Community case management 63% reduction in diarrhea-related mortality
Financial schemes Conditional transfer programs: 14% increase in preventive health care use,
22% increase in the percentage of newborns receiving colostrum, and 16%
increase in the coverage of vitamin A supplementation

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 168–172

DOI: 10.1159/000367878