Clinico-laboratory profile and treatment outcome of persistent diarrhea in under 5-year children of a tertiary care hospital in North India

Abstract

Persistent diarrhea (PD) accounts for a third of all deaths due to diar-rhea in under 5 children. Its etiology and treatment are poorly under-stood. So, we aimed to study various host and environmental risk fac-tors, clinical profile and treatment outcome of PD in children below 5 years of age. 60 children having PD who came to our institute were studied. History taking, clinical examination and investigations were done. Relevant data was collected in form of socio-demographic pro-file, infant and young child feeding (IYCF) indices, anthropometry, in-fections, micronutrient deficiency and secondary lactose intolerance (SLI). The treatment protocol consisted of stepwise diet plan along with supportive measures. All patients were started with diet plan A (low lactose diet), which was prepared by cheap and locally available items. Those who did not respond, were shifted to diet plan B (lactose free diet) and then to diet plan C (monosaccharide-based diet). Successful outcome was defined as decrease in stool frequency along with ade-quate food intake and weight gain. The risk factors associated with PD were found to be age < 2 years, malnutrition, SLI, micronutrient defi-ciency and previous history of infections. Out of total children (n=60), severe acute malnutrition, prior history of diarrhea/pneumonia in past 2 months and anemia were found in 58.3%, 60% and 52% of the PD children respectively. Concomitant enteric and systemic infections were found in 30% and 28.3% of PD children. SLI was observed in 61% of cases and most of the children (75%) improved on diet A only. Proper rehydration, screening and treatment of infections and enteral nutrition-al rehabilitation (both macro and micronutrient) are critical in manage-ment of children with PD.