title: The effective case management of childhood diarrhoea with oral rehydration therapy in the Kingdom of Lesotho.
abstract: In Lesotho prior to 1986, diarrhoea was the leading cause of hospital mortality in children less than 5 years of age. At the Queen Elizabeth II Hospital, diarrhoea-related admissions as a proportion of all admissions in children less than 5 years of age declined from 23% in the year prior to the opening of the Oral Rehydration Therapy Unit (ORTU) to 13% in the first nine months of 1987 (p less than 0.05). In addition, the case-fatality ratio of children treated in the ORTU declined from 1.4% in the first quarter of 1986 to zero in the second and third quarters of 1987 (p less than 0.05). In a case-control study conducted to identify reasons for children failing ORTU treatment, factors associated with an increased risk of hospitalization included male gender (odds ratio [OR] = 4.9; 95% confidence limits [CL] = 2.0, 11.9), fever greater than or equal to 38.5 degrees C (OR = 2.0; CL = 1.2, 3.3), undernutrition (OR = 3.2; CL = 1.1, 9.4), and moderate dehydration (OR = 2.3; CL = 1.2, 4.4) or severe dehydration. (OR = 12.1; CL = 3.8, 38.5). Breastfed children less than 2 years of age were at decreased risk of hospitalization (OR = 0.4; CL = 0.2, 0.7). At this major hospital in Lesotho, the standardization of outpatient treatment for diarrhoea with oral rehydration salts (ORS) in the context of an ORTU resulted in a marked decrease in diarrhoea-associated hospitalization and deaths in children less than 5 years of age.
authors.affiliation: Technical Support Division, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: D L
authors.initials: DL
authors.lastname: Hatch
authors.forename: R C
authors.initials: RC
authors.lastname: Vreuls
authors.forename: M J
authors.initials: MJ
authors.lastname: Toole
authors.forename: M M
authors.initials: MM
authors.lastname: Moteetee
authors.forename: I
authors.initials: I
authors.lastname: Monoang
authors.forename: C M
authors.initials: CM
authors.lastname: Ngatane
authors.forename: D M
authors.initials: DM
authors.lastname: Gittelman
authors.forename: R J
authors.initials: RJ
authors.lastname: Waldman
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D003681:Dehydration / Q000628:therapy; D003967:Diarrhea / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D007927:Lesotho / Q000453:epidemiology; D008297:Male; D009748:Nutrition Disorders; D010044:Outpatient Clinics, Hospital; D010343:Patient Admission / Q000706:statistics & numerical data; D012737:Sex Factors