Diagnosis and management of dysentery by community health workers.
To develop guidelines for community health workers in the treatment of patients with diarrhoea, diarrhoea prevalence was actively surveyed for a year in a remote rural community of 915,000 persons, and the enteric pathogens and clinical features associated with diarrhoeal illness were determined in a sample of 300 patients. Bloody diarrhoea accounted for 39% of all diarrhoea episodes and 62% of diarrhoea-associated deaths. 51 (50%) of 101 patients with a history of bloody diarrhoea had Shigella infection, compared with 31 (16%) of 199 patients with other types of diarrhoea. A history of bloody diarrhoea was as predictive of the presence of shigella infection (positive predictive value 50%, negative predictive value 86%) as more complex prediction schemes incorporating other clinical features or stool microscopic examination. In the area of Bangladesh where the study was done reduction of diarrhoea-related morbidity and mortality will depend on control and treatment of shigellosis, and community health workers have been instructed to provide antibiotics for patients with a history of bloody dysentery.
D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001459:Bangladesh; D002675:Child, Preschool; D003150:Community Health Workers; D004338:Drug Combinations / Q000627:therapeutic use; D004403:Dysentery / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D004405:Dysentery, Bacillary / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D009268:Nalidixic Acid / Q000627:therapeutic use; D012424:Rural Population; D013048:Specimen Handling; D013420:Sulfamethoxazole / Q000627:therapeutic use; D013997:Time Factors; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
D000892:Anti-Infective Agents, Urinary; D004338:Drug Combinations; D009268:Nalidixic Acid; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D013420:Sulfamethoxazole