Anthropometric Measurements as Predictors of Low Birth Weight Among Tanzanian Neonates: A Hospital-Based Study
November 7, 2025
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Background
Diarrhea is a condition characterized by an increase in water content in stool due to loss of ions and other substrates and water imbalance in the small and large intestine. Acute diarrhea is the condition of having 3 or more loose stools in a day within 14 days and usually associated with infection. Chronic diarrhea is more likely to be non-infectious in origin. Different forms of treatment and management depend on the duration and the cause of the diarrhea. Oral rehydration therapy is important for any patient with diarrhea and hand washing is critical to prevent transmission of infection. Infectious diarrhea that is due to such diseases as cholera and shigellosis does not necessarily always involve enteritis.
Epidemiology
Norovirus accounts for about 20% of all cases of infectious diarrhea and is regarded as an equal opportunity pathogen. It is estimated for it accounts for over 200,000 deaths per year in developing countries. Rotavirus was the leading cause of severe diarrhea in young children in developing countries in the past. The production of attenuated vaccines for these viruses has led to a considerable decline in the incidence of rotavirus-prompted diarrhea.
Under-five children are known to have three instances of diarrhea attacks per year in developing countries. The prevalence increases to six to eight episodes per child per year in some parts of the country. In these cases malnutrition acts as an additional risk factor for the development of diarrhea. Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease are the main causes of chronic diarrhea. The occurrence of ulcerative colitis in Europe also rose from 6 to 35 cases per year for every 100000 people.
One hospitalization for diarrhea for every 23 to 27 children in the US before the introduction of rotavirus vaccination in 2006 and one hospitalization for every 18 to 20 children in Finland in 2008. This led to more than 50,000 hospital admissions each year as rotavirus accounted for about 4 to 5% of all childhood hospitalizations and billed the health care industry approximately up to $1 billion.
Anatomy
Pathophysiology
Diarrhea is a condition whereby there is a decrease in the amount of water that is reabsorbed by the bowel or an increase in the amount of water that is secreted into the bowel. Infection is the most common cause of acute diarrhea. Chronic diarrhea is categorized into three groups: watery, fatty (obstructive) or infection. Diarrhea may be categorized into secretory and osmotic diarrhea depending on the pathology.
Lactase deficiency is a type of watery diarrhea resulting from the increased flow of water from the intestinal lumen to increase bloating and flatulence. This is because lactase breaks down the lactose in the intestine which is osmotically active and retains water. Other common causes of fatty diarrhea include celiac disease and chronic pancreatitis which lead to excess fat excretion due to loss of enzyme production. Symptoms include pain in the upper part of the abdomen, flatulence, and loose and foul-smelling stools that are pale and bulky. Secretory diarrhea is caused by bacterial and viral infections that lead to loss of water stools due to injury of the intestinal epithelium.
Etiology
Diarrhea can be acute, chronic, infectious diarrhea, or non-infectious diarrhea depending on the nature of the condition. Viral infection is usually the cause of acute diarrhea and is not usually treated. Chronic diarrhea refers to an extended diarrhea which is greater than 2 weeks and not caused by an infection. Malnutrition may be caused by malabsorption, inflammatory bowel illness, and potential drug reactions. Diagnosis and management of diarrhea in a child could be crucial and this could be established by considering feature of the stool, the presence or absence of associated symptoms, history of the child attending child daycare centres, history of ingestion of infected food or water. Travel history is also important since common pathogens affect certain areas as well and enterotoxigenic Escherichia coli has been found to be the main pathogen. It is important to understand these factors to be able to diagnose and manage diarrhea.
Genetics
Prognostic Factors
The evidence shows a trend of elevated diarrhea-related mortality among US children from the mid-1980s and 2006. Among the 1,087 cases of diarrhea deaths seen within the period of 2005 to 2007, 86% were Low birth weight babies – infants that weigh less than 2500 grams. Other factors associated with these deaths included male sex, black ethnicity, and low Apgar score (less than 7).
Dehydration and secondary malnutrition are the primary and secondary diseases associated with diarrhea deaths. In case of severe dehydration, the patient should be rehydrated via intravenous fluids. Malnutrition leads to severe fatality if the individual is not administered with nutrient IV as an outpatient within a hospital or clinic.
Clinical History
Infants and young children can also develop diarrhea characterized by frequent bowel movements, loose or watery stools or stools with mucus or blood. Examples are rotavirus, norovirus, bacterial infections, and parasites. These factors include hygiene, breastfeeding, malnutrition, teething, food hypersensitivity reactions, and antibiotics. The onset is acute and may be associated with dehydration and may be related to malabsorption syndromes or chronic infections, or other gastrointestinal diseases.
Teenagers may develop loose or watery stools with or without abdominal cramps or pain in the stomach and diarrhea may also be accompanied by nausea or vomiting. Common causes include the following: viral illnesses; bacterial infections; inflammatory bowel disease (IBD); and irritable bowel syndrome (IBS). Risk factors are travel, contaminated food or water, stress, food poisoning, lactose intolerance, and celiac disease.
Physical Examination
The general assessment involves checking the patient’s vital signs, overall appearance, hydration, facial and mucous membrane color, urine output and sunken eyes. Vital signs monitoring includes temperature, heart rate, blood pressure, or respiratory rate to observe the level of dehydration, fever or hemodynamic status. The appearance of the patient such as the level of alertness, level of distress, and hydration should also be assessed.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Fluid and Electrolyte Management: Educate the patients to consume diluted fruit juice, Pedialyte, or Gatorade to replace the minerals and fluids that are lost due to diarrhea. In cases of severe dehydration solutions of salt and potassium may be administered intravenously.
Dietary Recommendations: It is advisable to recommend the bland ‘BRAT’ diet- ‘bananas, rice, applesauce, and toast’ with low fiber content as they are easily digestible. This can make the stools firmer and get rid of the symptoms. Some alternative options for solid food include oatmeal, white rice, and soup/broth.
Medications:
Anti-diarrheal Agents: It has been suggested that the use of medications to inhibit the production or movement of stools may be helpful in controlling the frequency of stools. They should not be used in case of adults having bloody diarrhea or high fever because these may increase intestinal infection.
Antibiotics: Oral fluoroquinolone may be prescribed as empiric antibiotic therapy in cases where there is high suspicion of having significant symptoms from diarrhea.
Probiotic Supplementation: Probiotics have been proven to be effective in preventing the development of diarrhea and its symptoms and their severity and duration. Advise patients who have acute diarrhea to consider using probiotics to increase their rate of recovery.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-a-non-pharmacological-approach-for-treating-diarrhea
Fluid Replacement: The treatment of diarrhea is therefore focused on preventing dehydration. ORS which are used as an oral liquid and contains compounds like glucose and electrolytes are very important for preventing further fluid loss and maintaining electrolyte balance.
Dietary Modifications:
BRAT Diet: It is a nutrition plan that means bananas, rice, applesauce, and toast. It may be concluded that these foods are low in fiber and can contribute to making firm stools.
Avoid Certain Foods: Fatty, oily and spicy foods or alcohol and caffeine containing products and dairy products are better refused during the time of diarrhea.
Increase Fluid Intake: In addition to ORS, it is also recommended to consume clear fluids such as water, different types of herbal teas and glucose-rich drinks such as coconut water.
Probiotics: Lactobacillus and Saccharomyces boulardii are probiotic strains that have demonstrated efficacy in shortening and mitigating the symptoms of infectious diarrhea by promoting colonic microflora homeostasis.
Rest and Hygiene: Rest is important in a sense that it allows the human body to heal faster. Infectious diarrhea can be prevented by following hygiene practices like; washing of hands before eating and after visiting the toilet.
Heat and Stomach Compresses: The use of a stove adequate heat or a heating pad on the stomach can help alleviate the cramps related to diarrhea.
Role of Antibiotics and antiparasitic agents
Antibiotics and antiparasitic are used for diarrhea resulting from bacterial or parasitic infections respectively. But it is important to be cautious in the use of such drugs to avoid the overuse of such drugs that may reach a level where the replicating bodies of the bacteria can develop resistances to the drugs. Here’s a breakdown of their roles along with examples:
Antibiotics: Antibiotics are given to a patient that is affected by diarrhea due to bacterial pathogens. They achieve this by killing offending bacterial organisms or by preventing them from multiplying so that the body’s natural defence can destroy the infection.
Fluoroquinolones: Ciprofloxacin and levofloxacin are commonly used for bacterial diarrhea but are particularly indicated in the cases of travelers’ diarrhea due to selected types of Escherichia coli.
Macrolides: Azithromycin can be used in the treatment of Campylobacter and some of the types of Salmonella.
Tetracyclines: Doxycycline can be used for physical dysentery, for example, Shigella, Campylobacter, and Salmonella infections.
Rifaximin: It is especially suitable for treating traveler’s diarrhea and is also used for the treatment of hepatic encephalopathy and irritable bowel syndrome with diarrhea (IBS-D).
Antiparasitic Agents: Drugs for antiparasitic conditions are employed in the treatment of diarrheal diseases brought about by pathogens including Giardia lamblia, Cryptosporidium, Entamoeba histolytica among others.
Metronidazole: Active against mild Giardia lamblia, Entamoeba histolytica, and some anaerobic bacteria.
Nitazoxanide: Antiparasitic agent that is used for treatment of Cryptosporidium parvum and Giardia lamblia.
Paromomycin: It is used for the treatment of amoebiasis due to E. histolytica.
Iodoquinol: Active against amoebiasis and against some parasites but not invasive amoebiasis.
Role of Rotavirus Vaccine in the treatment of Diarrhea
At present, there are two available oral live-virus vaccine for rotavirus gastroenteritis that is considered as the leading cause of severe diarrhea in infants in the United States. RotaTeq is a combination of 5 live reassortant rotaviruses which contains pentavalent vaccine. It is administered in 3 doses and targets G1, G2, G3, G4 serotypes – for the most common group A rotaviruses strains as well as P1A of the rotavirus attachment protein.
The main difference between the two is that the Rotarix provides immunity against the rotavirus gastroenteritis disease with G1, G3, G4, and G9 predominant viral strains. It is given as a 2-dose series for infants between 6 to 24 weeks old. These vaccines have been found to reduce 74-78% of all cases of rotavirus gastroenteritis; 95% of the severe cases due to the disease; and 86% of all rotavirus hospitalizations due to the disease.
use-of-intervention-with-a-procedure-in-treating-diarrhea
Endoscopy: This procedure involves a flexible tube with a camera at the end that is inserted into the digestive tract to make visual observation of abnormalities, tumors or polyps or remove them. It can be used to diagnose either IBD or the infectious group that is responsible for diarrhea.
Colonoscopy: This procedure is like endoscopy but is particularly concerned with the colon and can help diagnose conditions such as ulcerative colitis, Crohn’s disease, or colorectal cancer, which may lead to chronic diarrhea.
Stool Studies: Bacterial or parasitic infections are also diagnosed through stool examination. This helps in appropriate prescription of either antibiotics or antiparasitic drugs as can be the case.
Sigmoidoscopy: This procedure passes a shorter flexible scope through the anus to view the sigmoid colon which is the lower part of the large intestine. It can be useful in determining the presence of ulcers in the colon like ulcerative colitis or diverticulitis.
Fluid Replacement via IV: For more serious cases of dehydration due to prolonged diarrhea, IV fluids may be needed to correct electrolyte imbalances and avoid worsening the condition.
Surgical Interventions: Diarrhea may develop due to structural changes in the digestive system in extremely rare instances.
use-of-phases-in-managing-diarrhea
The identification phase involves the collection of information about the nature of the condition and the duration and type of symptoms experienced. To identify the causes of the disorder, diagnostic tests are performed, which point to underlying causes such as bacterial or viral infections, parasites, drugs, or medical conditions. The acute management phase encompasses rehydration and correction of fluid and electrolyte imbalance, control of symptoms, and antibiotic or antiparasitic drugs. Dietary restrictions are recommended to control the condition. The recovery and maintenance phase includes the measurement of hydration level and the consumption of normal food that has adequate nutrition.
Medication
6
mg
Solution
Orally
every 6 hours
Do not exceed 6ml/day
5 - 10
ml
Solution
orally
every 6 hours
500
mg
Tablet
Orally
every 12 hrs
3
days
Indicated for diarrhea,HIV/AIDS :
125
mg
Tablets
Orally
twice a day
2 Tablets
Orally
then 1 mg tablet every 3-4 hours as needed
Do not exceed > 8 mg a day
diphenoxylate is used in combination with atropine to treat diarrhea
5 mg of diphenoxylate with 0.05 mg of atropine is prescribed every 6 hours as 2 tablets orally
The drug should not be administered more than 20 mg per day
Discontinue the treatment if clinical improvement is not seen within 10 days
For infectious diarrhea, 500 mg of ciprofloxacin should be administered orally every 12 hours for 5-7 days
3 g/day orally divided for each 6 hour
Diarrhea
1.2-1.5 gm orally after the loose bowel movement.
Should not exceed 8.4 gm in a day
Suggested Dosing
Seed Extract
Take 250 to 750 mg orally daily in divided doses
Tincture
Take 1 to 4 ml orally three times daily
Take 2 to 4g/day orally
Indicated for Acute diarrhea
500 mg every day is suggested
URT infections
500 mg of S. cerevisiae every day has been used in the clinical trials for nearly 12 weeks for treating respiratory infections
Hyperglycemia
68 mcg to 500 mcg every day for nearly 2 to 8 months decreased fasting plasma glucose levels in individuals with diabetes type II
Body Weight management
3 gm of S. cerevisiae extract every day as suspension for nearly 12 weeks decreased the incidence of body weight gain, BMI, and also waist circumference
Indicated to treat enteritis and protozoal diarrhea caused by Vibrio cholerae and Giardia lambia
100 mg orally every 6 hours each day
Tablet
Orally
once a day
Administer a single dose of loperamide/ simethicone 4 mg/250 mg by oral route after the initial occurrence of loose stool
Subsequently, provide a single dose of loperamide/ simethicone 2 mg/125 mg by oral route after every further episode of loose stool
The recommended maximum dose is loperamide/ simethicone 8 mg/500 mg within 24 hours
Therapy should not exceed two days
Take as per physician advised
100mg capsule, orally once daily as an initial dose, followed by 100mg orally thrice daily for a maximum of one week. Treatment needs to be continued until two normal stools are observed Indications:it is indicated in the treatment of acute diarrhea
100mg capsule, orally once daily as an initial dose, followed by 100mg orally thrice daily for a maximum of one week. Treatment needs to be continued until two normal stools are observed Indications: it is indicated in the treatment of acute diarrhea
The isolated ileum experiments used 10 mg/ml of the extract to inactivate acetylcholine-induced contraction
The administration of isolated canna indica extract was shown to be statistically significant (p< .050) in terms of its ability to inhibit both castor oil-induced diarrhea and charcoal plug in a dose-dependent manner
The suggested dose is consumption of arrowroot powder 10 to 30 grams a day
furazolidone/metronidazole/dicyclomine
50 mg/200 mg/10 mg orally with or without food as directed by the physician
0.25 - 0.5
ml/kg
liquid
Orally
every 6 hrs
<1 year: Safety and efficacy not established
1-3 years:5 ml orally every 12 hours for three days
4-11 years: 10 ml orally every 12 hours for three days
>12 years: 500mg orally every 12 hours for three days
Children of 2 to 13 years of age are only administered with a liquid formulation
<2 years- safety and efficacy are not seen for children under two
2 years- 1.5 to 3 ml orally every 6 hours
3 years- 2 to 3 ml orally every 6 hours
4 years- 2 to 4 ml orally every 6 hours
5 years- 2.5 to 4.5 ml orally every 6 hours
6 to 8 years- 2.5 to 5 ml orally every 6 hours
9 to 12 years- 3.5 to 5 ml every orally every 6 hours
<3 years- Safety & efficacy not seen
3-6 years- 1/3 tablet orally every hour as needed
6-9 years- 2/3 tablet orally every hour as needed
9-12 years- 1 tablet orally every hour as needed
>12 years- 2 tablets orally every hour as needed
50mg/kg/day orally divided for each 6 hour up to 2 to 3 days
Diarrhea
Age 6-12 years
600-750 mg orally after the loose bowel movement.
Should not exceed 4.5 gm in a day
Age 3-6 years
300 mg orally after the loose bowel movement.
Should not exceed 2.1 gm in a day
Indicated to treat enteritis and protozoal diarrhea caused by Vibrio cholerae and Giardia lambia
1.25 mg/kg every 6 hours administered for 2-5 days
In the case of giardiasis, extend the regimen to 10 days
Dosing based on Age-
Age six-eight: Administer loperamide/ simethicone 2 mg/125 mg by oral route as an initial dose following the initial episode of loose stool, and subsequently administer loperamide/simethicone 1mg/62.5 mg by oral route following every further episode of loose stool
The recommended maximum dose is loperamide/ simethicone is 4 mg/250 mg within a 24 hours
Therapy should not exceed two days
Age nine-eleven: Administer loperamide/ simethicone 2 mg/125 mg by oral route as an initial dose following the initial episode of loose stool, and subsequently administer loperamide/simethicone 1 mg/62.5 mg by oral route following every further episode of loose stool
The recommended maximum dose is loperamide/ simethicone is 6 mg/375 mg within a 24 hours
Therapy should not exceed two days
Age12 years and older-
Administer loperamide/ simethicone 4 mg/250 mg by oral route as an initial dose following the initial episode of loose stool, and subsequently administer loperamide/ simethicone 2 mg/125 mg by oral route following every further episode of loose stool
The recommended maximum dose is loperamide/ simethicone 8 mg/500 mg within a 24 hours
Therapy should not exceed two days
Dosing based on weight
Weight 21.8-26.8 kg-Administer loperamide/ simethicone 2 mg/125 mg by oral route as an initial dose following the initial episode of loose stool, and subsequently administer loperamide/ simethicone 1 mg/ 62.5 mg by oral route following every further episode of loose stool
The recommended maximum dose is loperamide/ simethicone 4 mg/250 mg within a 24 hours
Therapy should not exceed two days
Weight-27.3 -43.2 kg-Administer loperamide/ simethicone 2 mg/125 mg by oral route as an initial dose following the initial episode of loose stool, and subsequently administer loperamide/ simethicone 1 mg/62.5 mg by oral route following every further episode of loose stool
The recommended maximum dose is loperamide/ simethicone 6 mg/375 mg within a 24 hours
Therapy should not exceed two days
Combination with oral rehydration
Recommended dose: 1.5mg/kg powder or granules thrice daily
Maximum dose: 6mg/kg orally in a day
Usual doses:
For infants of three months and weight less than 9 kg-10 mg, orally, three times daily
For children of weight 9–13 20mg, orally, three times daily
For children of weight 13–27 30mg, orally, three times daily
For children of weight more than 27 kg, 60mg, orally, three times daily
Maximum duration: 1 week
Treatment needs to be continued until two normal stools are observed
Future Trends
References
Diarrhea is a condition characterized by an increase in water content in stool due to loss of ions and other substrates and water imbalance in the small and large intestine. Acute diarrhea is the condition of having 3 or more loose stools in a day within 14 days and usually associated with infection. Chronic diarrhea is more likely to be non-infectious in origin. Different forms of treatment and management depend on the duration and the cause of the diarrhea. Oral rehydration therapy is important for any patient with diarrhea and hand washing is critical to prevent transmission of infection. Infectious diarrhea that is due to such diseases as cholera and shigellosis does not necessarily always involve enteritis.
Norovirus accounts for about 20% of all cases of infectious diarrhea and is regarded as an equal opportunity pathogen. It is estimated for it accounts for over 200,000 deaths per year in developing countries. Rotavirus was the leading cause of severe diarrhea in young children in developing countries in the past. The production of attenuated vaccines for these viruses has led to a considerable decline in the incidence of rotavirus-prompted diarrhea.
Under-five children are known to have three instances of diarrhea attacks per year in developing countries. The prevalence increases to six to eight episodes per child per year in some parts of the country. In these cases malnutrition acts as an additional risk factor for the development of diarrhea. Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease are the main causes of chronic diarrhea. The occurrence of ulcerative colitis in Europe also rose from 6 to 35 cases per year for every 100000 people.
One hospitalization for diarrhea for every 23 to 27 children in the US before the introduction of rotavirus vaccination in 2006 and one hospitalization for every 18 to 20 children in Finland in 2008. This led to more than 50,000 hospital admissions each year as rotavirus accounted for about 4 to 5% of all childhood hospitalizations and billed the health care industry approximately up to $1 billion.
Diarrhea is a condition whereby there is a decrease in the amount of water that is reabsorbed by the bowel or an increase in the amount of water that is secreted into the bowel. Infection is the most common cause of acute diarrhea. Chronic diarrhea is categorized into three groups: watery, fatty (obstructive) or infection. Diarrhea may be categorized into secretory and osmotic diarrhea depending on the pathology.
Lactase deficiency is a type of watery diarrhea resulting from the increased flow of water from the intestinal lumen to increase bloating and flatulence. This is because lactase breaks down the lactose in the intestine which is osmotically active and retains water. Other common causes of fatty diarrhea include celiac disease and chronic pancreatitis which lead to excess fat excretion due to loss of enzyme production. Symptoms include pain in the upper part of the abdomen, flatulence, and loose and foul-smelling stools that are pale and bulky. Secretory diarrhea is caused by bacterial and viral infections that lead to loss of water stools due to injury of the intestinal epithelium.
Diarrhea can be acute, chronic, infectious diarrhea, or non-infectious diarrhea depending on the nature of the condition. Viral infection is usually the cause of acute diarrhea and is not usually treated. Chronic diarrhea refers to an extended diarrhea which is greater than 2 weeks and not caused by an infection. Malnutrition may be caused by malabsorption, inflammatory bowel illness, and potential drug reactions. Diagnosis and management of diarrhea in a child could be crucial and this could be established by considering feature of the stool, the presence or absence of associated symptoms, history of the child attending child daycare centres, history of ingestion of infected food or water. Travel history is also important since common pathogens affect certain areas as well and enterotoxigenic Escherichia coli has been found to be the main pathogen. It is important to understand these factors to be able to diagnose and manage diarrhea.
The evidence shows a trend of elevated diarrhea-related mortality among US children from the mid-1980s and 2006. Among the 1,087 cases of diarrhea deaths seen within the period of 2005 to 2007, 86% were Low birth weight babies – infants that weigh less than 2500 grams. Other factors associated with these deaths included male sex, black ethnicity, and low Apgar score (less than 7).
Dehydration and secondary malnutrition are the primary and secondary diseases associated with diarrhea deaths. In case of severe dehydration, the patient should be rehydrated via intravenous fluids. Malnutrition leads to severe fatality if the individual is not administered with nutrient IV as an outpatient within a hospital or clinic.
Infants and young children can also develop diarrhea characterized by frequent bowel movements, loose or watery stools or stools with mucus or blood. Examples are rotavirus, norovirus, bacterial infections, and parasites. These factors include hygiene, breastfeeding, malnutrition, teething, food hypersensitivity reactions, and antibiotics. The onset is acute and may be associated with dehydration and may be related to malabsorption syndromes or chronic infections, or other gastrointestinal diseases.
Teenagers may develop loose or watery stools with or without abdominal cramps or pain in the stomach and diarrhea may also be accompanied by nausea or vomiting. Common causes include the following: viral illnesses; bacterial infections; inflammatory bowel disease (IBD); and irritable bowel syndrome (IBS). Risk factors are travel, contaminated food or water, stress, food poisoning, lactose intolerance, and celiac disease.
The general assessment involves checking the patient’s vital signs, overall appearance, hydration, facial and mucous membrane color, urine output and sunken eyes. Vital signs monitoring includes temperature, heart rate, blood pressure, or respiratory rate to observe the level of dehydration, fever or hemodynamic status. The appearance of the patient such as the level of alertness, level of distress, and hydration should also be assessed.
Fluid and Electrolyte Management: Educate the patients to consume diluted fruit juice, Pedialyte, or Gatorade to replace the minerals and fluids that are lost due to diarrhea. In cases of severe dehydration solutions of salt and potassium may be administered intravenously.
Dietary Recommendations: It is advisable to recommend the bland ‘BRAT’ diet- ‘bananas, rice, applesauce, and toast’ with low fiber content as they are easily digestible. This can make the stools firmer and get rid of the symptoms. Some alternative options for solid food include oatmeal, white rice, and soup/broth.
Medications:
Anti-diarrheal Agents: It has been suggested that the use of medications to inhibit the production or movement of stools may be helpful in controlling the frequency of stools. They should not be used in case of adults having bloody diarrhea or high fever because these may increase intestinal infection.
Antibiotics: Oral fluoroquinolone may be prescribed as empiric antibiotic therapy in cases where there is high suspicion of having significant symptoms from diarrhea.
Probiotic Supplementation: Probiotics have been proven to be effective in preventing the development of diarrhea and its symptoms and their severity and duration. Advise patients who have acute diarrhea to consider using probiotics to increase their rate of recovery.
General Practice
Fluid Replacement: The treatment of diarrhea is therefore focused on preventing dehydration. ORS which are used as an oral liquid and contains compounds like glucose and electrolytes are very important for preventing further fluid loss and maintaining electrolyte balance.
Dietary Modifications:
BRAT Diet: It is a nutrition plan that means bananas, rice, applesauce, and toast. It may be concluded that these foods are low in fiber and can contribute to making firm stools.
Avoid Certain Foods: Fatty, oily and spicy foods or alcohol and caffeine containing products and dairy products are better refused during the time of diarrhea.
Increase Fluid Intake: In addition to ORS, it is also recommended to consume clear fluids such as water, different types of herbal teas and glucose-rich drinks such as coconut water.
Probiotics: Lactobacillus and Saccharomyces boulardii are probiotic strains that have demonstrated efficacy in shortening and mitigating the symptoms of infectious diarrhea by promoting colonic microflora homeostasis.
Rest and Hygiene: Rest is important in a sense that it allows the human body to heal faster. Infectious diarrhea can be prevented by following hygiene practices like; washing of hands before eating and after visiting the toilet.
Heat and Stomach Compresses: The use of a stove adequate heat or a heating pad on the stomach can help alleviate the cramps related to diarrhea.
General Practice
Antibiotics and antiparasitic are used for diarrhea resulting from bacterial or parasitic infections respectively. But it is important to be cautious in the use of such drugs to avoid the overuse of such drugs that may reach a level where the replicating bodies of the bacteria can develop resistances to the drugs. Here’s a breakdown of their roles along with examples:
Antibiotics: Antibiotics are given to a patient that is affected by diarrhea due to bacterial pathogens. They achieve this by killing offending bacterial organisms or by preventing them from multiplying so that the body’s natural defence can destroy the infection.
Fluoroquinolones: Ciprofloxacin and levofloxacin are commonly used for bacterial diarrhea but are particularly indicated in the cases of travelers’ diarrhea due to selected types of Escherichia coli.
Macrolides: Azithromycin can be used in the treatment of Campylobacter and some of the types of Salmonella.
Tetracyclines: Doxycycline can be used for physical dysentery, for example, Shigella, Campylobacter, and Salmonella infections.
Rifaximin: It is especially suitable for treating traveler’s diarrhea and is also used for the treatment of hepatic encephalopathy and irritable bowel syndrome with diarrhea (IBS-D).
Antiparasitic Agents: Drugs for antiparasitic conditions are employed in the treatment of diarrheal diseases brought about by pathogens including Giardia lamblia, Cryptosporidium, Entamoeba histolytica among others.
Metronidazole: Active against mild Giardia lamblia, Entamoeba histolytica, and some anaerobic bacteria.
Nitazoxanide: Antiparasitic agent that is used for treatment of Cryptosporidium parvum and Giardia lamblia.
Paromomycin: It is used for the treatment of amoebiasis due to E. histolytica.
Iodoquinol: Active against amoebiasis and against some parasites but not invasive amoebiasis.
General Practice
Pediatrics, General
At present, there are two available oral live-virus vaccine for rotavirus gastroenteritis that is considered as the leading cause of severe diarrhea in infants in the United States. RotaTeq is a combination of 5 live reassortant rotaviruses which contains pentavalent vaccine. It is administered in 3 doses and targets G1, G2, G3, G4 serotypes – for the most common group A rotaviruses strains as well as P1A of the rotavirus attachment protein.
The main difference between the two is that the Rotarix provides immunity against the rotavirus gastroenteritis disease with G1, G3, G4, and G9 predominant viral strains. It is given as a 2-dose series for infants between 6 to 24 weeks old. These vaccines have been found to reduce 74-78% of all cases of rotavirus gastroenteritis; 95% of the severe cases due to the disease; and 86% of all rotavirus hospitalizations due to the disease.
General Practice
Endoscopy: This procedure involves a flexible tube with a camera at the end that is inserted into the digestive tract to make visual observation of abnormalities, tumors or polyps or remove them. It can be used to diagnose either IBD or the infectious group that is responsible for diarrhea.
Colonoscopy: This procedure is like endoscopy but is particularly concerned with the colon and can help diagnose conditions such as ulcerative colitis, Crohn’s disease, or colorectal cancer, which may lead to chronic diarrhea.
Stool Studies: Bacterial or parasitic infections are also diagnosed through stool examination. This helps in appropriate prescription of either antibiotics or antiparasitic drugs as can be the case.
Sigmoidoscopy: This procedure passes a shorter flexible scope through the anus to view the sigmoid colon which is the lower part of the large intestine. It can be useful in determining the presence of ulcers in the colon like ulcerative colitis or diverticulitis.
Fluid Replacement via IV: For more serious cases of dehydration due to prolonged diarrhea, IV fluids may be needed to correct electrolyte imbalances and avoid worsening the condition.
Surgical Interventions: Diarrhea may develop due to structural changes in the digestive system in extremely rare instances.
Genomic Medicine
The identification phase involves the collection of information about the nature of the condition and the duration and type of symptoms experienced. To identify the causes of the disorder, diagnostic tests are performed, which point to underlying causes such as bacterial or viral infections, parasites, drugs, or medical conditions. The acute management phase encompasses rehydration and correction of fluid and electrolyte imbalance, control of symptoms, and antibiotic or antiparasitic drugs. Dietary restrictions are recommended to control the condition. The recovery and maintenance phase includes the measurement of hydration level and the consumption of normal food that has adequate nutrition.
Diarrhea is a condition characterized by an increase in water content in stool due to loss of ions and other substrates and water imbalance in the small and large intestine. Acute diarrhea is the condition of having 3 or more loose stools in a day within 14 days and usually associated with infection. Chronic diarrhea is more likely to be non-infectious in origin. Different forms of treatment and management depend on the duration and the cause of the diarrhea. Oral rehydration therapy is important for any patient with diarrhea and hand washing is critical to prevent transmission of infection. Infectious diarrhea that is due to such diseases as cholera and shigellosis does not necessarily always involve enteritis.
Norovirus accounts for about 20% of all cases of infectious diarrhea and is regarded as an equal opportunity pathogen. It is estimated for it accounts for over 200,000 deaths per year in developing countries. Rotavirus was the leading cause of severe diarrhea in young children in developing countries in the past. The production of attenuated vaccines for these viruses has led to a considerable decline in the incidence of rotavirus-prompted diarrhea.
Under-five children are known to have three instances of diarrhea attacks per year in developing countries. The prevalence increases to six to eight episodes per child per year in some parts of the country. In these cases malnutrition acts as an additional risk factor for the development of diarrhea. Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease are the main causes of chronic diarrhea. The occurrence of ulcerative colitis in Europe also rose from 6 to 35 cases per year for every 100000 people.
One hospitalization for diarrhea for every 23 to 27 children in the US before the introduction of rotavirus vaccination in 2006 and one hospitalization for every 18 to 20 children in Finland in 2008. This led to more than 50,000 hospital admissions each year as rotavirus accounted for about 4 to 5% of all childhood hospitalizations and billed the health care industry approximately up to $1 billion.
Diarrhea is a condition whereby there is a decrease in the amount of water that is reabsorbed by the bowel or an increase in the amount of water that is secreted into the bowel. Infection is the most common cause of acute diarrhea. Chronic diarrhea is categorized into three groups: watery, fatty (obstructive) or infection. Diarrhea may be categorized into secretory and osmotic diarrhea depending on the pathology.
Lactase deficiency is a type of watery diarrhea resulting from the increased flow of water from the intestinal lumen to increase bloating and flatulence. This is because lactase breaks down the lactose in the intestine which is osmotically active and retains water. Other common causes of fatty diarrhea include celiac disease and chronic pancreatitis which lead to excess fat excretion due to loss of enzyme production. Symptoms include pain in the upper part of the abdomen, flatulence, and loose and foul-smelling stools that are pale and bulky. Secretory diarrhea is caused by bacterial and viral infections that lead to loss of water stools due to injury of the intestinal epithelium.
Diarrhea can be acute, chronic, infectious diarrhea, or non-infectious diarrhea depending on the nature of the condition. Viral infection is usually the cause of acute diarrhea and is not usually treated. Chronic diarrhea refers to an extended diarrhea which is greater than 2 weeks and not caused by an infection. Malnutrition may be caused by malabsorption, inflammatory bowel illness, and potential drug reactions. Diagnosis and management of diarrhea in a child could be crucial and this could be established by considering feature of the stool, the presence or absence of associated symptoms, history of the child attending child daycare centres, history of ingestion of infected food or water. Travel history is also important since common pathogens affect certain areas as well and enterotoxigenic Escherichia coli has been found to be the main pathogen. It is important to understand these factors to be able to diagnose and manage diarrhea.
The evidence shows a trend of elevated diarrhea-related mortality among US children from the mid-1980s and 2006. Among the 1,087 cases of diarrhea deaths seen within the period of 2005 to 2007, 86% were Low birth weight babies – infants that weigh less than 2500 grams. Other factors associated with these deaths included male sex, black ethnicity, and low Apgar score (less than 7).
Dehydration and secondary malnutrition are the primary and secondary diseases associated with diarrhea deaths. In case of severe dehydration, the patient should be rehydrated via intravenous fluids. Malnutrition leads to severe fatality if the individual is not administered with nutrient IV as an outpatient within a hospital or clinic.
Infants and young children can also develop diarrhea characterized by frequent bowel movements, loose or watery stools or stools with mucus or blood. Examples are rotavirus, norovirus, bacterial infections, and parasites. These factors include hygiene, breastfeeding, malnutrition, teething, food hypersensitivity reactions, and antibiotics. The onset is acute and may be associated with dehydration and may be related to malabsorption syndromes or chronic infections, or other gastrointestinal diseases.
Teenagers may develop loose or watery stools with or without abdominal cramps or pain in the stomach and diarrhea may also be accompanied by nausea or vomiting. Common causes include the following: viral illnesses; bacterial infections; inflammatory bowel disease (IBD); and irritable bowel syndrome (IBS). Risk factors are travel, contaminated food or water, stress, food poisoning, lactose intolerance, and celiac disease.
The general assessment involves checking the patient’s vital signs, overall appearance, hydration, facial and mucous membrane color, urine output and sunken eyes. Vital signs monitoring includes temperature, heart rate, blood pressure, or respiratory rate to observe the level of dehydration, fever or hemodynamic status. The appearance of the patient such as the level of alertness, level of distress, and hydration should also be assessed.
Fluid and Electrolyte Management: Educate the patients to consume diluted fruit juice, Pedialyte, or Gatorade to replace the minerals and fluids that are lost due to diarrhea. In cases of severe dehydration solutions of salt and potassium may be administered intravenously.
Dietary Recommendations: It is advisable to recommend the bland ‘BRAT’ diet- ‘bananas, rice, applesauce, and toast’ with low fiber content as they are easily digestible. This can make the stools firmer and get rid of the symptoms. Some alternative options for solid food include oatmeal, white rice, and soup/broth.
Medications:
Anti-diarrheal Agents: It has been suggested that the use of medications to inhibit the production or movement of stools may be helpful in controlling the frequency of stools. They should not be used in case of adults having bloody diarrhea or high fever because these may increase intestinal infection.
Antibiotics: Oral fluoroquinolone may be prescribed as empiric antibiotic therapy in cases where there is high suspicion of having significant symptoms from diarrhea.
Probiotic Supplementation: Probiotics have been proven to be effective in preventing the development of diarrhea and its symptoms and their severity and duration. Advise patients who have acute diarrhea to consider using probiotics to increase their rate of recovery.
General Practice
Fluid Replacement: The treatment of diarrhea is therefore focused on preventing dehydration. ORS which are used as an oral liquid and contains compounds like glucose and electrolytes are very important for preventing further fluid loss and maintaining electrolyte balance.
Dietary Modifications:
BRAT Diet: It is a nutrition plan that means bananas, rice, applesauce, and toast. It may be concluded that these foods are low in fiber and can contribute to making firm stools.
Avoid Certain Foods: Fatty, oily and spicy foods or alcohol and caffeine containing products and dairy products are better refused during the time of diarrhea.
Increase Fluid Intake: In addition to ORS, it is also recommended to consume clear fluids such as water, different types of herbal teas and glucose-rich drinks such as coconut water.
Probiotics: Lactobacillus and Saccharomyces boulardii are probiotic strains that have demonstrated efficacy in shortening and mitigating the symptoms of infectious diarrhea by promoting colonic microflora homeostasis.
Rest and Hygiene: Rest is important in a sense that it allows the human body to heal faster. Infectious diarrhea can be prevented by following hygiene practices like; washing of hands before eating and after visiting the toilet.
Heat and Stomach Compresses: The use of a stove adequate heat or a heating pad on the stomach can help alleviate the cramps related to diarrhea.
General Practice
Antibiotics and antiparasitic are used for diarrhea resulting from bacterial or parasitic infections respectively. But it is important to be cautious in the use of such drugs to avoid the overuse of such drugs that may reach a level where the replicating bodies of the bacteria can develop resistances to the drugs. Here’s a breakdown of their roles along with examples:
Antibiotics: Antibiotics are given to a patient that is affected by diarrhea due to bacterial pathogens. They achieve this by killing offending bacterial organisms or by preventing them from multiplying so that the body’s natural defence can destroy the infection.
Fluoroquinolones: Ciprofloxacin and levofloxacin are commonly used for bacterial diarrhea but are particularly indicated in the cases of travelers’ diarrhea due to selected types of Escherichia coli.
Macrolides: Azithromycin can be used in the treatment of Campylobacter and some of the types of Salmonella.
Tetracyclines: Doxycycline can be used for physical dysentery, for example, Shigella, Campylobacter, and Salmonella infections.
Rifaximin: It is especially suitable for treating traveler’s diarrhea and is also used for the treatment of hepatic encephalopathy and irritable bowel syndrome with diarrhea (IBS-D).
Antiparasitic Agents: Drugs for antiparasitic conditions are employed in the treatment of diarrheal diseases brought about by pathogens including Giardia lamblia, Cryptosporidium, Entamoeba histolytica among others.
Metronidazole: Active against mild Giardia lamblia, Entamoeba histolytica, and some anaerobic bacteria.
Nitazoxanide: Antiparasitic agent that is used for treatment of Cryptosporidium parvum and Giardia lamblia.
Paromomycin: It is used for the treatment of amoebiasis due to E. histolytica.
Iodoquinol: Active against amoebiasis and against some parasites but not invasive amoebiasis.
General Practice
Pediatrics, General
At present, there are two available oral live-virus vaccine for rotavirus gastroenteritis that is considered as the leading cause of severe diarrhea in infants in the United States. RotaTeq is a combination of 5 live reassortant rotaviruses which contains pentavalent vaccine. It is administered in 3 doses and targets G1, G2, G3, G4 serotypes – for the most common group A rotaviruses strains as well as P1A of the rotavirus attachment protein.
The main difference between the two is that the Rotarix provides immunity against the rotavirus gastroenteritis disease with G1, G3, G4, and G9 predominant viral strains. It is given as a 2-dose series for infants between 6 to 24 weeks old. These vaccines have been found to reduce 74-78% of all cases of rotavirus gastroenteritis; 95% of the severe cases due to the disease; and 86% of all rotavirus hospitalizations due to the disease.
General Practice
Endoscopy: This procedure involves a flexible tube with a camera at the end that is inserted into the digestive tract to make visual observation of abnormalities, tumors or polyps or remove them. It can be used to diagnose either IBD or the infectious group that is responsible for diarrhea.
Colonoscopy: This procedure is like endoscopy but is particularly concerned with the colon and can help diagnose conditions such as ulcerative colitis, Crohn’s disease, or colorectal cancer, which may lead to chronic diarrhea.
Stool Studies: Bacterial or parasitic infections are also diagnosed through stool examination. This helps in appropriate prescription of either antibiotics or antiparasitic drugs as can be the case.
Sigmoidoscopy: This procedure passes a shorter flexible scope through the anus to view the sigmoid colon which is the lower part of the large intestine. It can be useful in determining the presence of ulcers in the colon like ulcerative colitis or diverticulitis.
Fluid Replacement via IV: For more serious cases of dehydration due to prolonged diarrhea, IV fluids may be needed to correct electrolyte imbalances and avoid worsening the condition.
Surgical Interventions: Diarrhea may develop due to structural changes in the digestive system in extremely rare instances.
Genomic Medicine
The identification phase involves the collection of information about the nature of the condition and the duration and type of symptoms experienced. To identify the causes of the disorder, diagnostic tests are performed, which point to underlying causes such as bacterial or viral infections, parasites, drugs, or medical conditions. The acute management phase encompasses rehydration and correction of fluid and electrolyte imbalance, control of symptoms, and antibiotic or antiparasitic drugs. Dietary restrictions are recommended to control the condition. The recovery and maintenance phase includes the measurement of hydration level and the consumption of normal food that has adequate nutrition.
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