University of Zambia Medical Library

Diarrhoea Case Management Research (WHO-DOCS 11)

Changes to the CDD treatment chart over time:
CDD's case management guidelines are presented in its diarrhoea management chart. The chart shows health workers how to assess and manage patients who reach a health facility with diarrhoea. The Programme distributed the first such chart in 1980. It proposed that, to prevent dehydration in a child with diarrhoea, the mother should:

Prior to 1980:

• Give extra breast milk and/or other fluids until the diarrhoea stops.
• Continue normal feeding.

• Complementary foods offered to children with diarrhoea usually have low energy or nutrient density, so it is important to increase their energy and nutrient density to achieve adequate intake during and after diarrhoea.
• The body continues to absorb animal fats and vegetable oil during diarrhoea.
• promoting improved feeding during an episode of diarrhoea and during convalescence after-wards reduces the negative effects of the episode on a child's nutritional status and does not make the symptoms worse.
• Promoting food safety is important to prevent diarrhoea.
• Continued breastfeeding reduces the severity of the episode of diarrhoea, accelerates recovery and helps prevent further episodes.

• Give freshly prepared foods. Recommended foods are mixes of cereal and beans, or cereal and meat or fish. Add a few drops of oil.
• Give fresh fruit juices or bananas to provide potassium.
• Cook and mash or grind food well so it will be easier to digest.
• After the diarrhoea stops, give one extra meal each day for a week, or until the child has regained normal weight.
• Give breast milk or milk feeds prepared with twice the usual amount of water.

• Malnutrition is a significant risk factor for diarrhoea mortality.
• Breast milk represents a high proportion of the nutritional intake of infants with diarrhoea; frequent breastfeeding increases both milk production and the total duration of breastfeeding.
• Local cereal-milk mixtures can provide safe alternatives to milk for older infants and young children with diarrhoea.
• Milk feeds do not need to be diluted for infants 6 months or older.
• Maternal encouragement may be important in improving the food intake of children with diarrhoea.
• It is important to promote the continuation of improved complementary foods after the end of the diarrhoea episode.
• Persistent diarrhoea (lasting 14 days or longer) can represent up to 20% of diarrhoea episodes and have a considerable negative effect on nutritional status.

• Give the child plenty of food to prevent malnutrition.
• Continue to breastfeed frequently.
• If the child is not breastfed, give the usual milk. If the child is less than 6 months old and not yet taking solid foods, dilute milk or formula with an equal amount of water for 2 days.
• If the child is 6 months or older, or already taking solid foods, also give cereal or another starchy food mixed, if possible, with pulses, vegetables, and meat or fish. Add 1 or 2 teaspoonfuls of vegetable oil to each serving.
• Encourage the child to eat; offer food at least 6 times a day.
• Give the same foods after diarrhoea stops, and give an extra meal each day for 2 weeks.

• Dilute any animal milk with an equal volume of water or replace it with a fermented milk product such as yoghurt.
• Assure full energy intake by giving 6 meals a day of thick cereal and added oil, mixed with vegetables, pulses, meat or fish.
• Bring the child back in 5 days; if the diarrhoea has not stopped refer to hospital.

Future changes:
The CDD diarrhoea management chart reflects the fullest and most recent knowledge obtained from reliable research findings. As new findings become available and point to improved ways of managing diarrhoea in young children, however, CDD will revise the diarrhoea management chart further.

For instance, a multicentre trial evaluating guidelines for the management of persistent diarrhoea has recently been completed. Its findings will lead to new recommendations on management of persistent diarrhoea that will be incorporated into future versions of the chart. This close link between research and the establishment of case management guidelines will con-tinue to be an essential element in CDD's work.

For further information, contact:
The Director, Division of Diarrhoeal and Acute Respiratory Disease Control, World Health Organization, 1211 Geneva 27, Switzerland, Tel: +41 22 791-2632, Fax: +41 22 791-4853, E-mail: tullochj@who.ch

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Last updated January 21, 1999