RESUMO
The National Program for Maternal and Child Health (COSMI) of the Ministry of Health (MOH) of Brazil conducted a survey in nine state capitals from 29 March to 30 April 1993 to assess how well health facilities were managing diarrhea cases in patients under 5 years of age. One of seven PAHO/WHO health facility surveys performed in Latin America and the Caribbean in 1992-1993, the Brazilian survey took place in the Northeast Region where most diarrheal morbidity and mortality occur. Like the other six surveys, it used a new PAHO/WHO methodology designed to collect data on certain principal indicators through observation, interviews, and review of clinical records. Overall, 475 cases of patients with diarrhea were observed in 192 facilities, and 463 health workers and 474 caretakers were interviewed. The results indicated that few diarrhea patients received care that strictly followed the PAHO/WHO/Ministry of Health treatment guidelines. In terms of these guidelines, the correct procedure was used to assess the patient's hydration status only 8% of the time, and only 1% of the health workers provided correct advice to the caretaker on prevention and home care aspects of diarrheal diseases. The procedure used to rehydrate patients with oral rehydration salts (ORS) was correct in only 6% of the cases. Of those patients with bloody stools, 24% were treated appropriately with antibiotics. Besides collecting information on correct case management, the survey provided a basis for developing two-year operational plans of action in each of the nine participating states to strengthen efforts directed at controlling and preventing diarrheal diseases, including cholera.
Assuntos
Administração de Caso/normas , Serviços de Saúde da Criança/normas , Diarreia Infantil/terapia , Qualidade da Assistência à Saúde , Brasil/epidemiologia , Pré-Escolar , Cólera/mortalidade , Cólera/terapia , Diarreia Infantil/diagnóstico , Diarreia Infantil/mortalidade , Diarreia Infantil/prevenção & controle , Guias como Assunto , Humanos , Lactente , Recém-Nascido , Fatores de RiscoRESUMO
Twenty male infants less than 1 year of age with acute diarrhea and dehydration were randomly assigned to a study group and studied in blind fashion in a metabolic unit to assess the efficacy of the addition of 30 mmol/L alanine to the standard World Health Organization (WHO) oral rehydration solution (ORS). Patients were exclusively rehydrated with one of two types of ORS during the first 24 hours of treatment. On the second day, oral feedings were started with a lactose-free formula, and ORS was given to replace stool losses. Body weight, ORS, food intake, vomitus, stool, and urine output were recorded at 6-hour intervals. Blood was drawn at the time of admission, after rehydration, and at 24 and 48 hours of hospitalization to monitor blood gases and electrolytes. Rehydration was satisfactory in both groups of patients. ORS that contained alanine did not reduce the purging rates of the infants compared with those who received standard ORS. Clinically no adverse effect of the alanine-based ORS was observed during hospitalization. None of the patients had significant hypernatremia or hyponatremia, and serum amino acid levels were not altered. These data show that the addition of 30 mmol/L alanine to the standard WHO-ORS produces no further improvement in the outcome of the infants with acute diarrhea compared with those fed the standard WHO-ORS.