Management of acute childhood diarrhoea (8)

3 March, 2019

Dear Neil,

Thanks for sharing.

It is troubling that in India the withholding of fluids from children with diarrhoea has not improved in the interval between the two surveys, 2005/6 and 2016. It is a failure of getting evidence based information to the right locations and people. Surely a lot of education needs to be done to ensure that families, carers and parents, and even health workers get the right message. This goes to the heart of the mission of HIFA.

Nigeria has just concluded its 2018 National Demographic Health Survey (NDHS) going by the announcement in August 2018: ‘On August 16, 2018, the Nigerian Minister of Health announced that Nigeria has commenced the 2018 Nigeria Demographic and Health Survey. the 2018 Nigeria Demographic and Health Survey which is the sixth in the series of DHS conducted in Nigeria is a five year periodic worldwide survey program designed by USAID with support from other international donor organizations. The fieldwork at the state level will commence from 26th August to 15th December, 2018 in the 36 States and the FCT’’, and I believe the result is awaited.

But going through the 2013 NDHS Report, I did not see reference to 'withholding of fluids' to children with diarrhoea (not sure if that specific question was asked), but I quote here the paragraph on diarrohea treatment: ‘Table 9 also examines the treatment of diarrhoeal illness. Twenty-nine percent of children who were ill with diarrhoea were taken to a health facility or provider. Children born in the North East are less likely than children in other zones to have been taken to a health facility for treatment when they had diarrhoea. Similarly, children of mothers with more than secondary education were more likely than those with less education to be taken to a health facility for treatment of diarrhoea (64 percent). Oral rehydration therapy (ORT), which involves a prompt increase in the child’s intake of fluids, includes oral rehydration salts (ORS) from packets and/or a recommended home fluid (RHF). This is a simple and effective response to diarrhoeal illness. Mothers reported that 38 percent of the children with diarrhoea were treated with oral rehydration therapy (ORT), and 34 percent were given a solution prepared using a packet of oral rehydration salts (ORS). The use of ORT to treat diarrhoea was least common among children under age 6 months (24 percent) and in the North East zone (31 percent)’’ ( )

It appears that in Nigeria mothers are giving some form of fluids (proprietory or home-made ORT) to their children with diarrhoea. Obviously, to be exact, it would be useful to specifically ask about mothers, carers and even health workers attitude and belief to giving or not giving fluids to children with diarrhoea in future surveys.

Joseph Ana.


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group:

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