Persistent childhood diarrhoea: Patterns, pathogenesis and prevention

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Abstract
With improved management of acute episodes of infectious diarrhoea, increased attention is now being given to persistent diarrhoea and its nutritional consequences and associated mortality. Risk factors for the development of persistent diarrhoea include young age, malnutrition, impaired immune function, recent introduction of milk feedings, prior antimicrobial therapy and infection with pathogenic strains of Escherichia coli. Descriptive epidemiology indicates that 3-20% of episodes of acute diarrhoea in children in developing countries become persistent and cause about one-third to one-half of all deaths from diarrhoea. Environmental factors may be very important in causing persistent diarrhoea: these include undernutrition combined with the impact of living in highly contaminated environments and their effects on gastrointestinal microecology. Development of effective preventive strategies will depend on improved understanding of causes and pathogenesis of persistent diarrhoea.