Nutritional Management of Diarrhoea

Abstract

Diarrhoeal disease may cause, precipitate, or exacerbate protein-energy and micronutrient malnutrition through five possible mechanisms: 1) reduced food intake-reduction of food intake during diarrhoea may be due to the child's anorexia, maternal food-withholding behaviour, or both; 2) decreased absorption of nutrients-structural damage to the intestine, as well as the physical action of increased intestinal movement and reduced fluid transit time, interact to produce decreased absorption of nutrients; 3) increased catabolic losses-under the influence of the inflammatory process, diarrhoea of infectious origin induces an average daily negative nitrogen balance of 0.9 g/kg/day, as muscle protein is converted to glucose through gluconeogenesis by the liver; this glucose is used as a fuel by tissues to sustain the hypermetabolism associated with fever; 4) nutrient loss from the intestine-in diarrhoea nutrients are lost directly from the intestinal tract; 5) metabolic inefficiency due to micronutrient deficiency-the increased rate of tissue synthesis displayed by children recovering from protein-energy malnutrition may be hampered by a limited supply of nutrients from the body pool, which in turn may not be replenished fast enough by dietary intake. The two main driving forces that determine nutritional care of the sick child in the home are advice from healthcare providers (mainly physicians) and the mothers’ own beliefs; a third determinant of care is the social support network available to mothers or social pressure to act in a determined way. Therefore, health providers should be knowledgeable about appropriate feeding management of illness, and should provide sound advice to mothers.

The likelihood that mothers will follow the recommendations given by the health-care system (whether formal or informal) will be greater if these conform to mothers’ cultural norms and their explanatory model of disease. Feeding practices followed in health facilities should be consistent with those advised for the mothers at home. In order to make a successful change in a given practice, culture-sensitive interventions should be used.