icddr,b treatment guideline effective for persistent diarrhoea

Patients admitted with persistent diarrhoea (PD) at icddr,b have had up to 95 percent recovery in recent years, indicates icddr,b hospital data.

The treatment guideline at icddr,b Dhaka hospital for PD was found highly successful, indicates recent findings from icddr,b studies published in BMC Paediatrics and in Paediatrics and International Child Health.

A large number of patients recover from persistent diarrhoea at icddr,b. Photo: Shehzad Noorani / icddr,b

The Dhaka hospital follows a management algorithm with locally available foods for treating PD alongside standard intervention with Oral Rehydration Solution (ORS) and antibiotics.


One key component of treatment of PD is dietary change, switching over to diets that contain little or no lactose (a kind of sugar). The patients are subsequently given different lactose-free diets step-by-step, switching to the next in case one diet fails.

“Over 80 percent of patients have shown to recover with the first two steps comprising milk-based low-lactose diet and lactose-, sucrose- and milk-free diet,” says Dr Shoeb Bin Islam, medical officer at icddr,b Dhaka Hospital and principal author of one of the studies looking at over 500 patients with PD.

Dr Tahmeed Ahmed, senior director nutrition and clinical services division at icddr,b says, “Since icddr,b successfully treats a large number of patients with PD every year, our treatment guideline can be emulated at other hospitals across the country and in places with similar context and settings.”

Research is needed to further optimise the treatment of PD and also to find out how best these children can be treated at home, he observes.


The Problem with Persistent Diarrhoea

Persistent diarrhoea (PD) lasts for two weeks or longer, according to WHO and is among the major causes of diarrhoeal deaths in young children in low- and middle-income countries.

Nutritional status and recovery rates are linked. Photo: Shehzad Noorani / icddr,b

“PD affects more children with poor nutritional status, in whom the outcome of treatment may be suboptimal compared to children with normal nutritional status,” says Dr Tahmeed Ahmed.

The icddr,b study findings have demonstrated similar outcomes. “Among those who had slower recovery rates from PD at the Dhaka hospital were children with severe stunting and wasting,” says Dr Mustafa Mahfuz, principal author of one of the studies and deputy project coordinator at icddr,b.

Earlier multi-country studies have also pointed out that malnourished children were more likely to suffer and die from PD than their healthy counterparts.

Published in Bulletin of the World Health Organization, an icddr,b study has shown that PD caused 30 percent of diarrhoeal deaths in infants aged 1–11 months at five of the seven sites in Asia and Africa where the study was conducted.

“Over 50 percent of children who died from PD were malnourished at four of the seven study sites,” says Dr Ahmed Ehsanur Rahman, principal investigator of the study and assistant scientist at icddr,b.

Dr Tahmeed Ahmed feels that more research is required to understand the relationship between malnutrition and PD.