The Bandim project in Bissau in Guinea-Bissau, West Africa has conducted one of the longest standing surveillances of diarrhoeal morbidity in developing countries. The initial studies of the epidemiology of diarrhoea and associated risk factors led to the series of studies presented in this thesis. But the present studies are only a small part of a larger ongoing study with the aim of reducing the many burdens, troubles and grieves that result from repeated attacks of diarrhoea.
The present thesis is based on community studies in 3 suburban areas of the capital Bissau, Guinea»Bissau. The studies form part of the longitudinal surveillance of diarrhoeal morbidity, which was initiated in the area in 1986, and the health and demographic surveillance that was initiated in 1978. The thesis is based on five studies;
Study 1: Hospital data and follow up after discharge
Study 2: Management of severely ill children
Study 3: Maternal perception of muses of diarrhoea, signs of dehydration and assessment of severity
Study 4: Management of diarrhoea at the household level
Study 5: The association between malaria and diarrhoea
The results of the studies presented here form part of a larger intervention study against diarrhoeal diseases initiated in 1991, The intervention involves health education in nutrition (breast feeding and weaning food) and in management of childhood diarrhoea (ORS and continued breast feeding). Due to time restrictions of a PhD study the results of the final analysis of the effect of the intervention are not included in the studies that are covered by this thesis. Studies 1-5 are the results of the continuous monitoring of the intervention (Mortality, morbidity and management).
The thesis begins with an introductory review of literature on determinants of childhood mortality in developing countries. Some of the major determinants are on one hand a few childhood diseases (e. g. diarrhoea, pneumonia and malaria), and on the other hand is the inability of the health sector in developing countries to cope with these diseases. In the light of this, the thesis first analyses studies of care seeking prior to death. Finally, against the background of the longitudinal studies of childhood diarrhoea in the Bandim Project in Guinea-Bissau, a more thorough review of perception and management of childhood diarrhoea is presented together with a review of studies investigating the association between diarrhoea and another frequent disease: malaria.
The section presenting methodology, results and discussion of own data (studies 1-4) is followed by a closing discussion linking the results of the 4 studies with the introductory review.