Success and constraints in the implementation of WHO guidelines for the management of diarrhoea in Albania.
The aim of this study is to evaluate the advantages as well as the difficulties resulting from the introduction of WHO guidelines for the treatment of acute diarrhoea in Albania. The study was carried out at the Department of Paediatrics, Tirana, Albania. To evaluate the changes in case fatality and duration of hospital stay the clinical course of 226 children admitted for acute diarrhoea during a 1-month period was compared with the course of 235 children admitted for an equivalent period, prior to the introduction of World Health Organisation (WHO) guidelines. A detailed prospective study of 43 children admitted for acute diarrhoea with moderate (28 cases) or severe (15 cases) dehydration, managed according to WHO guidelines, was also carried out to identify problems arising from the new approach. The case fatality ratio was lower (0.44% versus 1.27%) and the mean duration of hospital stay shorter (4.8 versus 5.5 days) after the introduction of WHO guidelines. In 35% (10/28) of cases with moderate dehydration, the oral rehydration therapy failed to improve the hydration status, leading to the need of i.v. treatment. Failures in the Oral Rehydration Solution (ORS) group were always due to the insufficient intake of fluids, in the majority of cases because mothers were not administering it properly. The introduction of WHO Guidelines for diarrhoea case-management was beneficial. To obtain better compliance in giving ORS to moderately dehydrated children, appropriate training of nursing staff, together with better communication and support to mothers admitted with their child are necessary.