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7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
1/23
KG@KOG VM@KOP^KL\ 3>9 SAE]JM 0;QQO]I]\P ?3% >6?>
@ko~~bmo k| agm ac pbm pav cksm lo}|m| ac `mopb
ojagi kgcogp| og` }g`m~*cksm lbke`~mg kg
Kg`ko X?Z% `m|vkpm pbm osokeonkekp{ ac mo|ke{
kjvemjmgponem kgpm~smgpkag| og` mrk|pmglm ac
Gopkagoe I}k`mekgm| ca~ jogoimjmgp op pbm lajj}gkp{
emsme' A~oe ~mb{`~opkag pbm~ov{ "A^P+ ykpb a~oe
~mb{`~opkag |oep "A^\+ |ae}pkag ~mjokg| pbm la~gm~|pagm
ac ovv~av~kopm lo|m jogoimjmgp ac ko~~bmoe mb{`~opkag
og` k| lag|k`m~m` pbm |kgiem ja|p mccmlpksm |p~opmi{ pa
v~msmgp ko~~bmoe mopb| kg lbke`~mg' Baymsm~% opo c~aj
]gkpm` Gopkag| Lbke`~mg| C}g` "]GKLMC+ lasm~oim
msoe}opkag |}~sm{ "LM\+ X>Z og` pbm pbk~` Gopkagoe
Cojke{ Bmoepb \}~sm{ "GCB\*
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
2/23
KG@KOG VM@KOP^KL\ 3>2 SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
msk`mglm vm~pokgkgi pa `ko~~bmo "`k|mo|m n}~`mg% mpkaeai{%
v~msmgpksm kgpm~smgpkag|% lekmgp v~olpklm| og` v~m|l~kvpkag
v~olpklm|+ kg lbke`~mg oim` em|| pbog cksm {mo~|% ykpb
vo~pkl}eo~ ~mcm~mglm pa pbm Kg`kog lagpmrp' Pbm ~mskmy
c}~pbm~ okjm` pa k`mgpkc{ hgayem`im iov| og` avm~opkagoe
nappemgmlh| pbop veoi}m pbm l}~~mgp v~ai~oj laglm~gkgi
v~msmgpkag og` lagp~ae ac `ko~~bmo ca~ }g`m~*cksm lbke`~mgkg Kg`ko'
JMPBA@\
Pbm jmpba`aeai{ ca~ pbk| |{|pmjopkl ~mskmy bo| nmmg
v~m|mgpm` mo~ekm~ X0Z' O |mp ac hm{ q}m|pkag| ca~ ~mskmy
ym~m ckgoektm` pb~a}ib lag|mg|}| n}ke`kgi% og`
lopmia~ktm` o| Pmlbgkloe K||}m| og` Avm~opkagoe
K||}m| X0Z' Pbm `mpoke| ac pbm |mo~lb |p~opmi{ ca~ molb
q}m|pkag bosm nmmg v~m|mgpm` kg YmnPonem K' Ekpm~op}~m
|mo~lbm| ym~m kgkpkoee{ lo~~km` a}p }~kgi Ov~ke >6?6% og`
}v`opm` ag ?6 Dog}o~{ >6?>'
^M\]EP\
?' @ko~~bmoe Ja~nk kp{ og` Ja~poekp{ kg Kg ko
Olla~`kgi pa \^\ ^mva~p ">66;+ ag Lo}|m| ac @mopb
">66?*>66+ vm~ ?666 vm~ {mo~
X3%9Z' Pbm `ml~mo|m yo| ja|p v~aga}glm` kg lbke`~mg
oim` }g`m~ ? {mo~' @ko~~bmo olla}gpm` ca~ o jm`kog ac
>?- ac oee `mopb| ac lbke`~mg oim` }g`m~ = {mo~| kg pbm|m
o~mo| og` la}gp~km|% nmkgi ~m|vag|knem ca~ >'= jkeekag
`mopb| vm~ {mo~' Eoglmp lbke` |}~sksoe |m~km|% }|kgi o
v~m`klpkag ja`me% m|pkjopm` pbop >>- "?0*
la}gp~km|% ybm~m ;6- ac oee }g`m~*cksm `mopb| all}~ X2Z'
Ja|p ~mlmgp v~m`klpkag ja`mekgi `opo oe|a lagle}`m pbop
`ko~~bmoe `k|mo|m| ieanoee{ o~m ~m|vag|knem ca~ ja|p
}g`m~*cksm lbke` mopb| nm{ag` gmagopoe oim' Pbk| ja`me
v~m`klp| pbop ?0- ac }g`m~*cksm lbke` `mopb| papoekgi pa
ona}p 6'>0 jkeekag kg Kg`ko all}~ }m pa ko~~bmo X;Z' Pbk|
cki}~m k| |kjkeo~ pa pbm \^\ sm~noe o}pav|{ m|pkjopm|'
C}~pbm~% pbm~m yo| jo~hm` ~mikagoe so~kopkag ykpb
ja~poekp{ ~opm c~aj `ko~~bmoe `k|mo|m| kg Lmgp~oe Kg`ko
yo| pb~mm pkjm| pbop kg pbm Ym|p' Ik~e| kg Lmgp~oe Kg`ko bo`
ca}~ pkjm| bkibm~ `ko~~bmoe `k|mo|m ja~poekp{ ~opm
lajvo~m` pa na{| kg pbm Ym|p X?6Z'
Olla~`kgi pa GCB\*< ~mva~p% ;- ac oee }g m~*cksm
lbke`~mg ym~m ~mva~pm` pa nm |}ccm~kgi c~aj ko~~bmo kg eo|p
> ymmh| X- og` ?6-% ~m|vmlpksme{ X??%?>Z'
Pbm|m cki}~m| o~m gap p~}e{ lajvo~onem o| pbm|m `opo|mp|
ym~m anpokgm` c~aj japbm~| ac lbke`~mg ykpb kccm~mgp oimi~a}v| "5 0 {~ kg GCB\*?% 5 < {~ kg GCB\*> og` 5 = {~ kg
GCB\*
caeeaym` n{ o `mlekgm kg GCB\*< o~m gap lemo~'
\}~v~k|kgie{% |popm| ykpb |ajm ac pbm ya~|p bmoepb
kg`klopa~| ekhm ]V% JV og` odo|pbog ~mva~pm` o sm~{ eay
v~msoemglm ac `ko~~bmo kg GCB\*?8 kp kgl~mo|m` n{ >*' Ogapbm~ |}~v~k|kgi ckg`kgi c~aj GCB\*
? yo| pbop oeja|p =6- ac pbm v~msoemglm ac `ko~~bmo kg
v~mska}| pya ymmh| yo| lagp~kn}pm` n{ v~msoemglm }~kgi
eo|p >0 ba}~|' Pbk| jo{ |}iim|p o |kigkcklogp ~mloee nko| kg
}|kgi pya ymmh v~msoemglm o| og kg`klopa~' Pbm |mlag` og`
pbk~` |}~sm{ `k` gap v~m|mgp og{ `opo ag >0 ba}~
v~msoemglm' Asm~oee% pbm~m ovvmo~| pa nm `ml~mo|m kg
v~msoemglm c~aj GCB\*> pa GCB\*- kg 5 3 ja og` =- kg
3*?> ja8 GCB\*%9 |p}`km| c~aj
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
3/23
KG@KOG VM@KOP^KL\ 3>; SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
`msmeavkgi la}gp~km|% kgle}`kgi pb~mm c~aj Kg`ko%
|}iim|pm` pbop pbm jm`kog kglk`mglm ac ko~~bmo ca~ }g`m~*
cksm lbke`~mg yo| ' Mpkaeai{ ac Lbke`baa` @ko~~bmo kg Kg ko
Pbm~m k| ga eo~im*|loem gopkagoee{ ~mv~m|mgpopksm
lajj}gkp{ no|m` |p}`{ kg eo|p pya `mlo`m| ~mio~`kgi
mpkaeai{ a~ p~mg`| ac `ko~~bmo c~aj Kg`ko' Ja|p |p}`km|
bosm nmmg mkpbm~ `m|kigm` pa |vmlkckloee{ msoe}opm pbm
lagp~kn}pkag ac o |kgiem mpkaeaikloe oimgp a~ o~m no|m` ag
k|aeopkag ac jkl~anm| c~aj |paae |ojvem| ac ba|vkpoektm`
vopkmgp| ykpba}p pbmk~ lekgkloe `mpoke|' Ja~masm~% pbm
c~mq}mgp v~m|mglm ac mgpm~kl vopbaimg| kg bmoepb{
lbke`~mg c~aj `msmeavkgi la}gp~km| johm| kp ja~m
`kcckl}ep pa `mpm~jkgm pbmk~ p~}m mpkaeaikloe ~aem kg
lo}|opkag ac `ko~~bmo' Pbm |mo|agoekp{ ac |ajm oimgp|
oe|a v~mle}`m soek` ogoe{|k| c~aj |p}`km| ~mva~pkgi lo|m|
ykpbkg o |ba~p }~opkag'
O j}epklmgp~kl "Lbkgo% Kg`ko% Jmrkla% J{ogjo~ og`
Vohk|pog+% ba|vkpoe*no|m` |p}`{ kg ?;;? msoe}opm` pbm
mpkaeai{ ac ol}pm ko~~bmo "kgle}`kgi pba|m ykpb v~m|mglm
ac neaa` a~ j}l}| kg |paae|+ kg lbke`~mg "6*6Z' Pbm |p}`{ oppmjvpm` pa mekjkgopm pbm ~aem ac
|mo|agoekp{ n{ mg~aeekgi lajvo~onem g}jnm~ ac vopkmgp|
molb ymmh pb~a}iba}p pbm pya*{mo~ |p}`{*vm~ka`' Pbm
|p}`{ oe|a msoe}opm` pbm v~m|mglm ac jkl~aa~iogk|j| kg
bmoepb{ lagp~ae| pa c}~pbm~ kgl~mo|m pbm soek`kp{' Og mgpm~kl
vopbaimg la}e` nm mpmlpm` kg 32- lo|m|' Pbm a~iogk|j|
ja~m v~msoemgp kg lo|m| pbog kg lagp~ae| ym~m ~aposk~}|%
\bkimeeo |vv' og` mgpm~aparkimgklM' laek "MPML+' C~aj
Kg`ko "G:=%23>+% ~aposk~}| yo| `mpmlpm` kg ?2-%Mgpm~aparkimgklM' laek "MPML+ kg ?0- og` \bkimeeo |vv'
kg >6-' Mgpm~avopbaimgkl M' laek "MVML+% \oejagmeeo
|vv'% Lea|p~k`k}j dmd}gk ym~m mq}oee{ v~msoemgp kg lo|m|
og` lagp~ae|' Skn~ka lbaem~om yo| k|aeopm` c~aj >- ac
lo|m| "6'>- ac lagp~ae|+ ybm~mo| M' bk|pae{pklo yo|
`mpmlpm` age{ kg 6'?- ac lo|m| "6'>- ac lagp~ae|+'
^aposk~}| yo| k|aeopm` ja|p c~mq}mgpe{ `}~kgi pbm ck~|p
{mo~ ac ekcm ybm~mo| \bkimeeo |vv' yo| pbm ja|p lajjag
k|aeopm kg lbke`~mg oim` ?>*6- ac
ba|vkpoektopkag|% *< mvk|a`m| ac `ko~~bmo vm~ {mo~'
Pbm vakgp*v~msoemglm "eo|p pya ymmh|+ ac ko~~bmo
ojagi }g`m~*cksm lbke`~mg k| ona}p ;*>6-'
O lbke` k| op jorkj}j ~k|h ac `ko~~bmo nmpymmg3*?> ja ac oim'
Ona}p ?6- ac pbm ko~~bmoe mvk|a`m| o~m {|mgp~{8
pbm~m bo| nmmg ga lbogim kg pbk| p~mg` asm~ eo|ppya `mlo`m|'
Pbm~m o~m ga joda~ ~}~oe!}~nog a~ img`m~`kccm~mglm| kg v~msoemglm ac `ko~~bmo'
@{|mgp~{ k| ja~m lajjag kg ~}~oe o~mo|% og` kg
lbke`~mg c~aj vaa~m~ cojkekm|'
Pbm~m |mmj| pa nm o va|kpksm p~mg` ac `ml~mo|mkg `ko~~bmoe ja~nk`kp{ og` ja~poekp{'
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
4/23
KG@KOG VM@KOP^KL\ 36?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
`mopb| o~m gap soek` o| ja|p `ko~~bmo `mopb| all}~ kg
lajj}gkp{% og` v~anone{ kg joega}~k|bm` lbke`~mg'
Ojagi `ko~~bmo ba|vkpoektopkag|% pbm lajjagm|p
I p{vm| ym~m I? og` I> ybkem lajjagm|p V p{vm| ym~m V2%
V3 og` V0'
@ko~~bmoimgklM' laek% m|v' Mgpm~aoii~miopksmM' laek%
k| pbm ja|p lajjag nolpm~koe vopbaimg k|aeopm` kg ja|p|p}`km|' Baymsm~% kp bo| oe|a nmmg k|aeopm` c~mq}mgpe{ kg
lagp~ae|' Skn~ka lbaem~om v~m`ajkgogpe{ all}~| kg
a}pn~moh|% og` ja|p occmlpm` lbke`~mg o~m >*= {~ ae`|' S'
lbaem~om A? k| pbm v~m`ajkgogp |m~ai~a}v ojagi
`ko~~bmoe vopkmgp|' Pbm bkib k|aeopkag ~opm ac Skn~ka
lbaem~om c~aj |p}`km| }pkektkgi jmpba`aeai{ ac ogoe{|k| ac
|ojvem| |mgp pa pbm jkl~ankaeai{ mvo~pjmgp ca~ l}ep}~m k|
ekhme{ pa nm ~meopm` pa pbm vopkmgp v~ackem o| kp k| ekhme{ pbop
|ojvem| ya}e` nm |mgp ja~m lajjage{ kg lbke`~mg boskgi
~klm yopm~{ |paae| og` |msm~m `mb{`~opkag pa |vmlkckloee{
eaah ca~ S' lbaem~om'
Lagle}|kag| og` Lajjmgp|4 NAR >
Hgayem`im iov| og` k~mlpkag| ca~ c}p}~m ~m|mo~lb4 Pbm~m
k| gmm` ca~ eo~im |loem lajj}gkp{ no|m` |p}`km| msoe}opkgi
pbm mpkaeai{ ac `ko~~bmo% ~opbm~ pbog laglmgp~opkgi ag
k`mgpkcklopkag ac agm vopbaimg' \p}`km| gmm` pa mpm~jkgm
mpkaeai{ ac ko~~bmo% og` la~~meopm| ac `ko~~bmoe mopb| kg
joega}~k|bm` lbke`~mg lajvo~m` pa ymee*ga}~k|bm`
lbke`~mg' \p}`km| gmm` pa msoe}opm pbm lagp~kn}pkag ac
~aposk~}| og` apbm~ colpa~| kg lo}|opkag ac ko~~bmoe mopb|'
Baymsm~% o| `mopb| c~aj `ko~~bmo v~kjo~ke{ all}~ kg
|mppkgi| ybm~m ollm|| pa jm`kloe lo~m k| ekjkpm`% laeemlpkag
ac ovv~av~kopm lekgkloe |vmlkjmg| pa vm~ca~j o
jkl~ankaeaikl msoe}opkag k| mrp~mjme{ lboeemgikgi'
Z' Ogpkjkl~ankoe| o~m
~mlajjmg`m` age{ ca~ i~a|| neaa` kg |paae| a~ \bkimeeova|kpksm l}ep}~m% lbaem~o% o||alkopm` |{|pmjkl kgcmlpkag% a~
|msm~m joeg}p~kpkag' Pbm ck~|p ekgm ogpknkapkl ~mlajjmg`m`
ca~ p~mopjmgp ac `{|mgpm~{ k| a~oe lkv~acearolkg X0?%0>Z'
Jmo|}~m| ca~ v~msmgpkag ac `ko~~bmo kgle}`m v~ajapkgi
mrle}|ksm n~mo|pcmm`kgi% }|m ac |ocm yopm~% bog`yo|bkgi%
caa` |ocmp{% |ocm `k|va|oe ac mrl~mpo% og` kjj}gktopkag
oiokg|p jmo|em|' Pbm|m ~mlajjmg`opkag| pohm kgpa
olla}gp gmy ~m|mo~lb ckg`kgi| ybkem n}ke`kgi ag vo|p
~mlajjmg`opkag|' Pya ~mlmgp o`soglm| kg jogoikgi
`ko~~bmoe k|mo|m4 "k+ ~m`}lm` a|jaeo~kp{ a~oe ~mb{`~opkag
|oep| "A^\+ lagpokgkgi eaym~ laglmgp~opkag| ac ie}la|m
og` |oep% og` "kk+ tkgl |}vvemjmgpopkag o| vo~p ac pbm
p~mopjmgp8 bosm pbm vapmgpkoe pa c}~pbm~ ~m`}lm `ko~~bmoe
ja~nk`kp{ og` ja~poekp{ n{ ~m`}lkgi pbm `}~opkag og`
NAR >
Pbm~m k| ga eo~im*|loem lajv~mbmg|ksm
lajj}gkp{ no|m` |p}`{ ~mio~`kgi mpkaeai{ ac`ko~~bmo c~aj Kg`ko'
^aposk~}| k| ~m|vag|knem ca~ ona}p ?=*6- ac
mvk|a`m|' Sk|knem neaa` k| v~m|mgp kg |paae| kg boec
pa pya*pbk~`| ac pbm|m mvk|a`m|'
Skn~ka lbaem~om v~m`ajkgogpe{ all}~| kg
a}pn~moh|' Ja|p occmlpm` lbke`~mg o~m >*= {~ ae`|'
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
5/23
KG@KOG VM@KOP^KL\ 3
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
|msm~kp{ ac ko~~bmoe mvk|a`m| og` eaym~ pbmk~ kglk`mglm'
Gopkagoe Mrvm~p I~a}v ca~j}eopm` n{ pbm Jkgk|p~{ ac
Bmoepb% Iasm~gjmgp ac Kg`ko v~ava|m` pbop o |kgiem
}gksm~|oe A^\ |ae}pkag lagpokgkgi |a`k}j 9= jjae!E og`
ie}la|m 9= jjae!E% og` ykpb a|jaeo~kp{ >0= jA|jae!E
yo| ollmvponem ca~ oee oim| og` oee p{vm| ac ko~~bmo' Pbm
~msk|m` ca~j}eopkag yo| ovv~asm` n{ pbm @~}i Lagp~aeem~ac Kg`ko og` pbm Iasm~gjmgp ca~joee{ eo}glbm` kp kg D}gm
>660' \kjkeo~e{% no|m` ag pbm YBA!]GKLMC!KOV
~mlajjmg`opkag|% pbm Jkgk|p~{ ac Bmoepb% Iasm~gjmgp ac
Kg`ko bo| ~mlajjmg`m` pbop >6 ji ac memjmgpoe tkgl
|ba}e` nm iksmg pa oee lbke`~mg ae`m~ pbog 3 jagpb| ykpb
`ko~~bmo% og` |ba}e` nm |po~pm` o| |aag o| `ko~~bmo |po~p|
og` lagpkg}m` ca~ o papoe vm~ka` ac ?0 `o{| X0?%0>Z'
Lbke`~mg oim` >*3 jagpb| |ba}e` nm o`sk|m` ?6 ji vm~
`o{ ac memjmgpoe tkgl ca~ ?0 o{|'
Tkgl `k|vm~|knem ponemp| og` ekq}k` ca~j}eopkag| o~m
gay osokeonem yk`me{ kg pbm v~ksopm |mlpa~' Tkgl k|vm~|knem
ponemp| o~m oe|a nmkgi |}vvekm` kg pbm LB hkp|' Mcca~p| o~mag ca~ johkgi pbmj osokeonem op ja|p vm~kvbm~oe lmgpm~|%
og` o| asm~ pbm la}gpm~ "APL+ ~}i X0?Z' L}~~mgpe{% pbm~m
o~m ga |p}`km| osokeonem ag pbm avm~opkagoektopkag ac tkgl
p~mopjmgp pb~a}ib iasm~gjmgp |mlpa~'
Hgayem`im iov| og` `k~mlpkag| ca~ c}p}~m ~m|mo~lb4Pbm
l}~~mgp `ko~~bmo jogoimjmgp i}k`mekgm| jokge{ `k|l}||
pbm pmlbgkloe k||}m| ykpb sm~{ ekppem mjvbo|k| ag
avm~opkagoektopkag' Pbm hm{ |p~opmikm| ca~ KML% og`
`k|p~kn}pkag |{|pmj ca~ ~m`}lm` a|jaeo~kp{ A^\% tkgl og`
lkv~acearolkg bosm gap nmmg iksmg o`mq}opm mjvbo|k|'
Oepba}ib Gopkagoe I}k`mekgm| ~mlajjmg` lkv~acearolkg
ca~ {|mgpm~{ og` ~m|k|pogp lbaem~o lo|m|% pbm~m o~m k||}m|~meopm` pa kp| ovv~asoe n{ @~}i Lagp~aeem~ Imgm~oe ac Kg`ko
ca~ }|m kg lbke`~mg'
0' V~msmgpksm Kgpm~smgpkag|
O'N~mo|pcmm`kgi
N~mo|pcmm`kgi bo| pbm vapmgpkoe ac v~msmgpkgi ?
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
6/23
KG@KOG VM@KOP^KL\ 3 SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
kgle}`m` v~ajapkag |p~opmikm| |}lb o| |joee i~a}v
`k|l}||kag| og` eo~im~ jmmpkgi|% j}epkjm`ko
lajj}gklopkag lojvokig| ykpb va|pm~|% ~o`ka!PS
lojvokig|% emocemp|% lajkl naah|% |agi|% |ek`m |bay|% }|m
ac P*|bk~p| og` no`im|% vklpa~koe |pa~km|% `~ojo|% og`
iojm|' Oee kg|pkp}pkag*no|m` p~koe| ym~m c~aj bkib kglajm
la}gp~km| "mrlmvp agm c~aj Lbkgo+ ykpb o`mq}opm v~ask|kagac yopm~ |}vve{ og` |aov' Lajj}gkp{*no|m` p~koe|
kgle}`m` cksm le}|pm~*~og`ajktm` lagp~aeem` p~koe| pbop
}|m` mgpk~m lajj}gkpkm| "imgm~oee{ skeeoim| a~
gmkibna~baa`|% mrlmvp agm p~koe% ybklb }|m` ba}|mbae`|+
o| }gkp| ac ~og`ajktopkag' Pbm|m p~koe| ym~m lag`}lpm` kg
eay*og` jk``em*kglajm la}gp~km| kg O|ko "G:0+ og`
Oc~klo "G:?+' Kg pb~mm a}p ac pbm|m cksm p~koe|% |aov yo|
v~ask`m` pa pbm lajj}gkp{ n{ ~m|mo~lbm~|' Pb~mm p~koe|
msoe}opm` bog` yo|bkgi o| pbm age{ kgpm~smgpkag% og` apbm~
pya p~koe| }|m` j}epkvem b{ikmgm kgpm~smgpkag| pbop
kgle}`m` bog` yo|bkgi ykpb |aov "pbm p{vm ac |aov }|m` k|
gap `m|l~knm`+' Vo~pklkvogp| ym~m jokge{ japbm~| a~
lo~miksm~| o| ymee o| lbke`~mg' Pbm a}plajm ac `ko~~bmoyo| o||m||m` age{ kg lbke`~mg kg oee pbm p~koe| kgle}`m` kg
pbk| ~mskmy' C~ajKg|pkp}pkag*no|m` p~koe|% pbm kglk`mglm ac
`ko~~bmo yo| o||m||m` kg 99?? lbke`~mg oim` em|| pbog
|msmg {mo~| kg ?3? o{*lo~m lmgp~m| og` 29 |lbaae| kg pbm
mkibp p~koe|' Pbm pya p~koe| pbop o`d}|pm` ca~ le}|pm~kgi og`
lagca}g`m~|% |baym` o ~m`}lpkag kg pbm kglk`mglm ac
`ko~~bmo n{ pa 6';68 0 p~koe|+
kg p~koe| pbop o`d}|pm` ca~ le}|pm~kgi og` lagca}g`m~|' Pbm
|kgiem p~koe ybklb k` gap o`d}|p ca~ le}|pm~kgi mccmlp| oe|a|baym` o |kjkeo~ nmgmckp' Pbm ~m`}lpkag kg pbm ~k|h ac
`ko~~bmo yo| i~mopm~ kg pbm p~koe| ybklb v~ask`m` |aov pa
pbm lajj}gkpkm| "K^^ 6'0;% ;=- LK 6'Z' Kp k|
kjva~pogp pa gapm pbop pbm lagp~ae i~a}v kg ja|p lo|m|
~mlmksm` q}kpm c~mq}mgp jagkpa~kgi% ybklb jo{ kp|mec bosm
kgce}mglm` bog` yo|bkgi nmboska~' Pbk| jkibp bosm
eaym~m` pbm m|pkjopm ac pbm q}ogp}j ac nmgmckp c~aj
bog`yo|bkgi' Asm~oee% pbk| ~mskmy v~ask`m` |p~agi
msk`mglm pbop bog`yo|bkgi kgpm~smgpkag| ~m`}lm ko~~bmoe
ja~nk`kp{ n{ ona}p agm*pbk~`' Baymsm~% ja|p p~koe| kg pbk|
~mskmy bo` |ba~p*pm~j caeeay }v% og` kp k| }glemo~ kc pbmk~
emsme ac mccmlpksmgm|| ya}e` nm jokgpokgm` kc pbm{ ym~m
|loem` }v pa eo~im~ ~mikag| ykpb em|| kgpmg|ksm jagkpa~kgi
asm~ o eagim~ pkjm*vm~ka`'
Kg ogapbm~ |{|pmjopkl ~mskmy ac v}nek|bm` |p}`km|
"laba~p% lo|m*lagp~ae og` ^LP|+ o||m||kgi pbm yopm~
|ogkpopkag og` b{ikmgm kgpm~smgpkag| pa ~m`}lm ko~~bmo kg
pbm em|| msmeavm` la}gp~km|% oee |p}`km` kgpm~smgpkag| ym~m
ca}g` pa ~m`}lm |kigkcklogpe{ pbm ~k|h| ac ko~~bmoe keegm||
X=
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
7/23
KG@KOG VM@KOP^KL\ 36?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
bog`yo|bkgi v~ajapkag ca~ ; jagpb| ~mva~pm` =*9*39- op pya {mo~| caeeaykgi pbm sollkgopkag'
Pbm mccklol{ kg v~msmgpkgi |msm~m ~aposk~oe `ko~~bmo yo|
i~mopm~ "26*;
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
8/23
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
9/23
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
10/23
KG@KOG VM@KOP^KL\ 36?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
sm~{ mccmlpksm' Kgdmlponem sollkgm| o~m ga eagim~ kg
lekgkloe }|m% og` pbmk~ v~apmlpksm mccklol{ eo|pm` age{ ca~
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lbaem~o sollkgm| ~mva~pm` o v~apmlpksm mccklol{ ac ymmh| emo`| pa ?=*
>=- cmym~ mvk|a`m| ac ko~~bmo kg }g`m~*cksm lbke`~mg kg
NAR =
^aposk~}| sollkgm k| mccklolka}| kg v~msmgpkag
oiokg|p |msm~m ~aposk~oe `ko~~bmo "26*;
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
11/23
KG@KOG VM@KOP^KL\ 36?>
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`klbapaj{ nmpymmg hgayem`im og` v~olpklm' @m|vkpm
pb~mm*ca}~pb ac yajmg hgaykgi ona}p A^\% age{ agm*
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apbm~ bajm osokeonem ce}k`| o| age{ 0
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
14/23
KG@KOG VM@KOP^KL\ 306 SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
lmgpm~ kg Lbmggok X29Z% 3=- ac lbke`~mg ba|vkpoektm` ykpb
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og` GCB\*?% ?0*?=- ac japbm~| ~mva~pm` pbop kgdmlpkag|
ym~m iksmg pa pbmk~ lbke` pa p~mop `ko~~bmo X??%?>Z' Kg pbm
~mlmgp ]GKLMC pmg*`k|p~klp |}~sm{ X?
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
15/23
KG@KOG VM@KOP^KL\ 30? SAE]JM 0;QQO]I]\P ?3% >6?>
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v~m|l~knm ogpknkapkl| kg lo|m| ac ko~~bmo'
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jm`klkgm kg |joeem~ vovm~*va}lbm| "v}`k{o|+'
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o| agm ac pbm ~mo|ag| ca~ vaa~ A^\ }|oim kg pbm ]GKLMC
pmg*`k|p~klp |}~sm{ X?%;'2!?666 }g`m~*cksm lbke`~mg+ nmpymmg pbm |p}`{ og`
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kjv~asmjmgp kg pbmk~ hgayem`im ~mio~`kgi |kig| ac
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Kg |vkpm ac v~ask`kgi gmlm||o~{ ca~j| pa jokgpokg ~mla~`|%
ga LBI| a~ OYY| olp}oee{ `k` |a' Pbm~m yo| ga
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pbm |p}`{ o~mo yo| age{ ??- kg lajvo~k|ag pa ?>- kg
lagp~ae o~mo|' Bajm osokeonem ce}k` "BOC+ }|oim ~opm|
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lagp~ae+' C}~pbm~% kp yo| ~msmoem` pbop pya*pbk~`| ac pbm
japbm~| k` gap msmg hgay pbmk~ skeeoim emsme ya~hm~ kg pbm
|p}`{ o~mo' Kg |vkpm ac ~mvmopm` p~okgkgi ac bmoepb ya~hm~|pa m`}lopm japbm~| pa }|m A^P mo~ekm|p kg og mvk|a`m ac
`ko~~bmo og` kg o`mq}opm ojagp|% pbm i~o||~aap emsme bmoepb
ya~hm~| cokem` pa `a |a msmg ojagi|p pbm |joee
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eolh ac v~avm~ |}vm~sk|kag op oee emsme|% og` "ks+ on|mglm ac
lagpkg}m` |}vve{ ac A^\ X;
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
16/23
KG@KOG VM@KOP^KL\ 30> SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
O |joee*|loem% q}m|pkaggok~m*no|m` |p}`{ c~aj pbm
|e}j| ac @mebk% msoe}opm` pbm mccmlpksmgm|| ac pbm Jkgk|p~{
ac Bmoepb| jo|| jm`ko lojvokig pa v~ajapm A^P }|m
`}~kgi `ko~~bmoe mvk|a`m| X?66Z' Pbm hgayem`im ac =;
japbm~| yba yoplbm` pbm pmemsk|kag "PS+ o`sm~pk|mjmgp
ykpb lmemn~kpkm| meksm~kgi |kjvem og` lemo~ jm||oim| ym~m
lajvo~m` pa ;6 japbm~| yba bo` ~mlmksm` A^P jm||oim|
c~aj apbm~ |a}~lm| |}lb o| bmoepb ya~hm~|' Japbm~| kg pbm
ck~|p i~a}v ym~m lag|k`m~one{ ja~m ekhme{ pa hgay bay pa
la~~mlpe{ v~mvo~m A^\ pbog pba|m yba emo~gm` ona}p A^P
c~aj apbm~ |a}~lm| "3>'9- s|
i~a}v| mrk|pm` "3;'0;- og` =
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
17/23
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
18/23
KG@KOG VM@KOP^KL\ 300 SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
OGJ| og` Oogiogyo`k ya~hm~|+ og` v~ksopm
v~olpkpkagm~| "kgle}`kgi }geklmglm`+ o| lboggme| ac
`meksm~{ ac kgpm~smgpkag "v~ask|kag ac tkgl og` A^\ oeagi
ykpb lo~miksm~ m`}lopkag ag pbmk~ }|m+ ocpm~ o n~kmc p~okgkgi
kg `ko~~bmo jogoimjmgp og` tkgl }|m' Pbm mo~ekm~ vkeap
ya~h X?6=Z n{ pbk| i~a}v bo` mjag|p~opm` pbm cmo|knkekp{
pa p~okg so~ka}| iasm~gjmgp og` lajj}gkp{ lboggme| pav~ajapm tkgl o| o p~mopjmgp ca~ ol}pm ko~~bmo pb~a}ib pbm
v~kjo~{ bmoepblo~m |{|pmj' Kgca~jopkag m`}lopkag og`
lajj}gklopkag "KML+ olpkskpkm| kgsaesm` va|pm~| og`
lojvokig| pa v~ajapm tkgl o| o p~mopjmgp ca~ ko~~bmo% o|
ymee o| o pagkl pbop v~msmgp| `ko~~bmo asm~ pbm mg|}kgi
jagpb|% pa mg|}~m lajvekoglm ykpb pbm c}ee ?0*`o{ la}~|m'
]gkgpm~~}vpm` |}vvekm| ac A^\ volhmp| og` tkgl ym~m
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v~msoemglm ac `ko~~bmo og` ba|vkpoektopkag|' A^\ }|m
kgl~mo|m` |kigkcklogpe{ kg pbm kgpm~smgpkag o~mo|% og` pbm
kgpm~smgpkag oe|a ~m|}epm` kg ~m`}lpkag kg pbm }|m ac
}gyo~~ogpm` a~oe og` kgdmlponem ~}i| }~kgi `ko~~bmo'
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p~mopjmgp ac `ko~~bmo bo| oe|a nmmg `mjag|p~opm` c~aj o
j}epklmgp~kl |p}`{ kg a}pvopkmgp bmoepb colkekpkm| ac |kr
lmgpm~| kg cksm la}gp~km| X?63Z ybm~m tkgl |}vvemjmgpopkag
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cmo|knkekp{ ac v~msmgpksm tkgl pbm~ov{ bo| oe|a nmmg
`mjag|p~opm` c~aj ~}~oe o~mo ac Ym|p Nmgioe X?69Z'
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ogpkjkl~ankoe }~kgi ko~~bmo yo| age{ ona}p agm*pbk~` kg
pbm kgpm~smgpkag lbke`~mg lajvo~m` pa pbop kg pbm
lajvo~k|ag lbke`~mg'
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ogpknkapkl }|m kg pbm vav}eopkag| ~mlmkskgi tkgl
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lo~miksm~| mrvmlpopkag ac jm`klkgm n{ `k|vmg|kgi tkgl%
og` o |bkcp kg lo~m|mmhkgi nmboska~ c~aj v~ksopm v~ask`m~
pa iasm~gjmgp c}glpkago~{' Kjv~asmjmgp kg A^\ }|m ~opm|
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^mva~p ag Lo}|m| ac @mopb4 >66?*6' ]gkpm Gopkag| Lbke`~mg| C}g` og` Jkgk|p~{ ac Bmoepb
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O eagikp}`kgoe |p}`{ kg og o~mo ac vaa~ |ogkpo~{ lag`kpkag|'
Kg`kog Vm`kop~' ?;;08=43?;*'
>;' \obo @^% ^odmg`~og H% ^ojoj}~pb{ P% Gog`{ ^H%
Nboppolbo~{o \H' Kgpm|pkgoe vo~o|kpk|j og` Skn~ka lbaem~om
kgcmlpkag ojagi `ko~~bamoe vopkmgp| kg Haehopo% Kg`ko'
Mvk`mjkae Kgcmlp' >6628?
7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea
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KG@KOG VM@KOP^KL\ 309 SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
mvk`mjkaeai{ ac ~aposk~}| kg lbke`~mg c~aj o lajj}gkp{*
no|m` nk~pb laba~p og` o ba|vkpoe kg \a}pb Kg`ko' D Lekg
Jkl~ankae' >6638004>032*90'
' Nboppolbo~{o ^% \obaa IL% Go{oh JH% Iba|b \% @}ppo V%
Nboppolbo~{o JH% mp oe' Jaeml}eo~ mvk`mjkaeai{ ac b}jog
o|p~ask~}| kgcmlpkag| kg Haehopo% Kg`ko' Kgcmlp Imgmp Msae'
>6638340>=*49>>*66>83;466?83242==*3>'
0?' Iasm~gjmgp ac Kg`ko4 Jkgk|p~{ ac Bmoepb # Cojke{
Ymeco~m8 Lbke` Bmoepb @ksk|kag' Jkg}pm| ac pbm Bkib Emsme
Lajjkppmm Jmmpkgi Bme` ag >6''v c'
Ollm||m` Dog}o~{ >3% >6?>'
0>' Nbopgoio~ \% Ea`bo % Lba}`b}~{ V% \olb ms BV\% \bob
G% Go~o{og \% mp oe' KOV I}k`mekgm| >663 ag jogoimjmgp
ac ol}pm ko~~bmo' Kg`kog Vm`kop~' >6698 0046?68?>34m?2*>='
0=' Mbeo{me J\% Nmgm~ O% On`}e~objog BJ' V~apmlpksm mccmlp
ac n~mo|pcmm`kgi ag `ko~~bmo ojagi lbke`~mg kg o ~ovk`e{
i~aykgi gmye{ `msmeavm` |alkmp{' P}~h D Vm`kop~'
>66;8=?4=>9*6608?64>2;*;0'
02' \oemmjk JO% Tojog \% Ohbpo~ BT% Doeke C% O|b~oc ^G%
Bog|ag EO% mp oe' Cmm`kgi voppm~g|% `ko~~bamoe keegm|| og`
ekgmo~ i~aypb kg 6*>0*jagpb*ae` lbke`~mg' D P~av Vm`kop~'
>6608=64?30*;'0;' Nbog o~k G% Nobe % Jot}j`o~ \% Jo~pkgm| D% Neolh M%
Nbog JH8 Kgcogp Cmm`kgi \p}`{ I~a}v' Mccmlp ac
lajj}gkp{*no|m` v~ajapkag ac mrle}|ksm n~mo|pcmm`kgi ag
`ko~~bamoe keegm|| og` i~aypb4 o le}|pm~ ~og`ajk|m`
lagp~aeem` p~koe' Eoglmp' >66' Mdmjap K% Mbk~k DM% Jm~mjkhy} JJ% L~kplbem{ DO' Bog`
yo|bkgi ca~ v~msmgpkgi ko~~bamo' Lalb~ogm @opono|m \{|p
^ms' >6628>3='
=66=8=40>*=>'
=0' L}~pk| S% Lok~gl~a|| \' Mccmlp ac yo|bkgi bog`| ykpb |aov
ag `ko~~bamo ~k|h kg pbm lajj}gkp{4 o |{|pmjopkl ~mskmy'
Eoglmp Kgcmlp @k|' >666?? 8?6346??8
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KG@KOG VM@KOP^KL\ 302 SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
oiokg|p lbke`baa` `ko~~bamo kg Me \oeso`a~4 lo|m*lagp~ae
|p}`{' NJD' >6?682>=' ak4?6'??6?6884>;;*6?6824L@666;90'
33' ^m``okob SV8 Hovaa~ \H' @am| jmo|em| kjj}gktopkag
~m`}lm `ko~~bamoe ja~nk`kp{' Kg`kog D Lajj Jm`
?;;66=8?;>"\}vve ?+4\?66;8'
9?' Iaiko \% \olb`ms B\' Skpojkg O |}vvemjmgpopkag ca~ pbm
v~msmgpkag ac ja~nk`kp{ og` ja~poekp{ kg kgcogp| |kr jagpb|
ac oim a~ em||' Lalb~ogm @opono|m \{|p ^ms'
>6??8>4L@669026'
9>' Jo{a*Yke|ag M% Kj`o` O% Bm~tm~ H% [ohaan J[% Nb}ppo
TO' Skpojkg O |}vvemjmgp| ca~ v~msmgpkgi ja~poekp{%
keegm||% og` nekg`gm|| kg lbke`~mg oim` }g`m~ =4 |{|pmjopkl
~mskmy og` jmpo*ogoe{|k|' NJD' >6??86??8??"\}vve 6'
90' Iaiko \% \olb`ms B\' Gmagopoe skpojkg O
|}vvemjmgpopkag ca~ v~msmgpkag ac ja~poekp{ og` ja~nk`kp{
kg kgcogl{4 |{|pmjopkl ~mskmy ac ~og`ajk|m` lagp~aeem`
p~koe|' NJD' >66;866286?? Ov~ ?6698??;4??>6*66286628?>24?3=*9?'
29' Noeo|}n~ojogkog \% Iogm|b ^' V~m|l~knkgi voppm~g ac tkgl
og` ogpkjkl~ankoe| kg ol}pm `ko~~bmo' Kg`kog Vm`kop~'
>66280=496?'
22' Lboh~ono~pk O' V~m|l~kvpkag ac ckrm` `a|m lajnkgopkag
`~}i| ca~ ko~~bamo' Kg`kog D Jm` Mpbkl|' >6698804?3=*9'
2;' Nbo~opbk~odo ^% \~k`bo~og \% Lbmeekob E^% \}~m|b \%
\mgi}pp}sog J' Colpa~| occmlpkgi ogpknkapkl v~m|l~knkgi
voppm~g kg vm`kop~kl v~olpklm' Kg`kog D Vm`kop~' >66=89>4299*
;'
;6' \kgib D% Na~o @% \olb`mso S% \bo~jo ^\% Sm~ibm|m P'
V~m|l~knkgi voppm~g n{ `alpa~| ca~ ol}pm `ko~~bamo kg
lbke`~mg kg @mebk% Kg`ko' @ko~~bamoe @k| ^m|' ?;;=8
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KG@KOG VM@KOP^KL\ 30; SAE]JM 0;QQO]I]\P ?3% >6?>
\BOB% mp oe' V^AJAPKGI OVV^AV^KOPMJOGOIMJMGPAC @KO^^BMO
?>;*?