Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh

Rabbani, Golam; Larson, C. Philip; Islam, Rafiqul; Saha, Unnati Rani; Kabir, Ahsanul

doi:10.1111/j.1365-3156.2010.02608.x

Cited by 40 publications

(33 citation statements)

References 17 publications

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“…Majority (80%) of the mothers believed thin watery diarrhea as the most dangerous, hence mothers may be more attentive to this type of diarrhea and may neglect or pay less attention toward the diarrhea of other types [2,17,18]. The beneficial role of green banana in diarrhea is well known, but the finding of this study pinpointed ripened maalbog kera , a special type of banana in eastern Nepal as beneficial during diarrhea [19]. This may affect the management of diarrhea at home due to reluctance to use available bananas of other types.…”

Section: Discussionmentioning

confidence: 99%

Mothers’ beliefs and barriers about childhood diarrhea and its management in Morang district, Nepal

et al. 2012

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BackgroundIn developing countries, mothers usually manage diarrhea at home with the pattern of management depending on perceived disease severity and beliefs. The study was carried out with the objective of determining mothers’ beliefs and barriers about diarrhea and its management.MethodsQualitative methods involving two focus group discussions and eight in-depth interviews were used to collect the data. The study was conducted at the following places: Tankisinuwari, Kanchanbari and Pokhariya of Morang district, Nepal during the months of February and March 2010. Purposive sampling method was adopted to recruit twenty mothers based on the inclusion criteria. A semi-structured interview guide was used to conduct the interviews. Written informed consent was obtained from all of the participants before conducting the interviews. The interviews were moderated by the main researcher with the support of an expert observer from Nobel Medical College. The interviews were recorded with the permission of the participants and notes were written by a pre trained note-taker. The recordings were transcribed verbatim. All the transcribed data was categorized and analyzed using thematic content analysis.ResultsTwenty mothers participated in the interviews and most (80%) of them were not educated. About 75% of the mothers had a monthly income of up to 5000 Nepalese rupees (US$ 60.92). Although a majority of mothers believed diarrhea to be due to natural causes, there were also beliefs about supernatural origin of diarrhea. Thin watery diarrhea was considered as the most serious. There was diversity in mothers’ beliefs about foods/fluids and diarrhea management approaches. Similarly, several barriers were noted regarding diarrhea prevention and/or management such as financial weakness, lack of awareness, absence of education, distance from healthcare facilities and senior family members at home. The elderly compelled the mothers to visit traditional healers.ConclusionsThere were varied beliefs among the mothers about the types, causes and severity of diarrhea, classification of foods/fluids and beliefs and barriers about preventing or treating diarrhea.

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Section: Discussionmentioning

confidence: 99%

Mothers’ beliefs and barriers about childhood diarrhea and its management in Morang district, Nepal

et al. 2012

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“…The dietary comparisons made in many existing studies on dietary management of childhood diarrhea were not compatible with the comparisons we ultimately identified for this review and were therefore not included (Additional File 3). Other approaches that have been evaluated by randomized controlled trial in low- and middle-income settings include the use of amylase-rich flours in cereal-based porridges to decrease viscosity and thus increase nutrient density and children’s nutrient intake [53-55], and incorporating into mixed diets specific ingredients thought or known to have antidiarrheal properties, such as green banana [56,57]. A synthesis of the evidence for the full range of management options would best inform guidelines for optimal diet selection for childhood diarrhea treatment.…”

Section: Discussionmentioning

confidence: 99%

Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

et al. 2013

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BackgroundCurrent WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea.MethodsWe conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately.ResultsEvidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet.ConclusionsAmong children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.

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“…SCFA have trophic effect on colon epithelia, and stimulate salt and water absorption (Rabbani et al ., ). Clinical trials in Bangladesh showed a clear therapeutic benefit of green banana in dietary management of persistent diarrhea (Rabbani et al ., ) and shigellosis (Rabbani et al ., ) in children. Green banana reduced stool volume and improved stool quality, shortened the duration of illness and hastened clinical recovery.…”

Section: Treatment Algorithms Further Define Pd Pathogenesis Modelsmentioning

confidence: 99%

Persistent diarrhea: a persistent infection with enteropathogens or a gut commensal dysbiosis?

Sarker

Ahmed

Brüssow

2017

Environmental Microbiology

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In children from developing countries 5-10% of acute diarrhea (AD) episodes develop into persistent diarrhea (PD) defined by > 14 days of diarrhea duration. PD represents a major health burden leading to growth faltering. It is also associated with half of all diarrhea mortality. A rational intervention is thus crucial, but depends on an understanding of the pathogenesis of PD, which is still lacking. Many surveys were conducted in Latin America and in South Asia; they differ, however, with respect to enteropathogens associated with PD. Enteroaggregative strains of Escherichia coli (EAEC) were identified by several studies, but they may reflect selection by the frequent antibiotic use during the preceding AD episode. Epidemiologists have in fact identified antibiotic misuse as a major risk factor for PD. Together with the effectiveness of empirical treatment based on nutritional interventions with lactose-reduced and lactose-free diets and particularly complex plant polysaccharides from green banana, one might suspect a role of commensal gut microbiota dysbiosis instead of a persistent infection with enteropathogens in many PD cases. An analysis of the commensal gut microbiota development in persistent diarrhea during nutritional interventions is likely to increase our understanding of PD pathogenesis.

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Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh

Cited by 40 publications

References 17 publications

Mothers’ beliefs and barriers about childhood diarrhea and its management in Morang district, Nepal

Mothers’ beliefs and barriers about childhood diarrhea and its management in Morang district, Nepal

Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

Persistent diarrhea: a persistent infection with enteropathogens or a gut commensal dysbiosis?

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