Community survey of diarrhoea in children under 5 years in Kinshasa, Zaire.

This community based survey was undertaken to assess the prevalence, characteristics and risk factors of diarrhoea in children < 5 years of age in an urban zone, at Kinshasa, Zaire. 155 community cases selected by cluster sampling, 155 age-matched controls, and 18 children with diarrhoea seen at a health centre (HC) were examined. The diarrhoea prevalence rate was 6.5%. The highest risk of persistent diarrhoea was in children of 2 to 3 years, non breast-fed, with more than one enteric agent in their stools and living in households without electricity. The rates of detection of Strongyloides stercoralis, Entamoeba histolytica and Salmonella, and heavy infections of Trichuris trichiura and Trichomonas hominis were significantly higher in cases (p < 0.05). The rate of detection of Cryptosporidium was rather high, specially in HC cases (22.2%). It was also found in both diarrhoeal (14.8%) and non-diarrhoeal specimens (12.9%). There was a lack of association between the presence of faecal white blood cells and enteric bacteria, and also between the presence of faecal red blood cells and E. histolytica, which might be due to the frequent practice of rectal injections and suppositories. A mother's perception of fever and stool aspect was fairly in agreement (respectively 70% and 53%) with that of the investigators. The high rate of dehydrated children (50.9%) may be due to the dehydration definition applied at the HC. The survey's results were used to improve the local case management flow chart and to adjust educational activities directed at mothers.