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首页> 外文期刊>BMC Pediatrics >Stool frequency recording in severe acute malnutrition (‘StoolSAM’); an agreement study comparing maternal recall versus direct observation using diapers
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Stool frequency recording in severe acute malnutrition (‘StoolSAM’); an agreement study comparing maternal recall versus direct observation using diapers

机译：严重急性营养不良时的粪便频率记录（“ StoolSAM”）;一项协议研究，比较了母亲回忆和使用尿布进行直接观察

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Background Approximately 50% of the deaths of children under the age of 5 can be attributed to undernutrition, which also encompasses severe acute malnutrition (SAM). Diarrhoea is strongly associated with these deaths and is commonly diagnosed solely based on stool frequency and consistency obtained through maternal recall. This trial aims to determine whether this approach is equivalent to a ‘directly observed method’ in which a health care worker directly observed stool frequency using diapers in hospitalised children with complicated SAM. Methods This study was conducted at ‘Moyo’ Nutritional Rehabilitation Unit, Queen Elizabeth Central Hospital, Malawi. Participants were children aged 5–59?months admitted with SAM. We compared 2?days of stool frequency data obtained with next-day maternal-recall versus a ‘gold standard’ in which a health care worker observed stool frequency every 2?h using diapers. After study completion, guardians were asked their preferred method and their level of education. Results We found poor agreement between maternal recall and the ‘gold standard’ of directly observed diapers. The sensitivity to detect diarrhoea based on maternal recall was poor, with only 75 and 56% of diarrhoea cases identified on days 1 and 2, respectively. However, the specificity was higher with more than 80% of children correctly classified as not having diarrhoea. On day 1, the mean stool frequency difference between the two methods was ?0.17 (SD; 1.68) with limits of agreement (of stool frequency) of ?3.55 and 3.20 and, similarly on day 2, the mean difference was ?0.2 (SD; 1.59) with limits of agreement of ?3.38 and 2.98. These limits extend beyond the pre-specified ‘acceptable’ limits of agreement (±1.5 stool per day) and indicate that the 2 methods are non-equivalent. The higher the stool frequency, the more discrepant the two methods were. Most primary care givers strongly preferred using diapers. Conclusions This study shows lack of agreement between the assessment of stool frequency in SAM patients using maternal recall and direct observation of diapers. When designing studies, one should consider using diapers to determining diarrhoea incidence/prevalence in SAM patients especially when accuracy is essential. Trial registration number ISRCTN11571116 (registered 29/11/2013).
机译：背景技术5岁以下儿童死亡的大约50％可归因于营养不良，其中还包括严重的急性营养不良（SAM）。腹泻与这些死亡密切相关，通常仅根据粪便频率和通过母体召回获得的一致性来诊断。该试验旨在确定这种方法是否等同于“直接观察方法”，在该方法中，医护人员使用尿布直接观察住院的复杂SAM儿童的粪便频率。方法该研究在马拉维伊丽莎白女王中心医院的“ Moyo”营养康复中心进行。参加者是接受SAM治疗的5至59个月大的儿童。我们将第二天产妇召回获得的2天粪便频率数据与“金标准”进行了比较，在“黄金标准”中，医护人员每隔2小时使用尿布观察一次粪便频率。完成学习后，询问监护人他们偏爱的方法和受教育程度。结果我们发现母体召回与直接观察到的尿布的“黄金标准”之间的一致性差。根据产妇召回来检测腹泻的敏感性很差，分别在第1天和第2天仅发现了75％和56％的腹泻病例。然而，超过80％的儿童正确分类为没有腹泻的特异性更高。在第1天，两种方法之间的平均大便频率差异为±0.17（SD; 1.68），对（大便频率的）一致极限为±3.55和3.20，类似地，在第2天，平均差异为±0.2（SD ; 1.59），协议限制为？3.38和2.98。这些限制超出了预先规定的“可接受的”同意限制（每天±1.5大便），并表明这两种方法是不等效的。粪便频率越高，两种方法的差异就越大。大多数初级护理人员强烈优选使用尿布。结论该研究表明，在使用产妇召回评估SAM患者的大便次数与直接观察尿布之间缺乏一致性。在设计研究时，应该考虑使用尿布来确定SAM患者的腹泻发生率/流行率，特别是在准确性至关重要的情况下。试用注册号ISRCTN11571116（2013年11月29日注册）。

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