The epidemiology of diarrhoeal disease in children at Queen Elizabeth Central Hospital, Blantyre, Malawi, 1994-1997

Diarrhoeal disease (DD) is a leading cause of childhood morbidity and mortality in developing countries throughout the world. To begin to understand the burden of DD at Queen Elizabeth Central Hospital (QECH), its seasonality and age distribution, we reviewed inpatient and outpatient records for cases of gastroenteritis between 1994 and 1997. Annually, DO. accounted for an average of 7,300 attendances to the; Under 5's rehydration clinic, 1219 paediatric admissions (12% of all hospitalisations) and 183 deaths in hospitalised children (19% of total). A distinct seasonal pattern was identified with monthly peaks for DD occurring between October to January. Over 75% children (inpatients and outpatients) were below two years of age. During the study period, an increase in the number of outpatient attendances for DD was observed. In contrast, the number of children with a more severe outcome, hospitalisation or death, declined during the study period. This is likely to be explicable by the increasing and appropriate use of oral rehydration therapy. We conclude that DD is a substantial cause of morbidity and mortality in Malawian children. Further studies of the patterns of DD at QECH will be necessary to assess the impact ofDD control programmes.