Effectiveness of enhanced care for treatment of acute or persistent diarrhea in malnourished children aged 0 months to 10 years: A systematic review

Background: Diarrhea poses a significant public health challenge, particularly affecting children under five. The link between malnutrition and diarrhea is well established, with diarrhea being a primary cause of malnutrition in young children and malnutrition exacerbating the severity of diarrhea. While the World Health Organization (WHO) recommends a comprehensive approach to both diarrhea and malnutrition management, including oral rehydration, continuous feeding, zinc supplementation, and antibiotics for specific strains, it does not adequately address the complex needs of malnourished children with diarrhea who may benefit from enhanced care in the form of follow-up and monitoring beyond initial treatment. We aimed to assess the effectiveness of enhanced care—defined as hospitalization, close clinical monitoring, or longer follow-up after completion of treatment—compared to WHO-defined standard care in improving clinical outcomes among malnourished children aged 0 to 10 years experiencing acute or persistent diarrhea.Methods: A systematic search across PubMed, CINAHL, Cochrane Library, and Scopus identified 1494 records from 2000 onwards. Observational studies and randomized trials assessing the effectiveness of enhanced care for malnutrition and diarrhea in children in community- or hospital-based settings were considered. This review was commissioned by WHO to revise their guidelines on childhood diarrhea management.Results: Of the 1494 records, 1417 studies were excluded during the title and abstract screening. The remaining 77 studies underwent full-text screening, but all were excluded for not meeting the eligibility criteria. However, three studies assessing alternative care were presented, but none focused on enhanced care. Consequently, no synthesis or risk of bias was conducted.Conclusions: Our review did not identify studies meeting the definition of enhanced care for dehydrating diarrhea in malnourished children, underscoring the need for further research. Future reviews focusing on additional risk factors, including HIV and age, are also essential to establish conclusive evidence regarding the effectiveness of enhanced care in managing children with diarrhea.