Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review

Carter, Emily; Bryce, Jennifer; Perin, Jamie; Newby, Holly

doi:10.1186/s12889-015-2127-1

Table 1 Prevalence of harmful practices by region and country

From: Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review

Author, Year [reference]	Country	Study design, study population, number of participants	Proportion restricting fluid		Proportion restricting breastfeeding		Proportion restricting food		Proportion using drugs
Americas
Emond et al., 2002 [84]	Brazil	Cross-sectional baseline survey preceding intervention, Northeast Brazil 1997, Caregivers of children with diarrhea in the previous 2 days, n = 922							Generally give medicines other than ORS	7
Strina et al., 2005 [63]	Brazil	Longitudinal survey, Salvador 1997–1999, Caregivers of children ≤36 months with diarrhea in previous 2 weeks, n = 2403 episodes							Gave industrial medicines	40.9
Strina et al., 2005 [63]	Brazil								Gave industrial medicines & home preparation	2.7
Webb et al., 2010 [85]	Guatemala	Longitudinal survey, Population of Spanish-Mayan Descent 1996–1999, Caregivers of children <36 months with diarrhea in previous 19 days, n = 466	Stopped or less fluid^a	55	Stopped or less breastfeeding^b	26.6	Stopped or less food	15
Bachrach et al., 2002 [21]	Jamaica	Case-control hospital based survey, Kingston 2007, Caregivers of children <5 years presenting at hospital, n = 215 total, 117 gastroenteritis cases							Child presenting with gastroenteritis: Gave antidiarrheal/ antimotility drug before coming to hospital	36
Martinez et al., 1991 [52]	Mexico	Cross-sectional survey, Rural Highlands of Central Mexico (year not specified), Caregivers of children <5 years, diarrhea episode reference unclear, n = 38							Give pill as first treatment for diarrhea	47
Martinez et al., 1991 [52]	Mexico								Give over-the-counter drug to child	53
Perez-Cuevas et al., 1996 [40]	Mexico	Cross-sectional survey, Tiaxcala (year not specified), Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 747	“Withheld” non-breast milk	27.2	Stopped breastfeeding^b	12.2	Stopped or reduced food other than milk	9.1	Treated with any drug	35.2
Perez-Cuevas et al., 1996 [40]	Mexico		No liquids given	3			Any dietary restriction	36.6
Martinez et al., 1998 [86]	Mexico	Cross-section of ethnographic study participants, 3 States (year not specified), Caregivers of children <5 years in reference to most recent diarrhea episode, n = 186							Gave antimicrobial	37.1
									Gave antidiarrheal	28
									Gave antipyretic	18
Smith et al., 1993 [51]	Nicaragua	Cross-sectional survey, Rural Pacific Coastal Plain (year not specified), Caregivers of infants, diarrhea episode reference unclear, n = 70			Stopped breastfeeding (among those who reported changing feeding)^b	4	Did not give solid foods (among those who reported changing feeding)^c	13
Gorter et al., 1995 [79]	Nicaragua	Cross-section of ethnographic study participants, Rural Pacific Coastal Plain 1990, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 216							Gave antibiotic	22
									Gave parasite medicine	19
									Gave laxative	6
Vazquez et al., 2002 [33]	Nicaragua	Cross-sectional survey, North of Central Region 1990, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 187					Child ate less than usual	43.5	Gave any pharmaceutical	60
Kristiansson et al., 2009 [87]	Peru	Cross-sectional survey, Yurimaguas and Moyobamba Departments 2002, Caregivers of children 6–72 months with illness in previous 2 weeks, n = 780							Antibiotic use reported by wealth quintile only
Europe
Berisha et al., 2009 [16]	Kosovo	Cross-sectional survey, Kosovo 2005, Mothers of children <5 years in reference to most recent diarrhea episode, n = 107	Less fluid or none^a	62.6	Stopped or reduced amount of food or breastfeeding	43.9
Berisha et al., 2009 [16]	Kosovo		Same fluids^a	19.6	Same amount of food or breastfeeding	48.6
Eastern Mediterranean
Azim et al., 1993 [37]	Afghanistan	Cross-sectional study, Paktika Province 1991, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 87	Same or less fluid^d	43.7	Stopped breastfeeding^b	5.9	Stopped or less food	33.5	Gave any drug	66
Langsten et al., 1994 [88]	Egypt	Longitudinal survey, Lower Egypt 1990, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 4900	Stopped fluids other than BF and milk^d	2.8	Stopped breastfeeding^b	2.5	Stopped food	5.8
			Reduced other fluids^d	10.9	Decreased breastfeeding^b	11.9	Reduced food	22.7
			Reduced non-breast milk^d	15.3
			Stopped non-breast milk^d	9.9
Langsten et al., 1995 [57]	Egypt	Longitudinal survey, Lower Egypt 1990–1991, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 4900							Among acute non-dysenteric cases: Used antibiotics	46.5
									Among acute non-dysenteric cases: Used antibiotics only	3.2
									Among acute non-dysenteric cases: Used other medicine	63.3
									Among acute non-dysenteric cases: Used other medicine only	18.6
									Among all cases: Used antibiotics	45.6
									Among all cases: Used antibiotics only	3.4
									Among all cases: Used other medicine	63.0
									Among all cases: Used other medicine only	19.3
Jousilahti et al., 1992 [75]	Egypt	Cross-sectional cluster study, Lower Egypt 1992, Caregivers of children <5 years with diarrhea in previous 24 h, n = 766	Same or less fluid^d	75.6	Stopped breastfeeding^b	3.7	Stopped or less solid or semi-solid food	30.2	Gave any drug	54.2
									Gave drug and ORS	17.6
									Gave drug but no ORS	36.5
El-GIlany et al., 2005 [62]	Egypt	Cross-sectional study, Dakahalia 2002–2003, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 1052	Same or less fluid^e	29			Stopped feeding^e	12.7	Gave any drug	74.7
									Among those receiving a drug:	36.9
									Antibiotic^f	73.9
									Antidiarrheal^f	73.9
									Antiemetic^f	16.7
									Antiprotozoal^f	5.7
									Antipyretic^f	9.6
									Antispasmodic^f	1.7
Amini-Ranjbar et al., 2007 [53]	Iran	Cross-sectional study, Kerman 2005, Caregivers of children 6–24 months with diarrhea in previous 2 months, n = 330			Same or less breastfeeding^g	53.8	Decreased solid foods	20
WHO, 1991 [89]	Morocco	Cross-sectional study, National 1990, Caregivers of children <5 years with diarrhea in previous 24 h, n = 1066	Same or less fluid^e	70					Gave any drug	22.6
Morisky et al., 2002 [90]	Pakistan	Cross-sectional survey, National 1991–1992, Caregivers of children <2 years in reference to most recent episode, n = 5433	Stop fluids^e	9.2			Stopped food	5.9	Gave antibiotic	11
Morisky et al., 2002 [90]	Pakistan						Reduced food	6.2	Gave other medicine	9.2
Quadri et al., 2013 [13]	Pakistan	Cross-sectional study (HUAS), Low-Income peri-urban area near Karachi 2007, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 959	Did not offer “to drink” (at home before seeking care)^e	22.5			Did not offer “to eat” (at home before seeking care)^c	44.1	Gave antibiotic (at home)	7.7
Nasrin et al., 2013 [91]	Pakistan	Cross-sectional study (HUAS), Low-Income periurban area near Karachi 2007, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 349	Offered same or less than usual to drink	33.9			Offered less than usual to eat^e	33.6
Bella et al., 1994 [92]	Saudi Arabia	Case–control study, Eastern Province (year not specified), Caregiver of infant with diarrhea at time of survey versus caregiver of infant without diarrhea, n = 344 total, 68 cases	Stopped bottle feeding (among cases who were bottle feeding)	35
al-Mazrou et al., 1995 [93]	Saudi Arabia	Cross-sectional survey, National 1991, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 6300 screened							Gave drugs	40.7
al-Mazrou et al., 1995 [93]	Saudi Arabia								Gave IV fluids	4.7
Bani et al., 2002 [12]	Saudi Arabia	Cross-sectional hospital based survey, Riyadh City (year not specified), Mothers of children ≤24 months with diarrhea attending primary health clinic, n = 237	Less fluid given^e	11.3	Less frequency of breastfeeding^b	24.6	Less solid/semi-solid food given	22.7
Bani et al., 2002 [12]	Saudi Arabia		Same fluid given^e	13.2	Same frequency of breastfeeding^b	37.7	Same solid/semi-solid food given	22.6
Moawed et al., 2000 [20]	Saudi Arabia	Cross-sectional hospital based survey, Riyadh City 1998, Mothers of infants with diarrhea attending 2 pediatric hospital diarrhea centers, n = 300			Stop breastfeeding or milk feeding	62			Gave unprescribed medicine	38
Africa
Wilson et al., 2012 [11]	Burkina Faso	Cross-sectional survey, Orodara Health District 2012, Primary caregivers of children <27 months with diarrhea in previous 2 weeks, n = 1067	Same or less fluid^e	64.1	Stopped breastfeeding^b	1.2	Stopped or decreased feeding normal diet^e	53.2	Gave any drug other than ORS	41.2
Wilson et al., 2012 [11]	Burkina Faso								Gave antibiotic or unidentified drug	27.6
Olango et al., 1990 [17]	Ethiopia	Cross-sectional survey, Rural population in Wolayta district (year not specified), Mothers of children <5 years with diarrhea in previous 2 weeks, n = 619	Stopped fluids (breastfed children separate category within fluid intake measure)	8.6			Stopped food (not weaned are additional category)	15.2	Gave injection	40.8
			Decreased fluids	42.3			Decreased food	54.4	Gave tablets	19.6
			Same amount of fluids	10.3			Same amount of food	10.2
Ketsela et al., 1991 [94]	Ethiopia	Cross-sectional survey, Shewa Administrative Regions 1990, Mothers of children <5 years, diarrhea episode reference unclear, n = 750	No fluids^a	26.8	No breastfeeding^g	3.5	Gave less fluid than^c	35.9
			Less than usual fluid^a	31.4			Gave same fluid as usual^c	38.2
			Same as usual fluid^a	23.8			Gave no food^c	10.5
Mash et al., 2003 [95]	Ethiopia	Cross-sectional survey, Oromia Region 1997, Caregivers of children <24 months with diarrhea in the previous fortnight, n = 111	Stopped or decreased fluids^a	47.7	Stopped or decreased breastfeeding^b	67.6	Stopped or less solid or semi-solid food	67.6
Mediratta et al., 2010 [9]	Ethiopia	Case–control hospital based study, Gondar 2007, Caregivers of children <5 years with diarrhea attending referral hospital, case n = 220	Less of other fluids^a	29	Gave less breast milk^b	24	“Withheld” food	46
Mediratta et al., 2010 [9]	Ethiopia		Same amount^a	44	Same amount of breast milk^b	34
Saha et al., 2013 [96]	Gambia	Cross-sectional survey, Upper River Region 2009, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 258	Same or less fluid^e	36.1			Less than usual amount of food	72.5	Gave antimicrobial (at home)	9.7
									Gave antimicrobial (among those seeking care at health facility)	18.6
									Gave injectable medicine (among those seeking care at health facility)	43.7
Oyoo et al., 1991 [39]	Kenya	Cross-sectional survey, 6 sites across Kenya 1990, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 23884 screened	Same or less fluid^e	74 - 96	Stopped breastfeeding^b	0-3.1	Stopped feeding^a	19.5 - 53.3	Gave any drug (range across clusters)	25.9 - 47.1
Mirza et al., 1997 [97]	Kenya	Longitudinal study with 24 h dietary recall, Kibera Slum 1989–1990, Caregivers of children 3–37 months with diarrhea in the previous 3 days, n = 1496 episodes	Gave less cow’s milk than before diarrhea	28.7
Othero et al., 2008 [7]	Kenya	Longitudinal study, Nyanza Province 2004–2006, Caregivers of children <5 years in reference to most recent episode, n = 927	Offered nothing to drink^e	20.5			Did not eat anything (among all children)	39	Gave anti-diarrheal drugs	45.3
			Offered much less^e	59.9
			Offered somewhat less^e	3.3
			Offered same^e	5.3
Burton et al., 2011 [98]	Kenya	Cross-sectional survey, Rural Western Kenya 2005, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 188							Gave antibiotic	62.4
									Gave antimalarial	52.4
									Gave IV fluid	2.6
Olson et al., 2011 [42]	Kenya	Cross-sectional survey, Asembo (n = 371) and Kibera (n = 389) 2007, Caregivers of children <5 years with diarrhea in the previous 2 weeks	Asembo: Stopped fluids other than breast milk and porridge (among those giving fluids in week before illness)	9	Asembo: Stopped breastfeeding^b	5	Asembo: Stopped porridge	9	Asembo: Gave oral medication (not ORS or herbs)	77
			Kibera: Stopped fluids other than breast milk and porridge	18	Kibera: Stopped breastfeeding^b	16	Kibera: Stopped porridge	36	Kibera: Gave oral medication (not ORS or herbs)	81
			Asembo: Decreased fluids^h	42	Asembo: Decreased breastfeeding^h	32	Asembo: Decreased porridge^h	54	Asembo: Gave injected medication	24
			Kibera: Decreased fluids^h	47	Kibera: Decreased breastfeeding^h	47	Kibera: Decreased porridge^h	69	Kibera: Gave injected medication	28
			Asembo: Same fluids^h	47	Asembo: Same breastfeeding^h	59	Asembo: Same porridge^h	41	Asembo: Gave IV fluids	8
			Kibera: Same fluids^h	22	Kibera: Same breastfeeding^h	28	Kibera: Same porridge^h	18	Kibera: Gave IV fluids	7
							Asembo: Stopped soft or solid food	10
							Kibera: Stopped soft or solid food	37
							Asembo: Decreased solid food^h	54
							Kibera: Decreased solid food<	70
							Asembo: Same solid food^h	41
							Kibera: Same solid food^h	23
							Asembo: Stopped or Decreased feeding (including BF, porridge, solids)	36
							Kibera: Stopped or Decreased feeding (including BF, porridge, solids)	54
Omore et al., 2013 [41]	Kenya	Cross-sectional survey (HUAS), Western Kenya 2007, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 275	Offered same amount to drink	19			Offered usual amount to eat	16
			Offered less to drink	67			Offered less to eat	83
			Among those offering less: Somewhat less	52			Among offering less: Somewhat less	33
			Much less	38			Much less	30
			Nothing	10			Nothing	37
Nasrin et al., 2013 [91]	Kenya	Cross-sectional survey (HUAS), Western Kenya 2007, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 275							Gave leftover antibiotics at home	16
Zwisler et al., 2013 [68]	Kenya	Cross-sectional survey, 4 Provinces 2012, Caregivers of children <5 years with diarrhea in the previous 2 months, n = 857							Gave antibiotic	51.3
Zwisler et al., 2013 [68]	Kenya								Gave antimotility agent	10.4
Simpson et al., 2013 [99]	Kenya	Cross-sectional survey, Western Kenya (year not specified), Caregivers of children 6–60 month with diarrhea in the previous 6 months, n = 100							Gave antibiotic (at any point)	64
									Gave antimotility (at any point)	13
									Gave antibiotic (1^st treatment)	26
									Gave antibiotic (1^st or 2^nd treatment)	46
Winch et al., 2008 [71]	Mali	Cross-sectional baseline survey preceding intervention, Southern Mali 2004, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 228	Same or less fluid or breast milk	82.7					Gave antibiotics	57
			Stopped feeding or breastfeeding	46					Gave metronidazole	7.5
									Gave antidiarrheal	2.6
									Among children with only diarrhea symptoms gave: Antibiotic	16
									Antimalarial	16
									Paracetamol	10
Perez et al., 2009 [100]	Mali	Cross-sectional survey in intervention comparison area, Mopti Region 2006, Caregivers of children <5 years, reference episode unclear, n = 401							Gave any drug	56.1
Nasrin et al., 2013 [91]	Mozambique	Cross-sectional survey, Rural Southern Mali 2007, Caregivers of children <5 years with diarrhea in the previous 2 weeks, n = 67					Offered less than usual to eat	38.3	Gave leftover antibiotics at home	3.6
Nhampossa et al., 2013 [15]	Mozambique	Cross-sectional study (HUAS), Rural Southern Mozambique 2007 (Study 1 n = 67) and 2009–2012 (Study 2 n = 246), Caregivers of children <5 years with diarrhea in previous 2 weeks	Study 1: Reduced or stopped breastfeeding/usual fluid intake	12					Study 1: Gave antibiotic (Among those seeking treatment)	14
			Study 1: Maintained same fluid or breast milk intake	73
			Study 2: Reduced or stopped breastfeeding/usual fluid intake	79
			Study 2: Maintained same fluid or breast milk intake	1
Ekanem et al., 1990 [47]	Nigeria	Diarrhea surveillance survey, Periurban Lagos (year not specified), Mothers of children 6–36 months, reference episode is general case, n = 200			Normal breastfeeding pattern continued^b	76.9
Ekanem et al., 1990 [47]	Nigeria				Decreased breastfeeding^b	10.4
Babaniyi et al., 1994 [10]	Nigeria	Cross-sectional study, Suleja 1991, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 340	Normal amount of “other” fluids^ai	55.6	Stopped breastfeeding^b	7.7	Stopped or less solid food	42.4	Gave any drug (at home)	53.5
Babaniyi et al., 1994 [10]	Nigeria		Less “other” fluids^ai	22.6
Okoro et al., 1995 [74]	Nigeria	Cross-sectional study, Cross River State 1994, Caregivers of children <5 years with diarrhea in previous 24 h, n = 488							Gave any drug	75.6
Okoro et al., 1995 [74]	Nigeria								Gave drug and ORS/SSS	51.9
Okunribido et al., 1997 [26]	Nigeria	Longitudinal study, Rural Yoruba communities of rural Oyo State (year not specified), Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 98	Stopped fluids (among those who noticed fluid intake)^e	2	Child could not suck	23.4	Stopped food	3	Gave Western medicine: 1^sttreatment, among those treating	37.7
			Child refused fluid	29.5	Lost appetite	34.6	Reduced appetite	68.8	Gave Western medicine: 2^ndtreatment, among those treating	30.3
									Gave Western medicine at any point for watery diarrhea	50
									Gave Western medicine at any point for presumed dysentery	52.7
Edet et al., 1996 [101]	Nigeria	Cross-sectional study, Oduknani 1994, Caregivers of children <5 years with diarrhea in previous 24 h, n = 5296 screened	Less fluid^a	48.2	Stopped breastfeeding^b	59.9	Stopped feeding	13.8
			Same fluid^a	37.3			Less food	32.8
							Same food	49
Omokhodion et al., 1998 [102]	Nigeria	Cross-sectional study, Market women in Ibadan 1996–1997, Market women with children <5 years in reference to any diarrhea episode, Bodia n = 266, Gbagi n = 260							Bodija Market: Went to chemist to buy drugs	12
									Gbagi Market: Went to chemist to buy drugs	19
									Bodija Market: Used drugs prescribed for previous illness	7
									Gbagi Market: Used drugs prescribed for previous illness	5
Ene-Obong et al., 2000 [81]	Nigeria	Surveillance study, Market women in Enugu State 1993–1994, Market women with children <5 years with diarrhea in previous 2 weeks, n = 80							Gave pharmaceutical	28.8
Ene-Obong et al., 2000 [81]	Nigeria								Gave pharmaceutical & sugar-salt solution	33.8
Omotade et al., 2000 [38]	Nigeria	Surveillance study, Oyo State 1993–1994, Caregivers of children <5 years with diarrhea in previous week, n = 158							Gave antimicrobial	46.8
Uchendu et al., 2009 [60]	Nigeria	Cross-sectional hospital based study, Enugu 2006, Caregivers of children <5 years attending health clinic with diarrheal disease and vomiting, n = 156							Gave antibiotic (at home)	51.3
Uchendu et al., 2009 [60]	Nigeria								Gave antimotility/antidiarrheal (at home)	44.9
Uchendu et al., 2011 [45]	Nigeria	Cross-sectional hospital based study, Enugu 2006, Caregivers of children <5 years attending health clinic with diarrheal disease and vomiting, n = 156					Stopped feeds^e	5.2
Ogunrinde et al., 2012 [103]	Nigeria	Cross-sectional hospital based survey, Northwestern Nigeria (year not specified), Caregivers of child 1–59 months attending health clinic with diarrheal disease, n = 186							As first line treatment gave:
									Antibiotic	23.7
									Antidiarrheal	12.7
									ORS, antibiotic, antidiarrheal	3
Ekwochi et al., 2013 [64]	Nigeria	Cross-sectional hospital based study, Enugu 2012, Caregivers of children ≤5 years attending university teaching hospital, reference any diarrhea episode, n = 210							Gave unprescribed antibiotic	46.7
Cooke et al., 2013 [104]	South Africa	Cross-sectional hospital based study, Capetown 2007–2008, Caregivers of children <65 months with severe diarrhea attending hospital, n = 142	Same or less fluid among all (but gave some ORS or milk)	36.6	Stopped breastfeeding/milk (but gave other fluids)^b	35.2
Haroun et al., 2012 [105]	Sudan	Cross-sectional hospital based study, Gezira (year not specified), Mothers of children <5 years, diarrhea episode reference unclear, n = 110	Stopped or reduced fluid during episode^e	49			Stopped feeding^e	30
			Same amount of fluid during episode^e	33
			Stopped or reduced fluid during episode but didn’t change amount of food^e	23
Kaatano et al., 1997 [8]	Tanzania	Cross-sectional survey, North-western lake districts (year not specified), Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 89	Stopped or decreased fluid^e	12.6	Stopped breastfeeding^b	46.7	Stopped or decreased food	13.8	Gave anti-diarrheal	29.2
Kaatano et al., 1997 [8]	Tanzania								Gave antibiotic	13.5
South East Asia
Alam et al., 1998 [82]	Bangladesh	Cross-sectional survey, Metropolitan Chittagong 1996–1997, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 360							“Inappropriate or non-recommended drug use” among those receiving treatment	73.5
									Gave metronidazole (denominator all consultations)	38.6
									Gave antibiotic (denominator all consultations)	17.5
									Gave antiemetic (denominator all consultations)	12.2
									Gave antidiarrheal (denominator all consultations)	8
Ali et al., 2000 [27]	Bangladesh	Cross-sectional survey, Brahmanharia district 1993, Caregivers of children <5 years with diarrhea in previous 24 h, n = 186	Drank less than usual amount of water (not amount offered)	17
Taha et al., 2002 [106]	Bangladesh	Cross-sectional survey, Cox’s Bazar district 1994, Mothers of children <5 years, diarrhea episode reference unclear, n = 297	No fluids for treating diarrhea^e	11.7	Stopped breastfeeding^b	11.7	Did not give solid or semi-solid food^c	40.4
Baqui et al., 2004 [73]	Bangladesh	Community based controlled trial, Matlab 1998–2000, Caregivers of children 3–59 months with diarrhea in previous week, n = 297							Gave antibiotic	34.3
									Gave other medicine	44.8
									Gave IV	0.3
Larson et al., 2009 [107]	Bangladesh	Cross-sectional baseline survey preceding intervention, Dhaka 2006, Caregivers of children 6–59 months with diarrhea in previous 2 weeks, n = 640							Gave antibiotic	34.7
Das et al., 2013 [14]	Bangladesh	Cross-sectional survey (HUAS), Rural Mirzapur 2007, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 1128	Offered less than usual amount of fluids	10.8			Offered less to eat (at home before seeking care)	28.7	Gave antibiotics (at home before seeking care)	2.4
			Same amount	61.3
			Same or less	72.1
Sood et al., 1990 [108]	India	Cross-sectional survey, Rural Haryana State (year not specified), Caregivers of children <5 years, reference any diarrhea episode, n = 108			Generally stopped breastfeeding	0	Some food restricted	83.33
Rasania et al., 1993 [23]	India	Cross-sectional survey, New Delhi (year not specified), Caregivers of children <5 years, diarrhea episode reference unclear, n = 254			Restricted breastfeeding^b	12.59	Gave less food during convalescence	26.38
					Stopped breastfeeding^b	19.29	Shifted from solid to liquid diet	45.27
							Stopped all food^e	9.84
							Restricted “few” foods	16.53
Gupta et al., 2007 [109]	India	Cross-sectional survey, Urban Delhi slum 2004, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = unclear 1307	Stopped fluid^e	20			Stopped feeding (not clear if food or breastfeeding)	50
Ahmed et al., 2009 [46]	India	Cross-sectional survey, Kashmir Valley 2006, Caregivers of children <5 years with diarrhea in previous 24 h (n = 1055) and 2 weeks (n = 2836)					Among diarrhea in 15 days: Feeding restricted^e	4	Diarrhea in last 24 h: Gave antibiotic	77.9
Ahmed et al., 2009 [46]	India						Diarrhea in last 24 h: Feeding restricted^e	6.9
Shah et al., 2012 [31]	India	Cross-sectional survey, Urban slum of Aligarh 2009, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 101			Stopped or decreased breastfeeding (among EBF 0-6 m)^b	30.77	Interrupted, stopped or decreased feeding (among not breastfeeding: 7 m-5 years)	37.8
Shah et al., 2012 [31]	India				Stopped or decreased breastfeeding (among non-EBF 0-6 m)^b	80
Zwisler et al., 2013 [68]	India	Cross-sectional survey, 7 States 2012, Caregivers of children <5 years with diarrhea in the previous 2 months, n = 988							Gave antibiotic	56.4
Zwisler et al., 2013 [68]	India								Gave antimotility agent	3
WHO 1991 [110]	Nepal	Cross-sectional survey, Terai (n = 335) and Midhills (n = 526) 1990, Caregivers of children <5 years with diarrhea in previous 24 h	Terai: Same or less fluid^a	72	Terai: Stopped breastfeeding^b	1	Terai: Stopped or Less Feeding	25	Terai: Gave drug, no ORS	21.5
			Midhills: Same or less fluid^a	91	Midhills: Stopped breastfeeding^b	1	Midhills: Stopped or Less Feeding	39	Midhills: Gave drug, no ORS	14.3
									Terai: Gave drug and ORS	4.5
									Midhills: Gave drug and ORS	4.9
Jha et al., 2006 [111]	Nepal	Cross-sectional hospital based study, Sunsari District (year not specified), Caregivers of children <5 years with diarrhea attending PHC, n = 330					Not Given Food^ec	2.1	Gave any drug at any point	70
							Less frequency of food given^ec	12.5	Gave antibiotic	19.9
							More liquid mixed food given	13.1	Gave antimotility drug	16.8
							Fed as usual, child refused	14.6	Gave anti-vomiting drug	15.5
							Usual feeding	57.7	Gave IV	17.7
WHO 1993 [77]	Sri Lanka	Cross-sectional survey, North-western Province 1992, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 10077 screened	Same or less fluid^e	63			Stopped feeding^e	23	Gave any medicine	71
Wongsaroj et al., 1991 [65]	Thailand	Cross-sectional survey, 12 Regions 1991, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 733	Same or less fluid^e	91.8	Stopped breastfeeding^b	16.6	Stopped solid foods	28.7	Gave any antibiotic or antidiarrheal	58.6
									Gave IV	6.2
									Gave antibiotic	18
									Gave antidiarrheal	19.3
									Gave both antibiotic and antidiarrheal	21.3
Prohmmo et al., 2006 [28]	Thailand	Surveillance survey, Northeast Region 2002, Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 47 episodes	Same or decreased fluid	42.5	Stopped breastfeeding^b	0			Gave antimicrobial	45
									Gave antiemetic	19
									Gave antidiarrheal	13
									Gave cold medicine	15
									Gave antipyretic	25
Western Pacific
Dearden et al., 2002 [22]	Vietnam	Cross-sectional survey, Rural northern province, Caregivers of children 6–18 months, reference any diarrhea episode, n = 100					Generally give less or no foods and liquids	71
Hoan et al., 2009 [112]	Vietnam	Cross-sectional survey, Rural district (year not specified), Caregivers of children <5 years with diarrhea in previous 2 weeks, n = 133							Among children with only diarrhea symptoms gave:	54.1
									Antibiotics	36.1
									Anti-diarrheal	36.1
									Antihistamine	3
									Analgesic/antipyretic	13.5
									Cough and cold prep	0.8
									Corticosteroid	2.3

^aExcluding breast milk
^bAmong those breastfeeding
^cUnclear if only among those receiving solid or semi-solid food before illness
^dAmong drinking fluids other than breast milk
^eInclusion/exclusion of breastfeeding not specified
^fAmong those receiving drug as treatment
^gUnclear if only among those breastfeeding at time of illness
^hAmong those who continued to receive fluids; breast milk; food
ⁱExplicitly excluding ORS/SSS

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