Children's fluid intake during diarrhoea: A comparison of questionnaire responses with data from observations

Many of the individual questions used by the World Health Organization for household surveys on diarrhoea management have not been systematically assessed. This study assessed the use of simple questions to caretakers of children to estimate the proportion of young children who received increased quantities of fluids during diarrhoeal episodes by comparing caretakers' responses with data obtained by direct observations. Children aged 4-35 mo (n=215) with diarrhoea starting within the last 24 h were observed for 12 h. These children were observed for 12 h again 2 wk later, when healthy. On the following day the questionnaire was administered to the caretakers. The observation focused on the frequency of feeding episodes, including breastfeeding and the type and quantity of fluids consumed by the child. The same questionnaire was administered to the caretakers of another group of children (n = 421) with diarrhoea in the past 2 wk. The mean number of feedings (6.0 ± 3.8 vs 5.04±3.5), breastfeeding episodes (11.2 ± 3.6 vs 8.4 ± 3.3), breastfeeding duration (85.8 ± 36.3 min vs 49.1 ± 22.8 min), other fluid intake (345.8 ± 309.6 ml vs 120.9 ± 136.4ml) and total fluid consumption (653.9 ± 240.4 ml vs 399.5 ± 133.6 ml) were significantly higher (p < 0.0001) during diarrhoea compared with healthy periods. At the population level, the simple questionnaire administered to caretakers was found to have high agreement between the reported increase in fluid consumption and the actual increase in fluid intake (defined as ≥100 ml). At the individual level, caretakers' questionnaire responses for detecting increased fluid intake were highly sensitive (84.3%), but specificity (36.4%) and agreement (0.22) were low. Conclusion: This study documents that children had higher fluid intake, which included both breast milk and other fluid, during acute episodes of diarrhoea. Further research is warranted to improve the specificity and agreement of caretakers' responses to simple questions regarding change in fluid intake during diarrhoeal episodes.