As the AIDS pandemic has spread, diarrhoea in adults has become a major burden on health care institutions in central Africa and on the families of sufferers. In order to assess the magnitude of the problem, we carried out a survey of households in a high population density township of Lusaka to determine the prevalence of persistent diarrhoea in adults. We also carried out a study of the causes of persistent diarrhoea in patients attending the University Teaching Hospital, Lusaka. The community survey assessed 460 households, representing a sample of 1440 adults. 94 adults were reported as having had diarrhoea in the 2 weeks prior to the survey, implying an attack rate of 1.74 per adult per year. Of these 94 cases, six had diarrhoea of between 2 and 4 weeks duration, and ten had diarrhoea of over 4 weeks duration. In the hospital study, 75 (97%) out of 77 patients with diarrhoea of over 1 months' duration were HIV seropositive; potentially pathogenic parasites were found in 61/75 (81%) of seropositives. This information indicates that persistent diarrhoea in adults, mostly related to HIV infection, is likely to be an important and growing reservoir of enteric pathogens and represents a significant burden on hospitals and relatives. This emerging problem in sub-Saharan Africa may foreshadow developments in other continents.
PIP: This study assesses the prevalence of diarrheal diseases in adults in urban Zambia as it relates to HIV infection in order to develop possible strategies for the management of AIDS patients. The study was conducted in a community via a house-to-house survey. In addition, the causes for persistent diarrhea in patients at the University Teaching Hospital were also investigated. The community sample consisted of 1440 adults, of which 94 (6.5%) had had diarrhea in the previous 2 weeks, which translates into an attack rate of 1.74 episodes/adult/year. Of these cases, 6 (6.4%) had diarrhea lasting between 2 and 4 weeks; 10 (10.6%) had diarrhea lasting over 4 weeks. In the hospital setting, 75 (97.4%) out of 77 patients with diarrhea lasting over 4 weeks were also HIV seropositive. Pathogenic parasites were found in 61 (81.3%) of the seropositive patients. The authors conclude that persistent diarrhea in adults, mostly related to HIV infection, is likely to represent an important and growing reservoir of enteric pathogens; furthermore, it presents a significant burden on hospitals and families.