CASE PRESENTATION: A 78-year-old Han Chinese man living in a nursing home was diagnosed with fecal impaction; his initial symptom was overflow diarrhea, which is a rare occurrence with regard to fecal impaction. Nevertheless, we were able to effectively treat this situation by employing a new medical device that presents a novel method for addressing fecal impaction.
CONCLUSION: Early identification of fecal impaction with atypical symptoms is crucial to provide proper emergency management. A safe and noninvasive treatment method, especially for elderly patients with fecal impaction, should be chosen.
METHODS: Data from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available.
RESULTS: From 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases.
DISCUSSION AND CONCLUSION: We present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.
METHOD: Data from the National Health and Morbidity Survey 2016 conducted by Ministry of Health was analysed. This nationwide survey involved 15,188 children below five years old. The survey was carried out using a two-stage stratified sampling design to ensure national representativeness. The Questionnaire from UNICEF's Multiple Indicator Cluster Survey (MCIS) was adapted to suit local requirements. Analysis was done using SPSS Version 23. Descriptive followed by multiple logistic regression were done to identify relevant factors.
RESULT: The prevalence of diarrhoea among children under five in Malaysia was 4.4% (95% CI: 3.8,5.2). Analysis using logistic regression indicated that only ethnicity and usage of untreated water were significantly associated with diarrhoea among children after controlling for relevant factors. By ethnicity, children in the 'Other Bumiputera' group had 2.5 times the odds of having diarrhoea compared to children of Malay ethnicity. Children of Indian ethnicity were also at higher risk, at almost double the odds, as well as other ethnic groups (1.5 times). Children who used untreated water supply were two times more likely to develop diarrhoea.
CONCLUSION: There is a higher risk of diarrhoea among children of 'Other Bumiputera' ethnicity, Indian ethnicities, and other ethnic groups and those who consume untreated water. Strategies to reduce diarrhoea among children should be targeted towards these at-risk populations. In addition, the Government must strive to ensure universal access to treated clean water in Malaysia and the Ministry of Health must focus on raising awareness on how to prevent diarrhoea.