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3 RESEARCH RECOMMENDATIONS The subcommittee identified a number of gaps in knowledge that have limited its ability to make quantitative judgments. These gaps are outlined below as priorities for basic and programmatic research. Basic research addresses questions pertaining to disease mechanisms and etiology, and the information it yields tends to be generalizable to varied local situations. Programmatic, or operational, research tends to be more country-specific, and the research questions and priorities usually need to be determined for each country. BASIC RESEARCH The following subjects need to be addressed by basic research: o Effects of agent-specific diarrhea on nutrient absorption and utilization in age-specific populations at various levels of nutritional status. (Information is particularly scant on micronutrient metabolism and depletion.) · Methods for rapid assessment of specific nutrient depletion. · Determinants of anorexia and its role in decreasing nutrient intakes during and after diarrhea. · Effects of different diets and feeding protocols on dehydration, vomiting, severity and duration of diarrhea, and nutritional status during diarrhea. - 27 -
· Effects of different diets and of antibiotic therapy on intestinal flora and digestive and absorptive capacities during diarrhea. · Effects of different diets and feeding protocols on digestive and absorptive capacities and nutritional repletion during convalescence. · Effects of different diets and feeding protocols on the local immune function of the gastrointestinal tract in age-specific populations. · Effects of early feeding in diarrhea on the incidence and severity of later diarrhea! episodes and on the impairment of intestinal function in later episodes. PROGRAMMATIC RESEARCH . The following subjects need to be addressed by programmatic research: o Cultural determinants of feeding practices during and after diarrhea. Most appropriate foods for dietary management of diarrhea, with particular reference to type, quantity, processing, preparation, and acceptability of local foods. · Most effective methods of influencing behavior of health workers and mothers in dietary management of diarrhea. 0 Efficacy of dehydration solutions made with household staple foods for replacing body fluid, shortening duration of diarrhea, preventing or reducing dehydration, and improving nutritional status. - 28 -
