The effects of health services utilization on the recovery from dysentery.

A community-based programme for the treatment of dysentery in children under five years of age was implemented in Matlab, Bangladesh. Dysentery cases, identified at home, were referred to a sub-center for standard treatment with nalidixic acid. To assess the response to this intervention, a one year survey was carried out in 1990. The incidence of dysentery in this age group was 7 per cent. Isolation of Shigella species was 27 per cent (47/177) and was strongly associated with the frequency of stools (chi2 for trend, P = 0.001). S. flexneri accounted for 81 per cent of the isolates. Only 45 per cent of the cases were actually taken to the sub-center, 27 per cent went to traditional healers and 23 per cent used private allopathic services. Less than 40 per cent of the shigellosis cases received the suggested standard treatment. The overall recovery rate at 7 days, based arbitrarily on the number and type of stools, was 62 per cent and quite homogeneous among the types of services used. Neither the presence of Shigella isolates nor the type of treatment were associated with a higher recovery rate. We concluded that a systematic treatment of dysentery patients should be more selective on shigellosis.