{
  "abstract": "Diarrhoea remains an important cause of morbidity and mortality among children, and the bulk of diarrhoeal deaths occur in low- and middle-income countries. 1 2 Dysbiosis has been linked with the occurrence and increased duration of diarrhoea, and evidence suggests that probiotics can help reduce the duration and severity of diarrhoeal illnesses.3 4 A systematic review was conducted, following the PRISMA guidelines, to evaluate the effects of probiotics on the treatment of childhood diarrhoea in low-income and lower-middle-income countries.Databases (PubMed, Scopus, Web of Science, EMBASE, CENTRAL and Google Scholar) were searched in November 2024, using search terms including ‘probiotic’, ‘diarrhoea’, and ‘children’. Randomised controlled trials (RCTs) conducted in low-income and lower-middle-income countries which compared specific probiotics with ‘no probiotic or a placebo’ for the treatment of diarrhoea in children aged five years and below were included. Studies focusing on antibiotic-associated diarrhoea, synbiotics or the prophylactic use of probiotics for the prevention of diarrhoea were excluded. The methodological quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool for RCTs.5 A narrative synthesis approach was employed to summarise the findings of the studies.A total of 4,528 titles and abstracts were screened, and 33 studies that met the inclusion criteria were included in the review. The PRISMA flow diagram of the study selection process is shown in figure 1. Thirty-two of the studies focused on acute watery diarrhoea (three were specific for rotavirus aetiology), while one study involved children with persistent diarrhoea. The duration of probiotic therapy was 2 to 10 days, with 5 days being the most frequent. Twenty-five of the studies reported a significant reduction in the duration of diarrhoea with probiotic treatment, while seven found no significant beneficial effect. Probiotics reduced diarrhoea duration by a mean period of 1 day. Of the 21 studies that assessed the effect of probiotics on stool frequency, 16 reported a significant reduction in daily stool frequency with probiotic treatment. In most studies, the beneficial effects were particularly prominent on days 3 - 4 of probiotic therapy. Saccharomyces boulardii was the most frequently used probiotic, followed by Lactobacillus rhamnosus. Fifteen studies were rated as having a low risk for bias, 12 had a moderate risk, and 6 had a high risk for bias.The study showed that probiotics are effective in reducing the duration of diarrhoea and may also decrease stool frequency in children living in low-income and lower-middle-income countries, thereby potentially reducing diarrhoeal deaths. Variability in exclusion criteria across the included studies poses a limitation, as this could have affected the baseline severity of diarrhoea and consequently, the observed response to probiotics. Hence, sensitivity analysis and subgroup effects may be considered in future studies to assess the robustness of these findings.References Reiner RC, Wiens KE, Deshpande A, et al. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the global burden of disease study 2017. Lancet 2020;395:1779–801.Troeger C, Forouzanfar M, Rao PC, et al. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the global burden of disease study 2015. Lancet Infect Dis. 2017;17:909–948.Applegate JA, Fischer-Walker CL, Ambikapathi R, et al. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Public Health 2013;13(Suppl 3):S16.De Vrese M, Marteau PR. Probiotics and prebiotics: effects on diarrhea. J Nutr. 2007;137:803–11.Barker TH, Stone JC, Sears K, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis 2023;21:494–506.Abstract OC4 Figure 1PRISMA flow diagram of the study selection process for the systematic review",
  "authors": [
    {
      "affiliations": [
        "Benjamin Carson College of Health and Medical Sciences, Babcock University, Ilishan, Nigeria",
        "Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom"
      ],
      "name": "Olufunmilola Abolurin"
    },
    {
      "affiliations": [
        "Lagos State University College of Medicine, Lagos, Nigeria"
      ],
      "name": "Idowu Senbanjo"
    },
    {
      "affiliations": [
        "Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom"
      ],
      "name": "Alicia Green"
    },
    {
      "affiliations": [
        "Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom"
      ],
      "name": "Nicholas Croft"
    },
    {
      "affiliations": [
        "Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom"
      ],
      "name": "Farah Barakat"
    }
  ],
  "title": "OC4 A systematic review of the effects of probiotics on the treatment of childhood diarrhoea in low-income and lower-middle-income countries.",
  "uid": "9459b62c-7390-57fd-bda8-a358a1f7dab7"
}