Study of Stool Color Chart
Stool Colour Chart – A Qualitative Study Page 7
reference SCC for parents to mark the colour of stool on the card then the SCC is posted back to a central
registry office at around 30 days of age. Medical services are then mobilised if the stool colour is abnormal. A
routine 30 day infant check with a medical professional was another reporting time and opportunity for the
SCC to be sent back to the registry centre. Although rates of SCC return were variable, in Taiwan, the
sensitivity of this universal screening is 97.1 percent with a specificity of 99.9 percent, leading to earlier
diagnosis and intervention. [30, 31] As a positive consequence of earlier diagnosis, more successful HPE
operations have been seen in Taiwan and the five year survival rate with the child’s native liver increasing from
55.7 percent to 89.3 percent. [32] In Japan, the mean age at time of HPE was 58 days in the screening
programme, compared to 84 days without the programme. [33]
It is difficult to ascertain whether the SCC screening or better public awareness has led to the increased pick-
up rates, but nonetheless, the implementation of a SCC has led to improved outcomes for BA. In this study, a
combined initiative has been adopted, so the SCC is used as a passive screening tool but also as a means to
open up dialogue and raising awareness between families and health professionals in order to ensure all
infants with acholic stools are identified in a timely fashion. The Children’s Liver Disease Foundation (UK) has
found that parents whose children were diagnosed with BA after 90 days of life felt they had lacked enough
information to empower them to ask for referral earlier. [34] The Yellow Alert Campaign was started in order
to support families and health professionals alike to ensure important information, especially about acholic
stools is distributed. [9] A more consistent and better quality implementation of a SCC in the WCTO framework
may help disseminate this information and allow for greater empowerment and autonomy amongst families.
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