Abstract
It is important to determine the specific factors for diarrheal deaths in infants & young children to enable the intervention and reduce the mortality rates. This study aimed to identify these factors in children under five years of age, hospitalized with diarrheal complaints. Four hundred diarrheal children were included in the study. Twenty-seven (6.75%) of them died and 373 (93.25%) survived. The nutritional status of the patients was determined using weight for height for age as percentage of Harward Standard. It was found that severe malnutrition (p=0.000 for weight for height ration <70% and p=0.036 for height for age <85%), co-existent sepsis (p=0.000), shigella infection (p=0.0014), hypoalbuminemia (p=0.0000), hypoglycemia (p=0.0002), hyponatremia (p=0.016), hypokalemia (p=0.0041) and metabolic acidosis (p=0.0069 for pH<7.35 and p=0.000 for HCO3<20moL/l) were significant risk factors for diarrheal deaths in the univariate analysis. In the multivariate analysis, young age (under 6 months of age) {Odds ratio (OR) 10.49, 95% confidence interval (Cl) 1.75, 62.75)}, moderate or severe dehydration (OR 8.17, 95% Cl 1.53, 43.67), severe malnutrition (OR 0.04, 95% Cl 0.00, 0.22 of weight for height <70% and OR 0.03, 95% Cl 0.00, 0.36 for height for age<85%), co-existent sepsis (OR 37.26, 95% Cl 6.94, 200.06), shigella infection (OR 23.01, 95% Cl 3.08, 171.98), hypoalbuminemia (OR 0.11, 95% Cl 0.02, 0.54), metabolic acidosis (OR 0.03, 95% Cl 0.00, 0.33 of HCO3<20 mMol/L) were significant risk factors. It is concluded that, in addition to electrolyte and fluid treatments, prevention of malnutrition, continuation of feeding which lessens weight loss and may prevent fatal hypoglycemia, and early detection and treatment of probable sepsis are important in reducing diarrheal deaths.
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References
Cleason M, Merson MH. Global progress in the control of diarrheal diseases.Pediatr Infect Dis J 1990; 9:345–355.
Guerrant RL, Bobal DA. Bacterial and protozoal gastroenteritis.N Eng J Med 199; 325: 327–340.
Leung AKC, Robson WLM. Acute diarrhea in children, what to do and what not to do.Postgrad Med 1989; 86:161–174.
Glass RI, Lew JF, Gangarosa RE, Lebaron CW, Ho MS, Estimates of morbidity and mortality rates for diarrheal diseases in American children.J Pediatr 1991; 118:S27–33.
Richards L, Cleason M, Pierce NF. Management of acute diarrhea in children: Lessons learnt.Pediatr Infect Dis J 1993; 12: 5–9.
Jelliffe DB. The assessment of the nutritional status of the community. Geneva: WHO/1966.
Waterlow JC, Rutishauser IHE, Malnutrition in man. In:Early Malnutrition and Mental Development.Cravioto J, Hamraeus L, Vahlquist B, eds Sweden; Almquist and Wiksell, 1974; 13–26.
Jafar HS, McCracken GH. Sepsis and septic shock: A review for clinicians.Pediatr Infect Dis J 1992; 11: 739–49.
Bairage R, Koeing MA, Mazumder KA, Mortality-discriminating power of some nutritional, sociodemographic, and diarrheal disease indices.Am J Epidemiol 1993; 138:310–17.
Ryder RW, Reeves WC, Sack RB. Risk factors for fatal childhood diarrhea: A case-control study from two remote Panamanian Islands.Am J Epidemiol 1985; 121: 605–610.
Sachdev HPS, Kumar S, Singh KK, Satyanarayana L, Puri RK. Risk factors for fatal diarrhea in hospitalized children in India.J Pediatr Gastroenterol Nutr 1991; 12:76–81.
Teka T, Faruque ASG, Fuchs GJ. Risk factors for death in under-age five children attending a diarrhoea treatment center.Acta Paediatr 1996; 85:1070–75.
Bhutta ZA, Nizami SQ, Thobani S, Issani Z. Risk factors for mortality among hospitalized children with persistent diarrhoea in Pakistan.J Trop Pediatr 1997; 43: 330–335.
El Samani EF, Willett WC, Ware JH. Association of malnutrition and diarrhea in children aged under five years. A prospective follow-up study in a rural Sudanese community.Am J Epidemiol 1988; 128:93–105.
Schorling JB, McAuliffe JF, De Souza MA, Guerrant RL. Malnutrition is associated with increased diarrhoea incidence and duration among children in an urban Brazilian slum.Inter J Epidemiol 1990; 19:728–735.
Islam SS, Khan MU, Risk factors for diarrhoeal deaths: A case-control study at a diarrhoeal disease hospital in Bangladesh.Inter J Epidemiol 1986; 15:116–120.
Butta ZA, Punjwani N, Lindblad BS. Concomitant bacteraemia as a risk factor for diarrhoeal disease mortality in Karachi: A case-control study of hospital children.Acta Paediatr 1996; 85:809–13.
Struelens MJ, Bennish ML, Mondal G, Wojtyniak BJ. Bacteremia during diarrhea: Incidence, etiology, risk factors, and outcome.Am J Epidemiol 1991; 133:451–459.
Deitch EA, Berg RD. Endotoxin but not malnutrition promotes bacterial translocation of the gut flora in burnt mice.J Trauma 1987; 27:161–165.
Gupta P, Natarajan G, Agarwal KN. Transient hyperglycemia in acute childhood illnesses: To attend or ignore?Indian J Pediatr 1997; 64:205–210.
Bennish ML, Azad AK, Rahman O, Phillips RE. Hypoglycemia during diarrhea in childhood.N Engl J Med 1990; 322:1357–63.
Victora CG, Smith PG, Vaughan JP. Infant feeding and deaths due to diarrhea a case-control study.Am J Epidemiol 1989; 129: 1032–1041.
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Uysal, G., Sökmen, A. & Vidinlisan, S. Clinical risk factors for fatal diarrhea in hospitalized children. Indian J Pediatr 67, 329–333 (2000). https://doi.org/10.1007/BF02820679
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DOI: https://doi.org/10.1007/BF02820679