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Clinical risk factors for fatal diarrhea in hospitalized children
G Uysal1, A Sökmen, S Vidinlisan
1Department of Pediatric Infectious Diseases, Ankara Childrens' Hospital of Social Insurance Institute, Turkey. uysalg@superonline.com
Insights
Severe malnutrition, young age, dehydration, sepsis, and shigella infection significantly increase diarrheal deaths in children. Early detection and treatment of sepsis, alongside nutritional support, are crucial for reducing mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal diseases remain a leading cause of mortality in infants and young children globally.
- Identifying specific risk factors for diarrheal deaths is essential for developing targeted interventions.
- Hospitalized children with diarrhea represent a vulnerable population requiring focused study.
Purpose of the Study:
- To identify the key factors contributing to mortality among children under five years hospitalized with diarrhea.
- To provide data that can inform strategies for reducing diarrheal deaths in pediatric populations.
Main Methods:
- A cohort of 400 children hospitalized with diarrhea was studied.
- Nutritional status was assessed using weight-for-height and height-for-age percentages.
- Univariate and multivariate analyses were performed to determine significant risk factors for mortality.
Main Results:
- Mortality rate was 6.75% (27 deaths) among the 400 children studied.
- Significant risk factors identified included severe malnutrition, young age (under 6 months), moderate to severe dehydration, co-existent sepsis, shigella infection, hypoalbuminemia, and metabolic acidosis.
- Multivariate analysis confirmed young age, dehydration, severe malnutrition, sepsis, shigella infection, hypoalbuminemia, and metabolic acidosis as independent predictors of death.
Conclusions:
- Severe malnutrition, young age, dehydration, sepsis, and shigella infection are critical determinants of diarrheal mortality in hospitalized children.
- Prevention of malnutrition, continued feeding to prevent hypoglycemia, and prompt management of sepsis are vital strategies.
- Integrated approaches addressing nutritional status, hydration, and infection are necessary to reduce diarrheal deaths in children.
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 < 20 moL/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 (CI) 1.75, 62.75)¿, moderate or severe dehydration (OR 8.17, 95% CI 1.53, 43.67), severe malnutrition (OR 0.04, 95% CI 0.00, 0.22 of weight for height < 70% and OR 0.03, 95% CI 0.00, 0.36 for height for age < 85%), co-existent sepsis (OR 37.26, 95% CI 6.94, 200.06), shigella infection (OR 23.01, 95% CI 3.08, 171.98), hypoalbuminemia (OR 0.11, 95% CI 0.02, 0.54), metabolic acidosis (OR 0.03, 95% CI 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.