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Predictors of mortality in children hospitalized with dysentery in Harare, Zimbabwe
K J Nathoo1, J E Porteous, S Siziya
1Department of Community Medicine, University of Zimbabwe Medical School, Harare, Zimbabwe.
Insights
During a Shigella dysenteriae type 1 epidemic, hypothermia, severe dehydration, and electrolyte imbalances were key predictors of mortality in children. Early identification of these risk factors is crucial for managing dysentery outbreaks.
Area of Science:
- Infectious Diseases
- Paediatric Medicine
- Epidemiology
Background:
- Shigella dysenteriae type 1 outbreaks pose a significant threat to child health, particularly in resource-limited settings.
- Understanding complication patterns and mortality predictors is essential for effective clinical management and public health interventions.
Purpose of the Study:
- To document the spectrum of complications in children hospitalized with Shigella dysenteriae type 1 infection.
- To identify clinical and laboratory risk factors associated with mortality in this paediatric population.
Main Methods:
- A hospital-based prognostic study was conducted involving 312 children (1 month to 12 years) with bloody diarrhoea.
- Data collected included clinical signs, laboratory results, complications, and outcomes (mortality).
- Multivariate analysis was used to determine predictors of mortality.
Main Results:
- The overall case fatality rate was 30.4%, with a higher rate of 43% among children with haemolytic uraemic syndrome (HUS).
- Common complications included altered consciousness, severe dehydration, and abdominal distention.
- Predictors of mortality identified were temperature < 36°C, severe dehydration, hyperkalemia, hyponatremia, elevated urea, and abdominal distention.
Conclusions:
- Clinical and laboratory features can help identify children at high risk of death during dysentery outbreaks.
- The high fatality rate underscores the urgent need for sustainable preventive strategies in affected regions.
Objectives:
To document the pattern of complications and identify risk factors for subsequent mortality in a hospitalized paediatric population during a Shigella dysenteriae type 1 epidemic.
Design:
Hospital based prognostic study.
Setting:
Paediatric wards in Harare and Parirenyatwa tertiary referral hospitals.
Subjects:
All children aged one month to 12 years admitted to the wards with a history of bloody diarrhoea between January 1993 to June 30 1994 were included in the study (n = 312).
Main Outcome Measures:
Patterns of complications and predictors of mortality.
Results:
The peak age group of the patients was 12 to 23 months. Ninety five children died giving an overall case fatality rate (CFR) of 30.4% (95% CI, 25.3 to 35.6). One third (n = 107) had haemolytic uraemic syndrome (HUS), among whom the CFR was 43%. Other complications included altered consciousness (35%), seizures (12%), coma (4.5%), severe dehydration (14%), abdominal distention (17%), rectal prolapse (5%) and ileus (6%). In a multivariate analysis, temperature < 36 degrees C (OR 2.12; 95% CI, 1.33 to 3.39), severe dehydration (OR, 1.70; 95% CI, 1.15 to 2.53), hyperkalemia (> 5.5 mmol/L) (OR, 1.74; 95% CI, 1.01 to 1.97), hyponatremia (< 120 mmol/L) (OR, 1.57; 95% CI, 1.17 to 2.11), urea (> 8 mmol/L) (OR, 1.74; 95% CI, 1.29 to 2.36), and abdominal distention (OR, 1.67; 95% CI, 1.16 to 2.41) were found to be predictors of mortality.
Conclusion:
Some of the major clinical and laboratory features allowing the early identification of children at increased risk of dying during dysentery outbreaks have been delineated. The high fatality associated with complicated dysentery highlights the need for preventive strategies which are sustainable in the region.
