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Mortality associated with acute watery diarrhea, dysentery and persistent diarrhea in rural north India
N Bhandari1, M K Bhan, S Sazawal
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Insights
Diarrheal deaths in young children in rural North India were linked to persistent diarrhea and dysentery, especially in malnourished children. Malnutrition significantly increased mortality risk, highlighting its role in childhood diarrhea outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal diseases remain a leading cause of mortality in children under six years old, particularly in low-resource settings.
- Understanding the specific types and risk factors for diarrheal mortality is crucial for effective intervention strategies.
Purpose of the Study:
- To investigate the mortality associated with different types of diarrhea in a cohort of young children in rural North India.
- To identify the role of malnutrition as a contributing factor to diarrheal deaths.
Main Methods:
- A longitudinal cohort study followed 1467 children under six years of age for 20 months in rural North India.
- Data collected included episodes of diarrhea, duration, type (watery, dysentery, persistent), and related deaths.
- Nutritional status of children was assessed and correlated with diarrheal case fatality rates.
Main Results:
- A total of 1663 diarrhea episodes and 23 diarrhea-related deaths were recorded.
- Case fatality rates varied significantly: 0.56% for acute watery diarrhea, 4.27% for dysentery, and 11.94% for persistent diarrhea.
- Persistent diarrhea, particularly dysenteric persistent diarrhea (21.1% case fatality), posed a high mortality risk.
- Diarrheal case fatality rates increased dramatically with malnutrition severity, being 24 times higher in severely malnourished children (7.48%) compared to normally nourished children (0.31%).
Conclusions:
- Dysentery and persistent diarrhea are major contributors to diarrhea-related mortality in this population, especially with the advent of oral rehydration therapy.
- Underlying malnutrition is a critical factor exacerbating the risk of death from diarrhea.
- Targeted interventions addressing malnutrition and severe forms of diarrhea are essential to reduce child mortality.
Abstract:
Mortality associated with diarrhea was investigated in a longitudinally followed cohort of children under six years of age in rural North India. During the follow-up, 1663 episodes of diarrhea and 23 diarrhea related deaths were recorded in 1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery diarrhea, 4.27% for dysentery and 11.94% for non-dysenteric persistent diarrhea. Most of the episodes lasted less than a week; 5.2% became persistent (duration > 14 days). The case fatality rate was similar in episodes of one and two weeks' duration (0.64% and 0.8%) and increased to 13.95% for persistent episodes. Of the total 86 persistent episodes, 22.1% were dysenteric; the case fatality rate for such dysenteric persistent episodes was 21.1% and for watery persistent diarrhea 11.4%. Diarrheal attack rates were similar among different nutritional groups, but diarrheal case fatality rates progressively increased with increasing severity of malnutrition, these were 24 times higher in children with severe malnutrition (7.48%) compared to those normally nourished (0.31%). With availability and use of oral rehydration therapy, dysentery and persistent diarrhea emerge as major causes of diarrhea related mortality, with underlying malnutrition as a key associated factor.