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Risk factors for fatal diarrhea in hospitalized children in India
H P Sachdev1, S Kumar, K K Singh
1Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
Insights
Identifying risk factors for childhood diarrhea deaths is crucial in developing nations. Major infections, severe malnutrition, and prolonged illness significantly increase mortality risk in young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Diarrheal diseases remain a leading cause of mortality in children under five in developing countries.
- Limited data exists on specific risk factors contributing to fatal diarrheal outcomes in these vulnerable populations.
Purpose of the Study:
- To identify and quantify risk factors associated with mortality in hospitalized children under five with diarrhea.
- To inform targeted interventions for high-risk pediatric populations.
Main Methods:
- Prospective evaluation of 382 children under five hospitalized with diarrhea.
- Data collection included patient profiles, illness characteristics, and outcomes (death or survival).
- Statistical analyses (univariate and multivariate) were employed to determine significant risk factors and protective effects.
Main Results:
- Mortality rate was 10.4% (37 out of 357 patients).
- Significant risk factors for death included major infections (pneumonia, septicemia, meningitis), severe wasting, severe stunting, and prolonged illness (>14 days).
- Breastfeeding demonstrated a significant protective effect in children under 19 months.
Conclusions:
- Children with major infections, severe malnutrition (wasting and stunting), and prolonged diarrhea are at significantly higher risk of death.
- Early identification of these high-risk factors allows for targeted interventions to reduce diarrheal mortality in developing countries.
- Breastfeeding is a key protective factor against fatal diarrhea in infants.
Abstract:
There is scant information on the risk factors for diarrheal deaths in developing countries. A prospective evaluation was therefore conducted on 382 consecutive children (less than 5 years of age), who were hospitalized with diarrhea. A complete profile, including outcome, was available for 357 patients, 37 of whom died (10.4%). In the univariate analysis, four factors were significantly associated (p less than 0.02) with death: associated major infection (pneumonia, septicemia, or meningitis), severe wasting (less than or equal to 50% weight for age), severe stunting (less than or equal to 85% height for age), and protraction of illness (greater than 14 days). In the multivariate analysis, all four factors retained their significance. The adjusted odds ratios (95% confidence interval) were 4.7 (3.9, 5.6), 3.3 (2.7, 4.0), 1.9 (1.6, 2.3), and 1.5 (1.3, 1.8), respectively. In addition, in children less than 19 months of age (n = 241; 29 deaths) breast-feeding had a significant (p less than 0.001) protective effect (adjusted OR--2.3, 95% CI-1.9-2.8). It is concluded that even in a setting with high diarrheal fatality rates, high-risk children can be identified and targeted for intensive intervention.