Childhood diarrhoeal deaths in seven low- and middle-income countries

Area of Science:

• Global Health
• Pediatric Infectious Diseases
• Epidemiology

Background:

• Diarrheal diseases are a leading cause of death in children globally, particularly in low- and middle-income countries (LMICs).
• Understanding the specific characteristics of diarrheal deaths is crucial for developing targeted public health interventions.

Purpose of the Study:

• To investigate the clinical characteristics of children who died from diarrhea in LMICs.
• To analyze factors such as diarrhea duration, co-morbidities, care-seeking behaviors, and oral rehydration therapy (ORT) use.

Main Methods:

• Utilized verbal autopsy data from children who died from diarrhea between 2000 and 2012 across seven sites in LMICs.
• Included data from demographic surveillance sites, randomized trials, and the Demographic and Health Survey.
• Classified diarrhea types (acute watery, acute bloody, persistent) and analyzed risk factors, with separate analyses for infants (1-11 months) and young children (1-4 years).

Main Results:

• Diarrheal deaths varied significantly across sites (3% to 30%).
• Among children aged 1-4 years, acute watery diarrhea was the most common cause (31-69%), followed by persistent diarrhea (12-56%).
• Persistent diarrhea was a significant cause of death in infants (over 30% in several countries), often associated with malnutrition (over 40% in most sites).

Conclusions:

• Persistent diarrhea remains a critical contributor to childhood mortality in LMICs.
• Further research is essential to understand the public health impact of persistent diarrhea and current treatment effectiveness.
• Addressing persistent diarrhea requires improved understanding of its burden and treatment practices to reduce child deaths.