Fluid curtailment during childhood diarrhea: a countdown analysis
Jamie Perin1, Liliana Carvajal-Velez2, Emily Carter3
1Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. jperin@jhu.edu.
Insights
Fluid curtailment during childhood diarrhea is common in several countries, increasing dehydration risk. Discouraging this practice is vital for preventing child deaths globally.
Area of Science:
- Pediatrics
- Global Health
- Public Health Interventions
Background:
- Diarrhea management in children emphasizes increased fluid intake and continued feeding to prevent dehydration.
- Reducing or stopping fluids during diarrhea episodes is a harmful practice with potential to increase child mortality.
- Addressing fluid curtailment is crucial for global child survival strategies.
Purpose of the Study:
- To quantify the prevalence of fluid curtailment in children under five with diarrhea in high-mortality countries.
- To examine the associations between fluid curtailment and child, household, and management characteristics.
Main Methods:
- Utilized national cross-sectional survey data from Burkina Faso, DRC, Ethiopia, Nigeria, Tanzania, and Uganda.
- Analyzed the extent of fluid curtailment and its relationship with various demographic and health-seeking factors.
Main Results:
- Prevalence of fluid curtailment ranged from 32% in Burkina Faso to 55% in Nigeria.
- Fluid curtailment was linked to withholding food (OR 3.51), non-governmental provider care, breastfeeding, and unimproved water sources.
- Children of poorer, less educated, or rural mothers were more likely to experience fluid curtailment.
Conclusions:
- The widespread practice of curtailing fluids for children with diarrhea poses a significant risk for dehydration and complications.
- Specific subgroups, including those with certain care providers or from disadvantaged backgrounds, are disproportionately affected.
- Interventions targeting fluid curtailment are essential to reduce diarrhea-related morbidity and mortality in young children.
Background:
The foundation of recommended diarrhea management in young children is increased fluids and continued feeding. This increase in fluids is necessary to replace those lost during diarrhea and ultimately prevent dehydration. There may be an opportunity to prevent deaths in children under five by discouraging the practice of reducing or curtailing fluids during diarrhea episodes across different settings worldwide.
Methods:
We quantify and describe the extent of fluid curtailment in children with diarrhea in a selection of countries (Burkina Faso, Democratic Republic of Congo, Ethiopia, Nigeria, Tanzania, and Uganda) with high burden of diarrhea-related mortality with national cross sectional survey data. We examine the practice of fluid curtailment in these countries and its relationship to child and household traits and to characteristics of diarrhea management.
Results:
The prevalence of fluid curtailment among children under five with diarrhea is strikingly high in these countries: 55 % in Nigeria, 49 % in Ethiopia, 44 % in Uganda, 37 % in Tanzania, 36 % in DR Congo and 32 % in Burkina Faso. Fluid curtailment is associated with giving less food, potentially worsening the impact of this harmful practice. Children who were reported to have had fluids curtailed during diarrhea episodes were also 3.51 (95 % confidence, 2.66 - 4.64) times more likely to be reported to have food withheld (α = 0.05; p < 0.001). Children who received care from non-governmental providers, and those who were breastfed were more likely to have their fluids curtailed, as were children with an unimproved water source. Children of poorer or less educated mothers and those living in rural areas are more likely to have curtailed fluids, compared to children of less poor or more educated mothers, or those living in urban areas.
Conclusions:
The harmful practice of curtailing fluids for a child with diarrhea is highly prevalent, representing an increased risk of dehydration and complications due to diarrhea, including death, especially for children in specific subgroups.
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