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Risk factors for persistent diarrhoea
N S Shahid1, D A Sack, M Rahman
1International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Insights
Persistent diarrhea in young children is linked to factors like bloody stools, respiratory infections, malnutrition, and vitamin A deficiency. These risk factors increase mortality in children under five.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Persistent diarrhea is a significant health concern in children under five.
- Identifying risk factors is crucial for effective intervention and reducing mortality.
Purpose of the Study:
- To conduct a retrospective analysis of persistent diarrhea in children under five.
- To identify risk factors associated with persistent diarrhea.
Main Methods:
- Systematic sampling of children under five with diarrheal disease.
- Retrospective analysis comparing children with persistent diarrhea ( > 14 days) to those with acute diarrhea.
- Matched case-control study design.
Main Results:
- 10% of 4155 children had persistent diarrhea.
- Strongly associated risk factors included bloody/mucus stools, lower respiratory tract infection, malnutrition, vitamin A deficiency, and prior antibiotic use.
- Peak incidence at 2 years; no sex difference. Higher mortality in persistent diarrhea cases.
- No significant association with Shigella, Campylobacter jejuni, or Giardia lamblia isolation rates.
Conclusions:
- Several key factors significantly increase the risk of persistent diarrhea in young children.
- Early identification and management of these risk factors are essential for improving outcomes and reducing child mortality.
- Further research may be needed to clarify the role of diet and specific pathogens.
Abstract:
With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks.