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Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric
Rebecca L Brander1, Patricia B Pavlinac2, Judd L Walson3
1Department of Epidemiology, University of Washington, Seattle, WA, USA. rbrander@uw.edu.
Insights
Moderate-to-severe diarrhea (MSD) in young children can stunt growth. Factors like young age and malnutrition predict growth faltering, enabling early intervention for at-risk infants and toddlers.
Area of Science:
- Pediatric Gastroenterology
- Global Child Health
- Nutritional Epidemiology
Background:
- Moderate-to-severe diarrhea (MSD) in children under two years old is a significant risk factor for impaired linear growth.
- Identifying children at high risk for growth faltering after MSD is crucial for timely intervention.
Purpose of the Study:
- To identify clinical and sociodemographic risk factors for linear growth faltering in children with MSD.
- To develop a clinical prediction tool for identifying children most vulnerable to growth deterioration post-MSD.
Main Methods:
- Log-binomial and linear regression analyses were performed on data from the Global Enteric Multicenter Study (GEMS) involving 5902 children (0-23 months) with MSD in Africa and Asia.
- A prediction model was developed using backward elimination and Akaike Information Criterion, incorporating factors like age, malnutrition, and clinical signs.
Main Results:
- Severe linear growth faltering (loss of ≥0.5 length-for-age z-score) occurred in 24.2% of children over 50-90 days follow-up.
- Younger age (0-12 months), acute malnutrition, non-dysenteric diarrhea, poor sanitation, and IMCI danger signs were associated with growth decline.
- A prediction model including age, wasting, stunting, fever, and danger signs achieved an AUC of 0.67.
Conclusions:
- Younger age, acute malnutrition, MSD severity, and sociodemographic factors significantly impact short-term linear growth after diarrhea.
- Routine data collected during MSD episodes can effectively identify children at risk for growth deterioration, guiding targeted interventions.
Background:
Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD.
Methods:
Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model.
Results:
Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50-90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was - 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12-23 months old, those 0-6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6-12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%).
Conclusion:
Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.
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