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Risk factors for fatal diarrhea: a case-control study of African children
P M Griffin1, C A Ryan, M Nyaphisi
1Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333.
Insights
Identifying risk factors for childhood diarrhea deaths in developing regions is crucial. Young children under six months, severe dehydration, and prolonged illness before hospitalization significantly increase the risk of fatal diarrhea outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal diseases are a leading cause of mortality in children under five in developing countries.
- Limited research exists on specific risk factors contributing to diarrheal deaths in these vulnerable populations.
- A high mortality rate (9.5%) among hospitalized children with diarrhea was reported in Lesotho in 1984.
Purpose of the Study:
- To identify significant risk factors associated with mortality in young children hospitalized with diarrhea in Lesotho.
- To inform targeted interventions for reducing childhood diarrhea deaths in similar settings.
Main Methods:
- Two retrospective case-control studies were conducted involving children under five years old admitted for diarrhea.
- Data from 44 deceased children (cases) were compared with 89 survivors (controls) from 1983-1984.
- Univariate and multivariate analyses were employed to identify statistically significant risk factors (p < 0.05).
Main Results:
- Eight factors were significantly associated with death: major infection, age under six months, illness duration ≥7 days, thrush/stomatitis, severe dehydration, vomiting, persistent dehydration after 12 hours hospitalization, and abnormal temperature.
- Multivariate analysis confirmed major infection, young age (under six months), and prolonged illness duration as key predictors of death.
- No significant differences were found in sex or malnutrition levels between cases and controls.
Conclusions:
- Children under six months, those with major infections, and those experiencing prolonged illness before hospitalization are at high risk of death from diarrhea.
- Early identification and management of these risk factors are critical for improving survival rates in hospitalized children with diarrhea.
- The findings provide valuable insights for public health strategies aimed at reducing childhood mortality due to diarrhea in developing areas.
Abstract:
Few studies have determined risk factors for diarrheal deaths in developing areas. The Ministry of Health of Lesotho, southern Africa, reported that 9.5% of children under five years of age who were hospitalized for diarrhea in 1984 died. Of 104 children under five years of age who died during hospitalization for diarrhea, 85% were aged 24 months or younger and had nonbloody diarrhea during the warm season. We conducted two retrospective case-control studies of children aged 24 months or younger admitted for diarrhea at two hospitals in 1983 and 1984, comparing 44 who died with 89 who survived. Eight factors were significantly associated (p less than 0.05) with death at one or both hospitals by univariate analysis: diagnosis of a major infection, age under six months, illness for seven days or more before admission, thrush or stomatitis on admission, severe dehydration, history of vomiting, dehydration that had not improved after 12 hours in the hospital, and fever or subnormal temperature. Multivariate analysis of data from one hospital showed the first three factors to be significantly associated with death. Cases and controls were similar in sex and in degree of malnutrition. This study identified children at high risk for death from diarrhea.