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Acute diarrhea in Baltimore children attending an outpatient clinic
K L Kotloff1, S S Wasserman, J Y Steciak
1Division of Infectious Diseases and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore 21201.
Insights
Diarrhea is a common reason for clinic visits in young children, with viral and bacterial pathogens identified in less than half of cases. Socioeconomic factors significantly influence illness, highlighting a persistent public health challenge.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute diarrheal illnesses are a significant cause of healthcare utilization in children under two years old.
- Diarrhea accounts for one in five outpatient visits for children younger than two, with 5% requiring hospitalization.
Purpose of the Study:
- To identify potential etiologic agents responsible for acute diarrheal illnesses in young children.
- To investigate the association between identified pathogens and diarrheal episodes.
- To examine the role of sociodemographic factors in diarrheal illness morbidity.
Main Methods:
- A 12-month prospective study of acute diarrheal illnesses in children under two years old attending an outpatient clinic.
- Comprehensive stool sample analysis to identify viral and bacterial pathogens.
- Case-control study comparing children with diarrhea to healthy controls, analyzing sociodemographic data.
Main Results:
- Potential etiologic agents were identified in 43% of diarrhea cases and 28% of controls.
- Viral pathogens (rotavirus, enteric adenovirus) and bacterial pathogens (Salmonella) were significantly associated with diarrhea.
- Socioeconomic deprivation factors (household crowding, low maternal education, low birth weight) were more prevalent in cases, explaining observed racial differences in morbidity.
Conclusions:
- Despite intensive investigation, the etiologies of many diarrheal illnesses in young children remain unknown.
- Rotavirus, enteric adenovirus, and Salmonella are key pathogens, but do not explain all cases.
- Sociodemographic factors play a crucial role in the burden of diarrheal disease, underscoring the need for integrated public health interventions.
Abstract:
Acute diarrheal illnesses in Baltimore children younger than 2 years of age attending an outpatient clinic were studied during a 12-month period. One in five acute care visits made to the clinic by children younger than 2 years was for diarrhea, and 5% of diarrhea cases required hospitalization. With the use of comprehensive methodology, a potential etiologic agent was identified in the stool of 105 (43%) of the 246 episodes of diarrhea in cases and in 43 (28%) of the 155 controls. Viral pathogens were found in 26% of episodes, and bacterial pathogens were found in 14%. Only rotavirus, enteric adenovirus and Salmonella were significantly associated with diarrhea. Cases were more likely to have measures of socioeconomic deprivation, such as household crowding, low maternal educational level and low birth weight, when compared to controls. Racial differences in morbidity from diarrheal illnesses were observed but could be attributed to these specific sociodemographic factors. Despite the low mortality caused by infantile gastroenteritis in the United States, it remains an important public health problem. However, even with intensive investigation the etiologies remain largely unknown.