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Diarrhoeal children with concurrent severe wasting and stunting compared to severe wasting or severe stunting
Sharika Nuzhat1, K M Shahunja1, Abu S M S B Shahid1
1Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Insights
Children with severe wasting and severe stunting (SWSS) often have dehydrating diarrhea. Early detection and management of dehydration in these malnourished children are crucial for reducing mortality, especially in resource-limited settings.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Severe wasting and severe stunting (SWSS) in children represent critical forms of malnutrition, increasing susceptibility to severe infections.
- Diarrheal diseases pose a significant threat to children with SWSS, necessitating a deeper understanding of their clinical features and causes.
Purpose of the Study:
- To compare the clinical features and etiology of diarrhea in children with SWSS against those with severe wasting (SW) or severe stunting (SS) alone.
- To identify factors associated with SWSS to aid in the early recognition of high-risk children.
Main Methods:
- Utilized data from the diarrheal disease surveillance system (DDSS) at Dhaka Hospital, icddr,b, spanning from 2008 to 2017.
- Analyzed data from 14,403 under-five children with diarrhea, categorizing them into SWSS, SW alone, and SS alone groups based on anthropometric Z-scores.
Main Results:
- Children with SWSS were more likely to present with dehydrating diarrhea (69%) compared to SW (55%) or SS (43%) groups.
- Logistic regression revealed dehydrating diarrhea and slum dwelling were associated with SWSS vs. SW, while dehydration and maternal illiteracy were associated with SWSS vs. SS.
- SWSS cases less frequently involved rotavirus infection compared to SW or SS cases.
Conclusions:
- Dehydrating diarrhea is a prominent clinical feature in children with SWSS.
- Prompt identification and management of dehydrating diarrhea in children with concomitant severe wasting and stunting are essential for improving outcomes and reducing mortality, particularly in impoverished communities.
Objective:
Children with both severe wasting and severe stunting (SWSS) represent an extreme form of malnutrition and are prone to develop severe infection. The study aims to demonstrate clinical features and aetiology of diarrhoea among children with SWSS compared to those with either severe wasting (SW) or severe stunting (SS), which may help in early identification of high-risk children.
Methods:
Data were extracted from the database of the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital, icddr,b from 2008 to 2017. Among 14 403 under-five diarrhoeal children, 149 had concurrent SWSS (WLZ/WHZ ˂-3 with LAZ/HAZ ˂-3), 795 had SW (WLZ/WHZ ˂-3 but LAZ/HAZ ≥-3) alone, and 1000 had only SS (LAZ/HAZ ˂-3 but WLZ/WHZ ≥-3).
Results:
In logistic regression analysis after adjusting for potential confounders, dehydrating diarrhoea and slum dwelling were independently associated with SWSS vs. SW (P < 0.05). When compared with SS, dehydration and maternal illiteracy were independently associated with SWSS (P < 0.05). In comparison with SW or SS, SWSS less often included infection with rotavirus (P < 0.05). Dehydration was independently associated with SW vs. SS after adjusting for potential confounders (P < 0.05).
Conclusion:
Children with SWSS more often presented with dehydrating diarrhoea (69%) than children who had either SW (55%) or SS (43%). However, SWSS patients less frequently presented with rotavirus-associated diarrhoeal illnesses. This result underscores the importance of early detection and prompt management of dehydrating diarrhoea in children with concomitant severe wasting and severe stunting to reduce morbidity and mortality in these children, especially in poor settings.
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