Prolonged diarrhea among under-five children in Bangladesh: Burden and risk factors
Md Iqbal Hossain1, A S G Faruque1, Monira Sarmin1
1Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Insights
Prolonged diarrhea (ProD) affects 7.6% of under-five children in Bangladesh. Key risk factors include young age, bloody stools, and recent diarrhea, while rotavirus is less common. Understanding these factors aids in managing ProD.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Prolonged diarrhea (ProD), lasting over 7-13 days, is a significant health issue for children under five, particularly in Bangladesh.
- Limited data exists on the epidemiology and risk factors of ProD in Bangladesh, despite a reported high burden.
Purpose of the Study:
- To assess the prevalence of ProD in under-five children presenting at a hospital in Bangladesh.
- To identify associated and risk factors for ProD compared to acute diarrhea (AD).
Main Methods:
- Analysis of data from a hospital-based Diarrheal Disease Surveillance System (DDSS) in Dhaka, Bangladesh (1996-2014).
- Inclusion of 21,566 under-five children with diarrhea (≤13 days duration).
- Logistic regression was used to identify factors associated with ProD versus AD.
Main Results:
- 7.6% of children had ProD; 92.4% had AD.
- Factors associated with ProD included younger age (<12 months), mucoid/bloody stools, warmer months, prior home treatment, and recent diarrhea history.
- Rotavirus infection was less prevalent in ProD cases. ProD patients had higher inpatient admission rates.
Conclusions:
- A substantial proportion of under-five children attending the hospital experienced prolonged diarrhea.
- Identifying associated and risk factors is crucial for developing effective management strategies and reducing the burden of ProD.
Introduction & Background:
Prolonged (duration >7 to 13 days) diarrhea (ProD) in under-five children is a universal health problem including Bangladesh. Data on epidemiology and associated or risk factors of ProD are limited, particularly in Bangladesh where a high burden of ProD is reported. This study intended to assess the case load of ProD and its associated or risk factors compared to acute diarrhea (AD, duration ≤7 days).
Methods:
We analyzed the data collected between 1996-2014 from a hospital-based Diarrheal-Disease-Surveillance-System (DDSS) in the 'Dhaka Hospital' of International Centre for Diarrhoeal Diseases, Bangladesh (icddr,b). The DDSS enrolled a 2% systematic sample, regardless of age, sex, and diarrhea severity. The data included information on socio-demographic factors, environmental history, clinical characteristics, nutritional status, and diarrhea-pathogens. After cleaning of data, relevant information of 21,566 under-five children were available who reported with ≤13 days diarrhea (including AD and ProD), and their data were analyzed. Variables found significantly associated with ProD compared to AD in bi-variate analysis were used in logistic regression model after checking the multicollinearity between independent variables.
Results:
The mean±SD age of the children was 14.9±11.7 months and 40.4% were female; 7.6% had ProD and 92.4% had AD. Age <12 months, mucoid- or bloody-stool, warmer months (April-September), drug used at home before seeking care from hospital, and history of diarrhea within last one month were found associated with ProD (p<0.05); however, rotavirus infection was less common in children with ProD (p<0.05). ProD children more often needed inpatient admission than AD children (14.4 vs. 6.3, p<0.001). Case fatality rate of ProD vs. AD was 0.3% (n = 5) vs. 0.1% (n- = 22) respectively (p = 0.051).
Conclusion:
A considerable proportion (7.6%) of under-five children reporting to icddr,b hospital suffered from ProD. Understanding the above-mentioned associated or risk factors is likely to help policy makers formulating appropriate strategies for alleviating the burden and effectively managing ProD in under-five children.
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