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Are young and older children with diarrhea presenting in the same way?
Sharika Nuzhat1, Baharul Alam1, S M Tafsir Hasan2
1Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
Insights
Older children (5-9 years) with diarrhea present with more severe symptoms and different pathogens than younger children. This highlights the need for tailored clinical management strategies for this age group to reduce illness severity.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrhea remains a significant global health issue, disproportionately affecting children under five.
- Increasing survival rates mean a growing number of older children require attention for diarrheal diseases.
- Existing research primarily focuses on younger children, leaving a gap in understanding older children's diarrheal illness.
Purpose of the Study:
- To compare clinical presentations and identify pathogen variations in diarrheal children aged five to nine years versus those under five.
- To inform clinical management strategies for older children experiencing diarrhea.
Main Methods:
- Utilized data from the diarrheal disease surveillance system (DDSS) in urban (Dhaka) and rural (Matlab) Bangladesh from 2012-2021.
- Compared clinical data and identified fecal pathogens in children aged five to nine years against a matched cohort of children under five.
- Employed statistical adjustments for various demographic and clinical factors to ensure robust comparisons.
Main Results:
- Children aged five to nine years experienced significantly higher rates of vomiting, abdominal pain, and dehydrating diarrhea compared to younger children.
- Key fecal pathogens such as Vibrio cholerae, Salmonella, and Shigella were more common in the older age group.
- These differences persisted after adjusting for multiple confounding variables including study site, gender, and prior antibiotic use.
Conclusions:
- Despite lower admission percentages, children aged five to nine years present with critical illness and distinct pathogen profiles.
- Findings underscore the necessity for specialized clinical approaches for managing diarrhea in older children.
- Tailored strategies can potentially decrease morbidity in this understudied pediatric population.
Background:
Diarrhoea is a global health problem. More than a quarter of diarrhoeal deaths occur among children less than five years. Different literatures analyzed presentation and outcomes of less than five diarrhoeal children. The world has made remarkable progress in reducing child mortality. So, older children are growing in number. Our aim was to identify clinical differentials and variations of pathogens among younger (less than five) and older (five to nine years) diarrhoeal children.
Method:
Data were extracted from the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital (urban site) and Matlab Hospital (rural site) of the International Centre for Diarrhoeal Disease Research, Bangladesh for the period of January 2012 to December 2021. Out of 28,781 and 12,499 surveillance patients in Dhaka and Matlab Hospital, 614 (2.13%) and 278 (2.22%) children were five to nine-years of age, respectively. Among under five children, 2456 from Dhaka hospital and 1112 from Matlab hospital were selected randomly for analysis (four times of five to nine years age children, 1:4).
Results:
Vomiting, abdominal pain, and dehydrating diarrhoea were significantly higher in older children in comparison to children of less than five years age (p-value <0.05) after adjusting study site, gender, antibiotic use before hospitalization, diarrhoeal duration < 24 hours, intake of oral rehydration fluid at home, parental education, WASH practice and history of cough. Vibrio. cholerae, Salmonella, and Shigella were the common fecal pathogen observed among older children compared to under five after adjusting for age, gender and study site.
Conclusion:
Although percentage of admitted diarrhoeal children with five to nine years is less than under five years children but they presented with critical illness with different diarrhoeal pathogens. These observations may help clinicians to formulate better case management strategies for children of five to nine years that may reduce morbidity.
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