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Risk factors for persistent diarrhea among children under 2 years of age. Case control study
N Deivanayagam1, N Mala, T P Ashok
1Advance Center for Clinical, Epidemiological Research and Training (ACCERT), Madras Medical College, Institute of Child Health.
Insights
Malnutrition, dysenteric stools, and improper antimicrobial use are key risk factors for persistent diarrhea in young children. Early investigation and adequate treatment of acute diarrhea are crucial for prevention.
Area of Science:
- Pediatrics
- Gastroenterology
- Infectious Diseases
Background:
- Persistent diarrhea is a significant cause of morbidity and mortality in children under two years old.
- Identifying risk factors is essential for developing effective prevention and management strategies.
Purpose of the Study:
- To identify risk factors associated with persistent diarrhea in children aged 1-23 months.
- To inform clinical practice and public health interventions for managing childhood diarrhea.
Main Methods:
- A case-control study was conducted with 170 cases (diarrhea > 14 days) and 340 age-matched controls (diarrhea < 7 days).
- Fifteen potential risk factors were analyzed using logistic regression, adjusting for covariates.
Main Results:
- Significant risk factors for persistent diarrhea included malnutrition (OR 2.9), dysenteric stools (OR 2.4), indiscriminate antimicrobial use (OR 2.4), associated illnesses (OR 2.1), frequent stools (>10/day, OR 1.8), and persistent dehydration (OR 1.4).
- Weight loss during the study period became significant when invasive diarrhea was excluded.
Conclusions:
- Children with acute diarrhea require thorough investigation for associated illnesses and appropriate treatment.
- Avoiding indiscriminate antimicrobial use and providing nutritional support are vital for preventing persistent diarrhea.
Abstract:
A case control study was done at the Institute of Child Health, Madras, among prospectively recruited children aged 1-23 months to identify the risk factors for persistent diarrhea. Cases were children with diarrhea persisting for > 14 days. Controls were children with acute diarrhea who had recovered within 7 days. Two controls for each case, matched for age were recruited. The total number of cases and controls recruited were 170 and 340. Fifteen risk factors for association with persistent diarrhea were studied. When the factors were adjusted for covariables by logistic regression, only 6 factors were found to be significant, namely, malnutrition (OR 2.9; 95% CI 1.9-4.5), dysenteric stools (OR 2.4; 95% CI 1.3-4.3), indiscriminate use of antimicrobials (OR 2.4; 95% CI 1.6-3.9), associated illnesses (OR 2.1; 95% CI 1.5-3.1), stools > 10/day (OR 1.8; 95% CI 1.2-2.8) and persistence of dehydration (OR 1.4; 95% CI 1.2-1.7). However, when invasive diarrhea was excluded, weight loss during study period became a significant factor. It is concluded that all children with acute diarrhea should be investigated for associated illnesses and treated adequately, indiscriminate use of antimicrobials should be avoided and nutritional support should be provided.