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Risk factors for mortality among hospitalized children with persistent diarrhoea in Pakistan
Z A Bhutta1, S Q Nizami, S Thobani
1Department of Paediatrics, Aga Khan University Medical Center, Karachi, Pakistan.
Insights
Severe malnutrition and sepsis significantly increase mortality risk in children with persistent diarrhea (PD). Early infection screening and identifying severely malnourished children can improve management strategies for PD.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutritional Science
Background:
- Persistent diarrhea (PD) is a major cause of mortality in malnourished children.
- Nutritional rehabilitation is crucial for managing PD in this vulnerable population.
Purpose of the Study:
- To evaluate factors associated with mortality in malnourished children with PD undergoing nutritional rehabilitation.
- To identify risk factors for improved case management and screening strategies.
Main Methods:
- A cohort of 302 malnourished children with PD admitted for nutritional rehabilitation was studied.
- Univariate and multivariate logistic regression analyses were used to assess risk factors for mortality.
- Key indicators analyzed included anthropometric measures, biochemical parameters, stool characteristics, dehydration severity, and presence of bacteremia.
Main Results:
- Mortality rate was 4% (13 deaths), with most occurring within 72 hours of admission.
- Significant univariate risk factors for mortality included severe stunting, hypoalbuminemia, high stool frequency/volume, and severe dehydration.
- Multivariate analysis identified low weight-for-age z-score and sepsis as significant predictors of mortality.
- Children who died had shorter diarrhea duration and higher rates of bacteremia at admission.
Conclusions:
- Severe malnutrition and sepsis are independently associated with a significantly increased risk of mortality in children with PD.
- Enhanced screening for infections and early recognition of severe malnutrition and diarrhea are critical for improving outcomes.
- Targeted interventions for high-risk subgroups can optimize management strategies for PD.
Abstract:
We evaluated factors associated with mortality among a cohort of malnourished children with persistent diarrhoea (PD) admitted for nutritional rehabilitation with a defined rice-lentil (Khitchri) and yoghurt diet. Of 302 children consecutively admitted with PD, 13 (4 per cent) died, mostly (62 per cent) within 72 h of admission. Univariate analysis of risk factors at admission associated with mortality indicated significantly increased risk of death with severe stunting [relative risk (RR) 3.1, 95 per cent confidence interval (CI) 1.1-9.0], hypoalbuminaemia (RR 4.3, 95 per cent CI 1.5-12.3), stool frequency > 12/day (RR 6.0, 96 per cent CI 2.0-17.6), stool volume > 100 g/kg/day (RR 10.7, 95 per cent CI 3.0-37.6) and severe dehydration (RR 7.5, 95 per cent CI 2.6-21.8). Children who died also had comparatively shorter duration of diarrhoea at admission, and were also associated with higher rate of bacteremia at admission (Fisher's exact test P < 0.01). The logistic regression model evaluating multivariate risk of mortality identified weight-for-age z-score and sepsis as significant risk factors. Our data suggest that severe malnutrition and sepsis are associated with significantly increased risk of mortality in children with PD. Stringent screening for infections and recognition of subgroups with severe malnutrition and severe diarrhoea may improve screening and case management strategies for this disorder.