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Risk Factors for Predicting Diarrheal Duration and Morbidity in Children with Acute Diarrhea

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Abstract

Objective

To identify baseline risk factors for prolonged diarrheal duration and subsequent complications in children aged 6 to 59 mo with acute diarrhea who participated in a micronutrient clinical trial in a tertiary care hospital.

Methods

The adjusted odds ratio or incidence risk ratios (IRR) of the baseline variables for prolongation of diarrheal duration (cox proportional hazard model), diarrhea >7 d (multiple logistic regressions), severe dehydration experienced after hospitalization (poisson regression models) was estimated.

Results

Fever (OR 1.10, 95% CI 1.02–1.19, p = 0.02), dehydration (OR 1.32, 95% CI 1.10–1.59, p = 0.003), dysentery (OR 1.41 95% CI 1.09–1.82, p = 0.008), those who received medications (OR 1.19, 95% CI 1.03–1.39, p = 0.02), and weight for age Z-score ≤2 (OR 1.25, 95% CI 1.07–1.46, p = 0.004) were at a greater risk of prolonged diarrhea. Diarrhea >7 d was associated with younger age (OR 1.08, 95% CI 1.03–1.14, p = 0.003), female child (OR 2.33, 95% CI 1.19–4.55, p = 0.013), diarrheal duration before enrolment (OR 1.06, 95% CI 1.04–1.09, p < 0.001), fever (OR 1.7, 95% CI 1.23–2.49, p = 0.002) and the weight for age Z-score ≤2 (OR 4.32, 95% CI 2.03–9.16, p < 0.001). Severe dehydration after hospitalization was associated with dehydration at baseline (OR 6.7, 95% CI 2–3.0, p < 0.001), incomplete immunization (OR 3.33, 95% CI 1.5–7.69, p < 0.001), failure to receive any medication(OR 3.03, 95% CI 1.26–7.14, p = 0.01).

Conclusions

Few studies assess risk factors for diarrheal morbidity prospectively. The present study showed that children of acute diarrhea with above risk factors need stricter monitoring for complications to reduce diarrheal mortality.

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Abbreviations

IV:

Intravenous

ORS:

Oral rehydration solution

Pl:

Placebo

RH:

Relative hazards

WHO:

World Health Organization

Zn:

Zinc

Zn+Cu:

Zinc and copper

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Acknowledgements

The authors extend their thanks to all the women, children and their families who participated in the trial, also thank the following members of the research team who contributed to the successful implementation of the study: Mr. Hussaini Ali and Mr. Gadkari (Universal Medicaments Pharmacists), Ms. Smita Puppulwar and Ms. Shubhangi Puranik. Authors are grateful to Prof. Catherine D’Este, Dr. AV Shrikhande and Dr. Nitin Kimmatkar, the members of the treatment effects monitoring committee, who reviewed the unexpected trial events and conducted an interim analysis. The project was supported by a Wellcome Trust Collaborative Research Initiative Grant (number 068664/Z/02/Z).

Contributions

AP:developed the study protocol, questionnaires and clinical trial procedures, directed the conduct of the trial, data analysis, data interpretation and wrote the first draft of the paper; RO: helped in reviewing literature, drafting and editing the paper; NB: helped with data analysis and editing the manuscript; MJD: contributed to the development of the protocol, helped in the development of study questionnaires and trial procedures, contributed to the data analysis, data interpretation and edited the paper. All authors reviewed drafts of the manuscript, read and approved the final draft.

Conflict of Interest

None.

Role of Funding Source

Wellcome Trust Collaborative Research Initiative Grant.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Indira Gandhi Government Medical College, Nagpur, India

    Archana B. Patel

  2. Lata Medical Research Foundation, Nagpur, India

    Archana B. Patel & Neetu B. Badhoniya

  3. Indira Gandhi Government Medical College, Nagpur, India

    Ronithung Ovung

  4. Department of Biostatistics, Public Health Foundation of India, New Delhi, India

    Neetu B. Badhoniya

  5. The Sydney School of Public Health, University of Sydney, Sydney, Australia

    Michael J. Dibley

  6. 125, Raj Nagar, Opposite Tidke Vidyalay, Katol Road, Nagpur, 440 013, MS, India

    Archana B. Patel

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  1. Archana B. Patel
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  2. Ronithung Ovung
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  4. Michael J. Dibley
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Correspondence to Archana B. Patel.

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Patel, A.B., Ovung, R., Badhoniya, N.B. et al. Risk Factors for Predicting Diarrheal Duration and Morbidity in Children with Acute Diarrhea. Indian J Pediatr 79, 472–477 (2012). https://doi.org/10.1007/s12098-011-0561-3

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  • DOI: https://doi.org/10.1007/s12098-011-0561-3

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