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Preventing and Treating Childhood Diarrhea


Preventing and Treating Childhood Diarrhea:
Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study (5:26)

Running Time: 5 minutes, 26 seconds
Release Date: 7/3/2012

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Hello. I’m Dr. Ciara O’Reilly, an epidemiologist with the Waterborne Disease Prevention Branch at the Centers for Disease Control and Prevention (CDC). On behalf of the investigators, I would like to take this opportunity to summarize the findings of our study on the risk factors for death among young children who were hospitalized with diarrhea in Kenya 1.

Diarrhea is one of the leading causes of childhood illness and death in sub-Saharan Africa 2, 3. However, in this region, information on the pathogens associated with diarrhea deaths and the factors that place a child at increased risk of death from diarrhea is sparse. Knowing this information is critical to better tailor treatment for diarrhea and to stimulate new approaches for prevention, including vaccines.

To address the lack of available information, we carried out a study in Kenya to comprehensively look at the pathogens that cause diarrhea and to identify the factors that place a young child at increased risk of death when he or she is hospitalized with an episode of diarrhea.

The study took place over two years, from 2005 to 2007, in a rural province in Western Kenya called Nyanza Province. This province has high rates of infant and child mortality and high malaria and HIV prevalence 4, 5.

We enrolled over 1,000 children at two large hospitals. All children who had diarrhea which had begun in the past 5 days, were less than 5 years old, and hospitalized for their illness were eligible for enrollment. Diarrhea was defined as passing three or more loose stools in 24 hours. All of the children enrolled in the study were attended to by physicians working for the Kenyan Ministry of Health and treated according to the pediatric standard of care in Kenya.

After explaining the study and obtaining informed consent from each child’s caretaker, trained study staff asked the caretaker about the child’s age and gender, the child’s diarrhea history, and information regarding the child’s illness and the treatments he or she received. Additional clinical information was collected from medical records. We also collected a stool specimen from each child, which we tested in Kenya for bacterial and viral agents that cause diarrhea. We tracked the children’s progress during hospitalization and recoded whether each child was discharged from the hospital or if the child died during his or her hospital stay.

We worked with statisticians to analyze the data and identify risk factors for death.

We found that 9% of children in our study died during hospitalization. Rotavirus was the most common agent of diarrhea, identified in about 1 in 5 children, followed by nontyphoidal Salmonella, then Campylobacter, and then Shigella. When we looked specifically at the children who died, about 1 in 5 was infected with nontyphoidal Salmonella, followed by Shigella. Thus, while rotavirus was the most common agent of diarrhea identified in the children hospitalized with diarrhea, it was not the most frequently identified pathogen among the children who died during hospitalization.

When we looked at the risk factors for death we found children less than a year old who died were more likely to have infection with nontyphoidal Salmonella and children less than 5 years old to have Shigella. Other risk factors for death included being malnourished; having oral thrush, which can be associated with HIV/AIDS infection; having previously sought care at a hospital for their illness, which is often a marker for severe illness; and being dehydrated as diagnosed at the time of hospital discharge or death.

Please note that this study has limitations. We only captured the deaths among children who died in the hospital, so we likely missed a substantial number of additional deaths that happened at home after children were discharged or among children who were never hospitalized. Since most diarrheal deaths happen at home where people have less access to rehydration therapies, the relative importance of different pathogens as a cause of diarrheal deaths among children occurring in the community may be different to that of hospitalized children assessed in this study.

The findings of our study reinforce that improved prevention and treatment of diarrheal disease is urgently needed. Immediate priority should be given to the management of children presenting to the hospital with diarrhea who are at high risk of death, including those who have previously sought care at a health facility for their illness, are dehydrated, have oral thrush, and are malnourished. In addition to receiving appropriate diarrhea case management, malnourished children with diarrhea should be provided nutritional rehabilitation.

This study can also help inform policy makers on priority areas for interventions to reduce childhood diarrhea requiring hospitalization or resulting in death, such as the use of zinc for diarrhea management; reemphasis on community-level promotion of Oral Rehydration Solution; water, sanitation and hygiene interventions; and the development and roll-out of new vaccines for enteric pathogens, especially rotavirus vaccine which is currently available for global roll-out.

Thank you for your interest in this study and the prevention and treatment of diarrheal disease.

Eric Mintz - Safe Water for All. CDC Foundation video.

Safe Water For All (2:10)
Produced By: CDC Foundation
Running Time: 2 minutes, 26 seconds
Release Date: 2/14/2011

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  1. O'Reilly CE, Jaron P, Ochieng B, Nyaguara A, Tate JE, Parsons MB, Bopp CA, Williams KA, Vinjé J, Blanton E, Wannemuehler KA, Vulule J, Laserson KF, Breiman RF, Feikin DR, Widdowson MA, Mintz E. Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005-2007: A Cohort Study. PLoS Med. 2012 Jul;9(7):e1001256. Epub 2012 Jul 3.
  2. Boschi-Pinto C, Young M, Black RE. The Child Health Epidemiology Reference Group reviews of the effectiveness of interventions to reduce maternal, neonatal and child mortality. 2010. Int J Epidemiol 39 Suppl. 1: i3-i6.
  3. UNICEF/WHO. Diarrhea: Why children are still dying and what can be done. Geneva: The United Nations Children's Fund/World Health Organization. 2009;1-58.
  4. Kenya National Bureau of Statistics. Kenya Demographic and Health Survey 2003. [PDF - 390 pages] Calverton (Maryland): Kenya National Bureau of Statistics, Kenya Ministry of Health and ORC Macro. 2004.
  5. Adazu K, Lindblade KA, Rosen DH, Odhiambo F, Ofware P, et al. Health and demographic surveillance in rural western Kenya: a platform for evaluating interventions to reduce morbidity and mortality from infectious diseases. Am J Trop Med Hyg. 2005;73:1151-1158.
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