1921
Volume 97, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Diarrheal disease is a leading cause of death among young children worldwide. As rates of acute diarrhea (AD; 1–6 days duration) have decreased, persistent diarrhea (PD; > 14 days duration) accounts for a greater proportion of the diarrheal disease burden. We describe factors associated with the duration of moderate-to-severe diarrhea in Kenyan children < 5 years old enrolled in the Global Enteric Multicenter Study. We found 587 (58%) children experienced AD, 360 (35%) had prolonged acute diarrhea (ProAD; 7–13 days duration), and 73 (7%) had PD. We constructed a Cox proportional hazards model to identify factors associated with diarrheal duration. Risk factors independently associated with longer diarrheal duration included infection with (hazard ratio [HR]: 0.868, = 0.035), using an unimproved drinking water source (HR: 0.87, = 0.035), and being stunted at enrollment (HR: 0.026, < 0.0001). Diarrheal illness of extended duration appears to be multifactorial; given its association with adverse health and development outcomes, effective strategies should be implemented to reduce the duration and severity of diarrheal illness. Effective treatments for should be identified, interventions to improve drinking water are imperative, and nutrition should be improved through exclusive breastfeeding in infants ≤ 6 months and appropriate continued feeding practices for ill children.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.16-0898
2017-07-12
2018-12-12
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/1/tpmd160898.html?itemId=/content/journals/10.4269/ajtmh.16-0898&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2013. Diarrhoeal Disease Fact Sheet. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/mediacentre/factsheets/fs330/en/. Accessed May 1, 2015. [Google Scholar]
  2. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O'Brien KL, Campbell H, Black RE, , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.[Crossref] [Google Scholar]
  3. Kotloff KL, Blackwelder WC, Nasrin D, Nataro JP, Farag TH, van Eijk A, Adegbola RA, Alonso PL, Breiman RF, Faruque AS, Saha D, Sow SO, Sur D, Zaidi AK, Biswas K, Panchalingam S, Clemens JD, Cohen D, Glass RI, Mintz ED, Sommerfelt H, Levine MM, , 2012. The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study. Clin Infect Dis 55 (Suppl 4): S232S245.[Crossref] [Google Scholar]
  4. Bhutta ZA, Nelson EA, Lee WS, Tarr PI, Zablah R, Phua KB, Lindley K, Bass D, Phillips A, Persistent Diarrhea Working Group, 2008. Recent advances and evidence gaps in persistent diarrhea. J Pediatr Gastroenterol Nutr 47: 260265.[Crossref] [Google Scholar]
  5. Victora CG, Huttly SR, Fuchs SC, Nobre LC, Barros FC, , 1992. Deaths due to dysentery, acute and persistent diarrhoea among Brazilian infants. Acta Paediatr Suppl 381: 711.[Crossref] [Google Scholar]
  6. Lima AA, Moore SR, Barboza MS, Jr Soares AM, Schleupner MA, Newman RD, Sears CL, Nataro JP, Fedorko DP, Wuhib T, Schorling JB, Guerrant RL, , 2000. Persistent diarrhea signals a critical period of increased diarrhea burdens and nutritional shortfalls: a prospective cohort study among children in northeastern Brazil. J Infect Dis 181: 16431651.[Crossref] [Google Scholar]
  7. World Health Organization, 1988. Persistent diarrhoea in children in developing countries: memorandum from a WHO meeting. Bull World Health Organ 66: 709717. [Google Scholar]
  8. Niehaus MD, Moore SR, Patrick PD, Derr LL, Lorntz B, Lima AA, Guerrant RL, , 2002. Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. Am J Trop Med Hyg 66: 590593.[Crossref] [Google Scholar]
  9. Bartlett AV, Hurtado E, Schroeder DG, Mendez H, , 1992. Association of indicators of hygiene behavior with persistent diarrhea of young children. Acta Paediatr Suppl 381: 6671.[Crossref] [Google Scholar]
  10. Kermani NA, Jafari F, Mojarad HN, Hoseinkhan N, Zali R, , 2010. Prevalence and associated factors of persistent diarrhoea in Iranian children admitted to a paediatric hospital. East Mediterr Health J 16: 831836. [Google Scholar]
  11. Black RE, , 1993. Persistent diarrhea in children of developing countries. Pediatr Infect Dis J 12: 751761.[Crossref] [Google Scholar]
  12. Thanh PN, Ly DT, Dung PT, Le PD, , 1992. Clinical aspects of acute vs persistent diarrhea in Ho Chi Minh City, Vietnam. Acta Paediatr Suppl 381: 121123.[Crossref] [Google Scholar]
  13. Lima AA, Guerrant RL, , 1992. Persistent diarrhea in children: epidemiology, risk factors, pathophysiology, nutritional impact, and management. Epidemiol Rev 14: 222242.[Crossref] [Google Scholar]
  14. Das SK, Faruque AS, Chisti MJ, Malek MA, Salam MA, Sack DA, , 2012. Changing trend of persistent diarrhoea in young children over two decades: observations from a large diarrhoeal disease hospital in Bangladesh. Acta Paediatr 101: e452e457.[Crossref] [Google Scholar]
  15. Karim AS, Akhter S, Rahman MA, Nazir MF, , 2001. Risk factors of persistent diarrhea in children below five years of age. Indian J Gastroenterol 20: 5961. [Google Scholar]
  16. Umamaheswari B, Biswal N, Adhisivam B, Parija SC, Srinivasan S, , 2010. Persistent diarrhea: risk factors and outcome. Indian J Pediatr 77: 885888.[Crossref] [Google Scholar]
  17. Moore SR, Lima NL, Soares AM, Oria RB, Pinkerton RC, Barrett LJ, Guerrant RL, Lima AA, , 2010. Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children. Gastroenterology 139: 11561164.[Crossref] [Google Scholar]
  18. Fraser D, Dagan R, Porat N, el-On J, Alkrinawi S, Deckelbaum RJ, Naggan L, , 1998. Persistent diarrhea in a cohort of Israeli Bedouin infants: role of enteric pathogens and family and environmental factors. J Infect Dis 178: 10811088.[Crossref] [Google Scholar]
  19. Lanata CF, Black RE, Gilman RH, Lazo F, Del Aguila R, , 1991. Epidemiologic, clinical, and laboratory characteristics of acute vs. persistent diarrhea in periurban Lima, Peru. J Pediatr Gastroenterol Nutr 12: 8288.[Crossref] [Google Scholar]
  20. Bhan MK, Bhandari N, Sazawal S, Clemens J, Raj P, Levine MM, Kaper JB, , 1989. Descriptive epidemiology of persistent diarrhoea among young children in rural northern India. Bull World Health Organ 67: 281288. [Google Scholar]
  21. Mirza NM, Caulfield LE, Black RE, Macharia WM, , 1997. Risk factors for diarrheal duration. Am J Epidemiol 146: 776785.[Crossref] [Google Scholar]
  22. Patel AB, Ovung R, Badhoniya NB, Dibley MJ, , 2012. Risk factors for predicting diarrheal duration and morbidity in children with acute diarrhea. Indian J Pediatr 79: 472477.[Crossref] [Google Scholar]
  23. Strand TA, Sharma PR, Gjessing HK, Ulak M, Chandyo RK, Adhikari RK, Sommerfelt H, , 2012. Risk factors for extended duration of acute diarrhea in young children. PLoS One 7: e36436.[Crossref] [Google Scholar]
  24. Baqui AH, Black RE, Yunus M, Hoque AR, Chowdhury HR, Sack RB, , 1991. Methodological issues in diarrhoeal diseases epidemiology: definition of diarrhoeal episodes. Int J Epidemiol 20: 10571063.[Crossref] [Google Scholar]
  25. Morris SS, Cousens SN, Lanata CF, Kirkwood BR, , 1994. Diarrhoea–defining the episode. Int J Epidemiol 23: 617623.[Crossref] [Google Scholar]
  26. Pickering H, Hayes RJ, Tomkins AM, Carson D, Dunn DT, , 1987. Alternative measures of diarrhoeal morbidity and their association with social and environmental factors in urban children in The Gambia. Trans R Soc Trop Med Hyg 81: 853859.[Crossref] [Google Scholar]
  27. Wright J, Gundry SW, Conroy RM, , 2007. A review of changing episode definitions and their effects on estimates of diarrhoeal morbidity. J Health Popul Nutr 25: 448455. [Google Scholar]
  28. Wright JA, Gundry SW, Conroy R, Wood D, Du Preez M, Ferro-Luzzi A, Genthe B, Kirimi M, Moyo S, Mutisi C, Ndamba J, Potgieter N, , 2006. Defining episodes of diarrhoea: results from a three-country study in sub-Saharan Africa. J Health Popul Nutr 24: 816. [Google Scholar]
  29. Rahman AE, Moinuddin M, Molla M, Worku A, Hurt L, Kirkwood B, Mohan SB, Mazumder S, Bhutta Z, Raza F, Mrema S, Masanja H, Kadobera D, Waiswa P, Bahl R, Zangenberg M, Muhe L, Persistent Diarrhoea Research Group, 2014. Childhood diarrhoeal deaths in seven low- and middle-income countries. Bull World Health Organ 92: 664671.[Crossref] [Google Scholar]
  30. Adazu K, Lindblade KA, Rosen DH, Odhiambo F, Ofware P, Kwach J, van Eijk AM, Decock KM, Amornkul P, Karanja D, Vulule JM, Slutsker L, , 2005. 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 73: 11511158. [Google Scholar]
  31. Omore R, O'Reilly CE, Williamson J, Moke F, Were V, Farag TH, van Eijk AM, Kotloff KL, Levine MM, Obor D, Odhiambo F, Vulule J, Laserson KF, Mintz ED, Breiman RF, , 2013. Health care-seeking behavior during childhood diarrheal illness: results of health care utilization and attitudes surveys of caretakers in western Kenya, 2007–2010. Am J Trop Med Hyg 89: 2940.[Crossref] [Google Scholar]
  32. Robins-Browne RM, Levine MM, , 2012. Laboratory diagnostic challenges in case/control studies of diarrhea in developing countries. Clin Infect Dis 55: S312S316.[Crossref] [Google Scholar]
  33. Kenya National Bureau of Statistics and ICF Macro, 2012. Kenya Demograpic and Health Survey 2008–09. Calverton, MD: KNBS and ICF Macro. [Google Scholar]
  34. UNICEF, 2013. Statistics. Kenya. Available at: https://www.unicef.org/infobycountry/kenya_statistics.html. Accessed May 3, 2015. [Google Scholar]
  35. UNICEF/WHO Joint Monitoring Programme, 2015. Definitions and Methods . Available at: https://www.wssinfo.org/definitions-methods. Accessed May 3, 2015.
  36. Filmer D, Pritchett L, , 2001. Estimating Wealth Effects without Expenditure Data–or Tears: An Application to Educational Enrollments in States of India . Demography, 38: 115–132.
  37. Smith TS, Smith B, , 2003. Kaplan Meier And Cox Proportional Hazards Modeling: Hands on Survival Analysis . San Diego, CA: Department of Defense Center for Deployment Health Research, Naval Health Research Center.
  38. Klein JF, Moeschberger ML, , 2005. Survival Analysis: Techniques for Censored and Truncated Data, 2nd edition. New York, NY: Springer. [Google Scholar]
  39. Collett D, Chatfield CL, Tanner M, Zidek J, , 2003. Models for binary and binomial data: strategy for model selection. , eds. Modelling Binary Data. Boca Raton, FL: Chapman and Hall/CRC, Taylor & Francis Group. [Google Scholar]
  40. Nataro JP, Sears CL, , 2001. Infectious causes of persistent diarrhea. Pediatr Infect Dis J 20: 195196.[Crossref] [Google Scholar]
  41. Centers for Disease Control and Prevention, 2015. Cryptosporidium Illness and Symptoms . Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/parasites/crypto/illness.html. Accessed May 15, 2015.
  42. Baldursson S, Karanis P, , 2011. Waterborne transmission of protozoan parasites: review of worldwide outbreaks: an update 2004–2010. Water Res 45: 66036614.[Crossref] [Google Scholar]
  43. Keegan A, Daminato D, Saint CP, Monis PT, , 2008. Effect of water treatment processes on Cryptosporidium infectivity. Water Res 42: 18051811.[Crossref] [Google Scholar]
  44. Ryan U, Hijjawi N, , 2015. New developments in Cryptosporidium research. Int J Parasitol 45: 367373.[Crossref] [Google Scholar]
  45. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, Wu Y, Sow SO, Sur D, Breiman RF, Faruque AS, Zaidi AK, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ochieng JB, Omore R, Oundo JO, Hossain A, Das SK, Ahmed S, Qureshi S, Quadri F, Adegbola RA, Antonio M, Hossain MJ, Akinsola A, Mandomando I, Nhampossa T, Acácio S, Biswas K, O'Reilly CE, Mintz ED, Berkeley LY, Muhsen K, Sommerfelt H, Robins-Browne RM, Levine MM, , 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 382: 209222.[Crossref] [Google Scholar]
  46. McAuliffe JF, Shields DS, Auxiliadora de Sousa M, Sakell J, Schorling J, Guerrant RL, , 1986. Prolonged and recurring diarrhea in the northeast of Brazil: examination of cases from a community-based study. J Pediatr Gastroenterol Nutr 5: 902906.[Crossref] [Google Scholar]
  47. World Health Organization, 2015. Household Water Treatment and Safe Storage: Treatment Technologies. Geneva, Switzerland: World Health Organization. [Google Scholar]
  48. UNICEF/WHO Joint Monitoring Programme, 2012. Post-2015 WASH Targets and Indicators . Available at: https://www.unicef.org/wash/files/4_WSSCC_JMP_Fact_Sheets_4_UK_LoRes.pdf. Accessed May 20, 2015.
  49. Mintz E, Bartram J, Lochery P, Wegelin M, , 2001. Not just a drop in the bucket: expanding access to point-of-use water treatment systems. Am J Public Health 91: 15651570.[Crossref] [Google Scholar]
  50. Bhutta ZA, Ghishan F, Lindley K, Memon IA, Mittal S, Rhoads JM, Commonwealth Association of Paediatric Gastroenterology and Nutrition, 2004. Persistent and chronic diarrhea and malabsorption: working group report of the second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 39 (Suppl 2): S711S716.[Crossref] [Google Scholar]
  51. Nel E, , 2010. Diarrhoea and malnutrition. South Afr J Clin Nutr 23: S15S18.[Crossref] [Google Scholar]
  52. Das JK, Bhutta ZA, , 2015. 3.6 Reducing the burden of acute and prolonged childhood diarrhea. World Rev Nutr Diet 113: 168172.[Crossref] [Google Scholar]
  53. UNICEF/WHO, 2004. Clinical Management of Acute Diarrhoea. Available at: http://apps.who.int/iris/bitstream/10665/68627/1/WHO_FCH_CAH_04.7.pdf. Accessed May 2, 2015. [Google Scholar]
  54. Patel A, Mamtani M, Dibley MJ, Badhoniya N, Kulkarni H, , 2010. Therapeutic value of zinc supplementation in acute and persistent diarrhea: a systematic review. PLoS One 5: e10386.[Crossref] [Google Scholar]
  55. Roy SK, Tomkins AM, Akramuzzaman SM, Chakraborty B, Ara G, Biswas R, Islam KE, Khatun W, Jolly SP, , 2007. Impact of zinc supplementation on subsequent morbidity and growth in Bangladeshi children with persistent diarrhoea. J Health Popul Nutr 25: 6774. [Google Scholar]
  56. Roy SK, Hossain MJ, Khatun W, Chakraborty B, Chowdhury S, Begum A, Mah-e-Muneer S, Shafique S, Khanam M, Chowdhury R, , 2008. Zinc supplementation in children with cholera in Bangladesh: randomised controlled trial. BMJ 336: 266268.[Crossref] [Google Scholar]
  57. Arnold BF, Galiani S, Ram PK, Hubbard AE, Briceno B, Gertler PJ, Colford JM, Jr, 2013. Optimal recall period for caregiver-reported illness in risk factor and intervention studies: a multicountry study. Am J Epidemiol 177: 361370.[Crossref] [Google Scholar]
  58. Liu J, Platts-Mills JA, Juma J, Kabir F, Nkeze J, Okoi C, Operario DJ, Uddin J, Ahmed S, Alonso PL, Antonio M, Becker SM, Blackwelder WC, Breiman RF, Faruque ASG, Fields B, Gratz J, Haque R, Hossain A, Hossain MJ, Jarju S, Qamar F, Iqbal NT, Kwambana B, Mandomando I, McMurry TL, Ochieng C, Ochieng JB, Ochieng M, Onyango C, Panchalingam S, Kalam A, Aziz F, Qureshi S, Ramamurthy T, Roberts JH, Saha D, Sow SO, Stroup SE, Sur D, Tamboura B, Taniuchi M, Tennant SM, Toema D, Wu Y, Zaidi A, Nataro JP, Kotloff KL, Levine MM, Houpt ER, ., 2016. Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: a reanalysis of the GEMS case-control study. Lancet 388: 12911301.[Crossref] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.16-0898
Loading
/content/journals/10.4269/ajtmh.16-0898
Loading

Data & Media loading...

Supplemental Table

  • Received : 12 Nov 2016
  • Accepted : 31 Jan 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error