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Factors Associated with the Duration of Moderate-to-Severe Diarrhea among Children in Rural Western Kenya Enrolled in the Global Enteric Multicenter Study, 2008–2012
Katharine A. Schilling
Katharine A. Schilling
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Richard Omore
Richard Omore
Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya;
Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;
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Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;
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Gordana Derado
Gordana Derado
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Tracy Ayers
Tracy Ayers
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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John B. Ochieng
John B. Ochieng
Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya;
Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;
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Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;
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Tamer H. Farag
Tamer H. Farag
Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland;
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Dilruba Nasrin
Dilruba Nasrin
Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland;
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Sandra Panchalingam
Sandra Panchalingam
Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland;
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James P. Nataro
James P. Nataro
Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland;
Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia;
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Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia;
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Karen L. Kotloff
Karen L. Kotloff
Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland;
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Myron M. Levine
Myron M. Levine
Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland;
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Joseph Oundo
Joseph Oundo
Centers for Disease Control and Prevention, Nairobi, Kenya;
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Michelle B. Parsons
Michelle B. Parsons
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Cheryl Bopp
Cheryl Bopp
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Kayla Laserson
Kayla Laserson
Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya;
Centers for Disease Control and Prevention, Delhi, India;
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Centers for Disease Control and Prevention, Delhi, India;
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Christine E. Stauber
Christine E. Stauber
School of Public Health, Georgia State University, Atlanta, Georgia;
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Richard Rothenberg
Richard Rothenberg
School of Public Health, Georgia State University, Atlanta, Georgia;
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Robert F. Breiman
Robert F. Breiman
Centers for Disease Control and Prevention, Nairobi, Kenya;
Emory Global Health Institute, Emory University, Atlanta, Georgia
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Emory Global Health Institute, Emory University, Atlanta, Georgia
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Ciara E. O'Reilly
Ciara E. O'Reilly
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Eric D. Mintz
Eric D. Mintz
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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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 Cryptosporidium (hazard ratio [HR]: 0.868, P = 0.035), using an unimproved drinking water source (HR: 0.87, P = 0.035), and being stunted at enrollment (HR: 0.026, P < 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 Cryptosporidium 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.
- Supplemental Materials (PDF 20 KB)
Author Notes
Financial support: The Global Enteric Multicenter Study (GEMS) was funded by the Bill & Melinda Gates Foundation through the University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD. Additional support for technical assistance with GEMS in Kenya was provided by the U.S. Agency for International Development through an Inter-Agency Agreement with the U.S. Centers for Disease Control and Prevention.
Authors' addresses: Katharine A. Schilling, Gordana Derado, Tracy Ayers, Michele B. Parsons, Cheryl Bopp, Ciara E. O'Reilly, and Eric D. Mintz, Centers for Disease Control and Prevention, Atlanta, GA, E-mails schil1ka@gmail.com, uwx8@cdc.gov, eyk6@cdc.gov, zcp9@cdc.gov, cab4@cdc.gov, bwf1@cdc.gov, and edm1@cdc.gov. Richard Omore and John B. Ochieng, Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya, and Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya, E-mails: omorerichard@gmail.com and bochieng@kemricdc.org. Tamer H. Farag, Dilruba Nasrin, Sandra Panchalingam, James P. Nataro, Karen L. Kotloff, and Myron M. Levine, Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, MD, E-mails: faragt@uw.edu, dnasrin@medicine.umaryland.edu, 7lingam@gmail.com, jpn2r@virginia.edu, kkotloff@medicine.umaryland.edu, and mlevine@medicine.umaryland.edu. Joseph Oundo, Centers for Disease Control and Prevention, Nairobi, Kenya, E-mail: joundo@kr.cdc.gov. Kayla Laserson, Centers for Disease Control and Prevention, New Delhi, India, and Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya, E-mail: kel4@cdc.gov. Christine E. Stauber and Richard Rothenberg, School of Public Health, Georgia State University, Atlanta, GA, E-mails: cstauber@gsu.edu and rrothenberg@gsu.edu. Robert F. Breiman, Emory Global Health Institute, Emory University, Atlanta, GA, and Centers for Disease Control and Prevention, Nairobi, Kenya, E-mail: rfbreiman@emory.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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-
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