Risk Factors for Development of Moderate and Severe Dehydration in Young Children with Acute Watery Diarrhea
Keywords:
Acute Watery Diarrhea, Dehydration, Severity, Risk Factors.Abstract
Background: Diarrhoea is a primary cause of sickness and mortality among children in underdeveloped nations. Acute-onset diarrhoea is often self-limiting; nevertheless, an acute infection may have a prolonged duration. The predominant complication of severe diarrhoea is dehydration. Diarrhoeal diseases can substantially affect psychomotor and cognitive development in young children.
Objective: To detect the risk factors for development of moderate and severe dehydration in children below two years with acute watery diarrhea.
Patients and methods: A hospital based case-control study, in which children aged up to 2 years of age suffering from acute watery diarrhea admitted to Al-Imamin Al-Kadhmin Teaching hospital, between February 2023 to December 2023 in which 222 child were included in the study to determine the risk factors for development of moderate to severe dehydration in patients with acute watery diarrhea, children comprising 102 cases (moderate or severe dehydration) and 120 controls (no or mild dehydration) up to 2 years of age suffering from acute watery diarrhea were studied.
Results: The statically significant risk factors for the onset of mild to severe dehydration in acute watery diarrhea that were identified include : Infancy below one year of age ( 84 children, 82% of cases , p value =0.0001, OR =2.08 ) , artificial feeding ( 74 children , 72.5% , p value =0.0005) , withdrawal of breast feeding during diarrhea (63 children, 61.7% of cases , OR =2.11 , p value= 0.0004) , poverty (41children ,40% of cases , OR =4.7, p value=0.0001 ), residency in rural area (65 children , 63.7% of cases , OR = 2.07, p value= 0.008), cessation or reduction of home fluid (55children , 54% of cases , OR = 2.17, p value=0.005) and ORS (76 children, 74.5% of dehydrated cases, OR = 2.47 , p value=0.002) during diarrheal episode, frequency of stools >8/day (75children, 73.5%, OR = 3.75, p value=0.003), frequency of vomiting>2/ day (77 children , 75.4% , OR = 3.7, p value=0.001) and temperature>38c (76 children , 74.5%, OR= 2.55, p value 0.001) and malnutrition (p value =0.0002).
Conclusions: This study suggest that early infancy, severe or moderate malnutrition, poverty, bottle feeding whether mixed or alone, early development of high grade temperature , more frequent vomiting or stool per day and rural residency are risk factors for dehydration in young children with acute watery.
Downloads
References
Manetu WM, M’masi S, Recha CW. Diarrhea disease among children under 5 years of age: a
global systematic review. Open Journal of Epidemiology. 2021 Jun 28;11(3):207-21
Puspitasari AD, Wulandari N, Prabawati BM, Yusan LY. A Community's Knowledge and
Attitude in Recognizing Symptoms and Diarrhea Management in Children. Jurnal Farmasi Dan
Ilmu Kefarmasian Indonesia Vol. 2022 Aug;9(2):101-6
UNICEF. Diarrhea remains a leading killer of young children, despite the availability of a
simple treatment solution. https://data.unicef.org/topic/child-health/diarrhoeal-disease/,
Accessed on 03.08.2024.
Troeger C, Blacker BF, Khalil IA, Rao PC, Cao S, Zimsen SR, et al. Estimates of the global,
regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a
systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious
Diseases. 2018;18(11):1211–28.
Khaliq A, Amreen, Jameel N, Krauth SJ. Knowledge and practices on the prevention and
management of diarrhea in children under-2 years among women dwelling in urban slums of
Karachi, Pakistan. Maternal and child health journal. 2022 Jul;26(7):1442-52
Zulfiqar A. Bhutta. Acute gastroenteritis in children. In: Kliegman Behrman , Jenson Stanton,
Nelson Text Book of Pediatrics, 19th edition. Philadelphia, Pennsylvania: Saunders.
;332:1323-1339.
Asfaha KF, Tesfamichael FA, Fisseha GK, Misgina KH, Weldu MG, Welehaweria NB, et al.
Determinants of childhood diarrhea in Medebay Zana District, Northwest Tigray, Ethiopia: a
community based unmatched case–control study. BMC Pediatrics 2018;18, p:410-411.
Daley SF, Avva U. Pediatric Dehydration. [Updated 2024 Jun 8]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK436022/Mirdan & Ali, AJCS, Vol. 6, No. 4: 75-85
World Health Organization, WHO (2005) Treatment of Diarrhea: A manual for the treatment
of acute diarrhea for use by physicians and other senior health workers, 4th revision. Geneva
WHO PP 2005. Available from: https://iris.who.int/handle/10665/43209. Accessed on: June,
Harold Alderman, Meera Shekar . Nutrition, Food Security, and Health. In : Kliegman Behrman
Jenson Stanton, Nelson Text Book of Pediatrics , 19th edition . Philadelphia, Pennsylvania :
Saunders. 2011;43:170-179.
Muriu MW. Determinants of Dehydration Among Children Under Five Years with Acute
Diarrhea Attending Mbagathi Hospital in Nairobi City County, Kenya (Doctoral Dissertation,
School of Health Sciences, Kenyatta University). 2023.
Yeasmin S, Hasan ST, Chisti MJ, Khan MA, Faruque AS, Ahmed T. Factors associated with
dehydrating rotavirus diarrhea in children under five in Bangladesh: An urban-rural
comparison. Plos one. 2022 Aug 26;17(8):e0273862.
Debebe S, Kloos H, Assefa A. Diarrheal prevalence and associated risk factors among underfive children attending Robe Didea General Hospital, Arsi Robe Town, Oromia Regional State,
Ethiopia: a cross-sectional study. Alexandria Journal of Medicine. 2024 Dec 31;60(1):65-75
McCormick BJ, Richard SA, Murray-Kolb LE, Kang G, Lima AA, Mduma E, Kosek MN, McQuade
ET, Houpt ER, Bessong P, Shrestha S. Full breastfeeding protection against common enteric
bacteria and viruses: Results from the MAL-ED cohort study. The American Journal of Clinical
Nutrition. 2022 Mar 1;115(3):759-69
Korpe PS, Liu Y, Siddique A, Kabir M, Ralston K, Ma JZ, Haque R, Petri Jr WA. Breast milk
parasite-specific antibodies and protection from amebiasis and cryptosporidiosis in
Bangladeshi infants: a prospective cohort study. Clinical infectious diseases. 2013 Apr
;56(7):988-92.
Al-Marzoki JM, Khalaf BS. Risk Factors for Development of Dehydration in Children Below Five
Years with Acute Diarrhea. Medical Journal of Babylon. 2009;6(3-4)
Sharma A, Mathur A, Stålsby Lundborg C, Pathak A. Incidence and risk factors for severe
dehydration in hospitalized children in Ujjain, India. International Journal of Environmental
Research and Public Health. 2020 Jan;17(2):616-26
Mansour AM, El Mohammady H, El Shabrawi M, Shabaan SY, Abou Zekri M, Nassar M, Salem
ME, Mostafa M, Riddle MS, Klena JD, Messih IA. Modifiable diarrhoea risk factors in Egyptian
children aged< 5 years. Epidemiology & Infection. 2013 Dec;141(12):2547-59.
Ganguly E, Sharma PK, Bunker CH. Prevalence and risk factors of diarrhea morbidity among
under-five children in India: A systematic review and meta-analysis. Indian journal of child
health. 2015 Oct;2(4):152-60
Giri M, Behera MR, Behera D, Mishra B, Jena D. Water, sanitation, and hygiene practices and
their association with childhood diarrhoea in rural households of Mayurbhanj district, Odisha,
India. Cureus. 2022 Oct;14(10): e29888
Tran KQ, Van Tran V, Ly NT, Truong HT, Nguyen PM. First Steps in Constructing the KVAD
Score to Estimate the Risk of Dehydration in Children with Acute Diarrhea: A Case-Control
Study. Journal of Comprehensive Pediatrics. 2024;15(2): e146360.
Sumathi WS, Balasubramanian S, Pradeebaa T, Sumathi B. A study on knowledge, attitude
and practices of mothers about acute diarrhea and its management with oral rehydration
therapy and zinc in children under 5 years. Int. Arch. Integr. Med. 2020 1;7:1-0
Sangalang SO, Prado NO, Lemence AL, Cayetano MG, Lu JL, Valencia JC, Kistemann T,
Borgemeister C. Diarrhoea, malnutrition, and dehydration associated with school water,
sanitation, and hygiene in Metro Manila, Philippines: A cross-sectional study. Science of the
Total Environment. 2022 10;838:155882Mirdan & Ali, AJCS, Vol. 6, No. 4: 75-85
Arif F, Singh P, Koul H. A hospital based observational study to identify the host and
environmental risk factors associated with persistent diarrhea in children less than five years
of age in a tertiary care center. Int J Acad Med Pharm. 2024;6(1):1373-