Clinical risk factors for fatal diarrhea in hospitalized children.

ABSTRACT

It is important to determine the specific factors for diarrheal deaths in infants & young children to enable the intervention and reduce the mortality rates. This study aimed to identify these factors in children under five years of age, hospitalized with diarrheal complaints. Four hundred diarrheal children were included in the study. Twenty-seven (6.75%) of them died and 373 (93.25%) survived. The nutritional status of the patients was determined using weight for height for age as percentage of Harward Standard. It was found that severe malnutrition (p = 0.000 for weight for height ration < 70% and p = 0.036 for height for age < 85%), co-existent sepsis (p = 0.000), shigella infection (p = 0.0014), hypoalbuminemia (p = 0.0000), hypoglycemia (p = 0.0002), hyponatremia (p = 0.016), hypokalemia (p = 0.0041) and metabolic acidosis (p = 0.0069 for pH < 7.35 and p = 0.000 for HCO3 < 20 moL/l) were significant risk factors for diarrheal deaths in the univariate analysis. In the multivariate analysis, young age (under 6 months of age) ¿Odds ratio (OR) 10.49, 95% confidence interval (CI) 1.75, 62.75)¿, moderate or severe dehydration (OR 8.17, 95% CI 1.53, 43.67), severe malnutrition (OR 0.04, 95% CI 0.00, 0.22 of weight for height < 70% and OR 0.03, 95% CI 0.00, 0.36 for height for age < 85%), co-existent sepsis (OR 37.26, 95% CI 6.94, 200.06), shigella infection (OR 23.01, 95% CI 3.08, 171.98), hypoalbuminemia (OR 0.11, 95% CI 0.02, 0.54), metabolic acidosis (OR 0.03, 95% CI 0.00, 0.33 of HCO3 < 20 mMol/L) were significant risk factors. It is concluded that, in addition to electrolyte and fluid treatments, prevention of malnutrition, continuation of feeding which lessens weight loss and may prevent fatal hypoglycemia, and early detection and treatment of probable sepsis are important in reducing diarrheal deaths.