A prediction model for moderate or severe dehydration in children with diarrhoea.

A hospital-based unmatched case-control study (387 cases and 387 controls) was carried out at the Government Medical College Hospital, Nagpur, India, to devise and validate a risk-scoring system for predicting the development of moderate or severe dehydration in children, aged less than five years, with acute watery diarrhoea. On unconditional multiple logistic regression, 12 risk factors--infancy, minority religion, undernutrition, not washing hands by mother before preparation of food, frequency of stools > 8/day, frequency of vomiting > 2/day, measles in previous 6 months, withdrawal of breast-feeding/other feedings, withdrawal of fluids during diarrhoea, not giving oral rehydration solutions (ORS), home available fluids and both during diarrhoea--were significant. Based on regression coefficients, these factors were ascribed statistical weights of 5, 5, 4, 4, 22, 9, 11, 13, 5, 5, 5, and 7 respectively. The receiver-operating characteristic curve suggested a total score of 48 to be the best cut-off for predicting the development of moderate or severe dehydration. At this cut-off, the sensitivity, specificity, positive predictive value, Cohen's kappa, and overall predictive accuracy were 0.81, 0.81, 0.81, 0.61, and 0.86 respectively. If substantiated by further validation, this system can be used for predicting the development of dehydration at the earlier stage, thereby reducing the mortality associated with life-threatening dehydration.

Risk factors for development of dehydration in children aged under five who have acute watery diarrhoea: a case-control study.

OBJECTIVE: To identify factors for development of dehydration in under five year olds with acute watery diarrhoea. DESIGN: Hospital based unmatched case-control study. SETTING: Diarrhoea Treatment Unit, Government Medical College Hospital, Nagpur, India. PARTICIPANTS: The study included 387 cases of diarrhoea having severe or moderate dehydration and 387 controls suffering from diarrhea with mild or no dehydration. RISK FACTORS: The study included infancy, female sex, religion, residing in urban slums or rural area, under nutrition, cessation of breast feeding during diarrhoeal episode, fluid intake decrease/stopped during diarrhoea, ORS not received, home available funds (HAF) not received, both ORS and HAF not received, non-washing of hands by mother before preparation of food, after defaecation, after disposal of faeces, history of measles in the previous six months, frequency of stools > 8/d, frequency of vomiting more than twice per day and temperature more than 99 degrees F, as risk factors for development of dehydration. STATISTICAL ANALYSIS: Univariate analysis included OR, 95% CI for OR and Chi-square test. Multivariate analysis was carried out by unconditional multiple logistic regression (MLR). RESULTS: This study identified the significance of infancy, religion, severe undernutrition, non-washing of hands by mother before preparation of food, frequency of stool > 8/d, frequency of vomiting > 2/d, history of measles in previous six months, withdrawal of breast feeding during diarrhoea, withdrawal of fluids during diarrhoea and not giving ORS, HAF or both during diarrhoea, in the outcome of development of moderate or severe dehydration. CONCLUSIONS: Timely intervention in the preventable risk factors included in this study may prevent the development of moderate or severe dehydration in the children suffering form acute watery diarrhoea.

PIP: An unmatched case-control study conducted at the Diarrhea Treatment Unit of the Government Medical College Hospital in Nagpur, India, investigated risk factors for dehydration in 387 children under 5 years of age admitted with severe or moderate dehydration and 387 controls with no or mild dehydration. The presence of hypothesized risk factors for the development of moderate or severe dehydration in children with acute watery diarrhea was ascertained through interviews with the mothers. Multivariate analysis identified 12 significant risk factors: age under 12 months, Muslim religion, severe undernutrition, nonwashing of hands by the mother before food preparation, more than 8 stools per day, more than 2 vomiting episodes per day, a history of measles in the previous 6 months, withdrawal of breast-feeding during diarrhea, withdrawal of fluids during diarrhea, not giving home-available fluids during diarrhea, not giving oral rehydration solution (ORS) during diarrhea, and not giving both home-available fluids and ORS during diarrhea. These findings confirm the importance of continuing to supply breast milk, ORS, and other fluids to young children with watery diarrhea to prevent the development of life-threatening dehydration.