Risk factors for death among children 0-59 months of age with moderate-to-severe diarrhea in Manhiça district, southern Mozambique

ABSTRACT

In spite of very significant decreasing trends in the last three decades, childhood mortality remains unacceptably high globally, with 5.6 million children dying every year before reaching their 5th birthday, the majority of which in low and middle-income countries (LMIC) [1]. Diarrheal diseases still represent a major cause of morbidity and mortality in childhood, and are believed to account for 499,000­526,000 annual child deaths, nearly 9% of all under five global mortality [2, 3], in spite of the good intake of life-saving interventions such as oral rehydration solution (ORS) [3] and the rotavirus vaccine [4]. Deaths in sub-Saharan Africa and Southeast Asia account for ~ 78% of deaths due to diarrhea worldwide [5, 6], underscoring the inequities related to this particular syndrome. The Global Enteric Multi-center Study (GEMS) reported that most episodes of moderate-to-severe diarrhea (MSD) among children under 5 years old were primarily due to four pathogens Rotavirus, Cryptosporidium, Enterotoxigenic Escherichia coli (ST-ETEC), and Shigella [7]. The risk of dying from diarrheal disease was reported to be higher among children younger than 2 years of age, albeit with relatively different rates from one region to another [7]. The advent of the HIV/AIDS pandemic has also changed the incidence [8], clinical presentation and outcome of diarrheal diseases, as the immunosuppression derived from the infection favors a higher incidence of gastrointestinal infections, not only from "classical" diarrhea pathogens, but also from more aggressive opportunistic infections, typical of the immunocompromised host. This has resulted in significant changes in the last decades in the spectrum, clinical presentation, duration and prognosis of diarrheal episodes in those countries where HIV is highly prevalent [9, 10].