Bhandari N, Bhan M K, Sazawal S
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Acta Paediatr Suppl. 1992 Sep;381:3-6.
Mortality associated with diarrhea was investigated in a longitudinally followed cohort of children under six years of age in rural North India. During the follow-up, 1663 episodes of diarrhea and 23 diarrhea related deaths were recorded in 1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery diarrhea, 4.27% for dysentery and 11.94% for non-dysenteric persistent diarrhea. Most of the episodes lasted less than a week; 5.2% became persistent (duration > 14 days). The case fatality rate was similar in episodes of one and two weeks' duration (0.64% and 0.8%) and increased to 13.95% for persistent episodes. Of the total 86 persistent episodes, 22.1% were dysenteric; the case fatality rate for such dysenteric persistent episodes was 21.1% and for watery persistent diarrhea 11.4%. Diarrheal attack rates were similar among different nutritional groups, but diarrheal case fatality rates progressively increased with increasing severity of malnutrition, these were 24 times higher in children with severe malnutrition (7.48%) compared to those normally nourished (0.31%). With availability and use of oral rehydration therapy, dysentery and persistent diarrhea emerge as major causes of diarrhea related mortality, with underlying malnutrition as a key associated factor.
在印度北部农村地区对6岁以下儿童进行纵向随访的队列研究中，调查了腹泻相关的死亡率。在随访期间，对1467名儿童进行了20个月的随访，记录到1663次腹泻发作和23例腹泻相关死亡。急性水样腹泻的病死率为0.56%，痢疾为4.27%，非痢疾性持续性腹泻为11.94%。大多数腹泻发作持续时间不到一周；5.2%的发作转为持续性腹泻（持续时间>14天）。持续时间为一周和两周的腹泻发作病死率相似（分别为- 0.64%和0.8%），持续性腹泻发作的病死率升至13.95%。在总共86例持续性腹泻发作中，22.1%为痢疾性；此类痢疾性持续性腹泻发作的病死率为- 21.1%，水样持续性腹泻为11.4%。不同营养组的腹泻发病率相似，但腹泻病死率随着营养不良严重程度的增加而逐渐上升，重度营养不良儿童（7.48%）的腹泻病死率是营养正常儿童（0.31%）的24倍。随着口服补液疗法的可得性和使用，痢疾和持续性腹泻成为腹泻相关死亡的主要原因，潜在的营养不良是一个关键相关因素。
