Sachdev H P, Kumar S, Singh K K, Satyanarayana L, Puri R K
Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
J Pediatr Gastroenterol Nutr. 1991 Jan;12(1):76-81. doi: 10.1097/00005176-199101000-00016.
There is scant information on the risk factors for diarrheal deaths in developing countries. A prospective evaluation was therefore conducted on 382 consecutive children (less than 5 years of age), who were hospitalized with diarrhea. A complete profile, including outcome, was available for 357 patients, 37 of whom died (10.4%). In the univariate analysis, four factors were significantly associated (p less than 0.02) with death: associated major infection (pneumonia, septicemia, or meningitis), severe wasting (less than or equal to 50% weight for age), severe stunting (less than or equal to 85% height for age), and protraction of illness (greater than 14 days). In the multivariate analysis, all four factors retained their significance. The adjusted odds ratios (95% confidence interval) were 4.7 (3.9, 5.6), 3.3 (2.7, 4.0), 1.9 (1.6, 2.3), and 1.5 (1.3, 1.8), respectively. In addition, in children less than 19 months of age (n = 241; 29 deaths) breast-feeding had a significant (p less than 0.001) protective effect (adjusted OR--2.3, 95% CI-1.9-2.8). It is concluded that even in a setting with high diarrheal fatality rates, high-risk children can be identified and targeted for intensive intervention.
关于发展中国家腹泻死亡的风险因素，目前几乎没有相关信息。因此，对382名连续住院的腹泻儿童（小于5岁）进行了前瞻性评估。357名患者有完整的资料，包括预后情况，其中37人死亡（10.4%）。单因素分析显示，有四个因素与死亡显著相关（p<0.02）：合并主要感染（肺炎、败血症或脑膜炎）、严重消瘦（年龄别体重≤50%）、严重发育迟缓（年龄别身高≤85%）以及病程延长（>14天）。多因素分析中，这四个因素均保持其显著性。调整后的比值比（95%置信区间）分别为4.7（3.9，5.6）、3.3（2.7，4.0）、1.9（1.6，2.3）和1.5（1.3，1.8）。此外，在小于19个月的儿童中（n = 241；29例死亡），母乳喂养具有显著的（p<0.001）保护作用（调整后的OR为2.3，95%CI为1.9 - 2.8）。研究得出结论，即使在腹泻死亡率较高的环境中，也可以识别出高危儿童并针对其进行强化干预。
