Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark.
Trop Med Int Health. 2019 Sep;24(9):1088-1097. doi: 10.1111/tmi.13291. Epub 2019 Aug 16.
To assess the prevalence of prolonged and persistent diarrhoea, to estimate their co-occurrence with acute malnutrition and association with demographic and clinical factors.
Case-control study where cases were children under 5 years of age with diarrhoea and controls were children without diarrhoea, frequency-matched weekly by age and district of residency. Controls for cases 0-11 months were recruited from vaccination rooms, and controls for cases 12-59 months were recruited by house visits using random locations in the catchment area of the study sites. Data were analysed by mixed model logistic regression.
We enrolled 1134 cases and 946 controls. Among the cases, 967 (85%) had acute diarrhoea (AD), 129 (11%) had ProD and 36 (3.2%) had PD. More cases had acute malnutrition at enrolment (17% vs. 4%, P < 0.0001) and more were born prematurely (5.7% vs. 1.8%, P < 0.0001) than controls. About 75% of ProPD cases did not have acute malnutrition. Cases with AD and ProPD had different symptomatology, even beyond illness duration.
ProPD is common among children presenting with diarrhoea and is not confined to children with acute malnutrition. There is an urgent need for studies assessing causes of ProPD with and without acute malnutrition to develop treatment guidelines for these conditions.
评估迁延性和持续性腹泻的流行情况，估计其与急性营养不良的共同发生情况，并分析其与人口统计学和临床因素的相关性。
采用病例对照研究设计，以腹泻的 5 岁以下儿童为病例，无腹泻的儿童为对照，按照年龄和居住地区每周进行频数匹配。0-11 月龄病例的对照在接种室招募，12-59 月龄病例的对照通过在研究点的服务覆盖地区随机位置进行家访来招募。采用混合模型逻辑回归进行数据分析。
共纳入 1134 例病例和 946 例对照。在病例中，967 例（85%）为急性腹泻（AD），129 例（11%）为迁延性腹泻（ProD），36 例（3.2%）为持续性腹泻（PD）。病例组在入组时更易发生急性营养不良（17% vs. 4%，P<0.0001），且早产比例更高（5.7% vs. 1.8%，P<0.0001）。约 75%的 ProPD 病例无急性营养不良。患有 AD 和 ProPD 的病例其症状表现不同，甚至超出疾病持续时间的影响。
ProPD 在腹泻就诊的儿童中较为常见，并不局限于急性营养不良的儿童。迫切需要研究评估有无急性营养不良的 ProPD 的病因，以制定这些疾病的治疗指南。
