Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
PLoS One. 2022 Oct 3;17(10):e0273148. doi: 10.1371/journal.pone.0273148. eCollection 2022.
INTRODUCTION & BACKGROUND: Prolonged (duration >7 to 13 days) diarrhea (ProD) in under-five children is a universal health problem including Bangladesh. Data on epidemiology and associated or risk factors of ProD are limited, particularly in Bangladesh where a high burden of ProD is reported. This study intended to assess the case load of ProD and its associated or risk factors compared to acute diarrhea (AD, duration ≤7 days).
We analyzed the data collected between 1996-2014 from a hospital-based Diarrheal-Disease-Surveillance-System (DDSS) in the 'Dhaka Hospital' of International Centre for Diarrhoeal Diseases, Bangladesh (icddr,b). The DDSS enrolled a 2% systematic sample, regardless of age, sex, and diarrhea severity. The data included information on socio-demographic factors, environmental history, clinical characteristics, nutritional status, and diarrhea-pathogens. After cleaning of data, relevant information of 21,566 under-five children were available who reported with ≤13 days diarrhea (including AD and ProD), and their data were analyzed. Variables found significantly associated with ProD compared to AD in bi-variate analysis were used in logistic regression model after checking the multicollinearity between independent variables.
The mean±SD age of the children was 14.9±11.7 months and 40.4% were female; 7.6% had ProD and 92.4% had AD. Age <12 months, mucoid- or bloody-stool, warmer months (April-September), drug used at home before seeking care from hospital, and history of diarrhea within last one month were found associated with ProD (p<0.05); however, rotavirus infection was less common in children with ProD (p<0.05). ProD children more often needed inpatient admission than AD children (14.4 vs. 6.3, p<0.001). Case fatality rate of ProD vs. AD was 0.3% (n = 5) vs. 0.1% (n- = 22) respectively (p = 0.051).
A considerable proportion (7.6%) of under-five children reporting to icddr,b hospital suffered from ProD. Understanding the above-mentioned associated or risk factors is likely to help policy makers formulating appropriate strategies for alleviating the burden and effectively managing ProD in under-five children.
五岁以下儿童持续时间超过 7 至 13 天的腹泻（ProD）是一个普遍的健康问题，包括孟加拉国。关于 ProD 的流行病学和相关或危险因素的数据有限，特别是在孟加拉国，那里报告的 ProD 负担很高。本研究旨在评估 ProD 的病例负荷及其与急性腹泻（AD，持续时间≤7 天）相关的或危险因素。
我们分析了 1996 年至 2014 年期间，在孟加拉国国际腹泻病研究中心（icddr，b）的“达卡医院”基于医院的腹泻病监测系统（DDSS）中收集的数据。DDSS 招募了一个 2%的系统抽样，无论年龄、性别和腹泻严重程度如何。该数据包括社会人口因素、环境史、临床特征、营养状况和腹泻病原体的信息。在清理数据后，分析了 21566 名报告 13 天以下腹泻（包括 AD 和 ProD）的五岁以下儿童的相关信息。在双变量分析中发现与 ProD 显著相关的变量，在检查自变量之间的多重共线性后，用于逻辑回归模型。
儿童的平均年龄±标准差为 14.9±11.7 个月，40.4%为女性；7.6%患有 ProD，92.4%患有 AD。年龄<12 个月、黏液状或血便、温暖月份（4 月至 9 月）、在寻求医院治疗前在家中使用药物以及在过去一个月内有腹泻史与 ProD 相关（p<0.05）；然而，轮状病毒感染在 ProD 儿童中较少见（p<0.05）。ProD 患儿比 AD 患儿更常需要住院治疗（14.4%比 6.3%，p<0.001）。ProD 与 AD 的病死率分别为 0.3%（n=5）和 0.1%（n=22）（p=0.051）。
相当比例（7.6%）报告给 icddr，b 医院的五岁以下儿童患有 ProD。了解上述相关或危险因素可能有助于决策者制定减轻五岁以下儿童 ProD 负担和有效管理 ProD 的适当策略。
