International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Centre for Public Health Kinetics, Delhi, India.
J Glob Health. 2024 Oct 11;14:04196. doi: 10.7189/jogh.14.04196.
Approximately 12% of all diarrhoeal episodes last for 7-13 days. As such, they are termed prolonged diarrhoea, and are associated with over two-thirds of all diarrhoeal deaths. Due to a lack of robust data, we aimed to evaluate a comparative background characteristics of young children with acute and prolonged diarrhoea, and their outcomes at day 90 follow-up.
We performed a secondary analysis of data from the Antibiotics for Children with Diarrhea (ABCD) trial. Children aged 2-23 months were enrolled between July 2017 and July 2019 from seven Asian and sub-Saharan African countries. For this analysis, we divide diarrhoea into two categories: acute diarrhoea (duration <7 days) and prolonged diarrhoea (duration ≥7-13 days). We used logistic regression to observe baseline crude and adjusted associations and linear regression to compare post-discharge outcomes.
We analysed data on 8266 children, of whom 756 (9%) had prolonged diarrhoea and 7510 (91%) had acute diarrhoea. Pakistan had the highest proportion of children with prolonged diarrhoea (n/N = 178/1132, 16%), while Tanzania had the lowest (n/N = 12/1200, 1%). From an analysis that adjusted for sex, breastfeeding, nutritional status, clinical presentation, housing, water supply, sanitation, and country, we observed that presentation at a health facility with prolonged diarrhoea was associated with low age (2-12 months) (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.02, 1.53; P = 0.028), presence of three or more under-five children in the family (aOR = 1.54; 95% CI = 1.26, 1.87; P < 0.001), maternal illiteracy (aOR = 1.45; 95% CI = 1.21, 1.74, P < 0.001), moderate underweight (aOR = 1.25; 95% CI = 1.01, 1.55; P = 0.042) and pathogen (Campylobacter) (aOR = 1.27; 95% CI = 1.12, 1.44; P < 0.001). At day 90 follow-up, children with prolonged diarrhoea had significantly lower weight-for-age z-score compared to children with acute diarrhoea (-1.62, standard deviation (SD) = 1.11 vs -1.52, SD = 1.20; P = 0.032), as well as significantly higher frequency of hospital admission (6.1% vs 4.5%; P = 0.042).
Prolonged diarrhoea was more common in children of younger age, those who were moderately underweight, those with Campylobacter in stool, those with three or more under-five children in a family, and those with illiterate mothers compared to those who had acute diarrhoea. Children with prolonged diarrhoea more often required hospitalisation during the three-month follow-up period compared to their counterparts.
约 12%的腹泻持续时间为 7-13 天。因此，这些腹泻被称为迁延性腹泻，占所有腹泻死亡人数的三分之二以上。由于缺乏可靠的数据，我们旨在评估急性和迁延性腹泻的年轻患儿的背景特征，并评估其在第 90 天随访时的结局。
我们对儿童腹泻抗生素治疗试验（ABCD 试验）的数据进行了二次分析。2017 年 7 月至 2019 年 7 月期间，来自亚洲和撒哈拉以南非洲的 7 个国家的 2-23 月龄儿童入组该研究。在此分析中，我们将腹泻分为两类：急性腹泻（持续时间 <7 天）和迁延性腹泻（持续时间≥7-13 天）。我们使用逻辑回归观察基线粗和调整关联，使用线性回归比较出院后结局。
我们分析了 8266 名儿童的数据，其中 756 名（9%）患有迁延性腹泻，7510 名（91%）患有急性腹泻。巴基斯坦儿童迁延性腹泻比例最高（n/N=178/1132，16%），坦桑尼亚最低（n/N=12/1200，1%）。从调整性别、母乳喂养、营养状况、临床特征、住房、供水、卫生设施和国家的分析中，我们观察到迁延性腹泻患儿在医疗机构就诊与年龄较小（2-12 个月）相关（调整优势比（aOR）=1.25；95%置信区间（CI）=1.02，1.53；P=0.028），家庭中有 3 个或更多 5 岁以下儿童（aOR=1.54；95%CI=1.26，1.87；P<0.001），母亲文盲（aOR=1.45；95%CI=1.21，1.74，P<0.001），中度体重不足（aOR=1.25；95%CI=1.01，1.55；P=0.042）和病原体（弯曲菌）（aOR=1.27；95%CI=1.12，1.44；P<0.001）有关。在第 90 天随访时，与急性腹泻患儿相比，迁延性腹泻患儿的体重与年龄比值明显较低（-1.62，标准差（SD）=1.11 与-1.52，SD=1.20；P=0.032），且住院频率明显较高（6.1%与 4.5%；P=0.042）。
与急性腹泻患儿相比，迁延性腹泻患儿更常见于年龄较小的儿童、体重不足的儿童、粪便中存在弯曲菌的儿童、家庭中有 3 个或更多 5 岁以下儿童的儿童以及母亲为文盲的儿童。与急性腹泻患儿相比，迁延性腹泻患儿在 3 个月随访期间更常需要住院治疗。
