Abstract
Malnourished children are more prone to infectious diseases including severe diarrhea compared to non-malnourished children. However, data are scarce on differences in the presentation in such children. We aimed to identify clinical differentials among children with cholera with or without malnutrition. Data were extracted from the diarrheal disease surveillance system (DDSS) of Dhaka Hospital of International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) from January 2001 to December 2020. Among children under five in DDSS, cholera positive (culture confirmed) malnourished children (WAZ, WL/HZ or L/HAZ ˂ −2) were considered as cases (n = 920) and children with cholera but non-malnourished (WAZ, WL/HZ or L/HAZ ≥−2.00 to ≤+2.00) were controls (n = 586). After adjusting for potential confounders such as maternal illiteracy, day labor fathers, maternal employment, slum dwelling, non-sanitary latrine use, use of untreated water, and history of cough, it was revealed that malnourished cholera children significantly more often presented in hospital during evening hours (6 p.m. to 12 mid-night) (p < 0.05), had illiterate fathers (p < 0.05), >24 h history of diarrheal duration (p < 0.05), dehydrating diarrhea (p < 0.05), and had longer hospitalization (p < 0.05). The study results underscore the importance of understanding of basic differences in the presentation of severity of cholera in malnourished children for prompt identification and subsequent management of these vulnerable children.
Highlights
Introduction published maps and institutional affilCholera is a leading public health concern globally, with an estimated 1.3–4.0 million cases occurring each year, worldwide [1]
The cases compared to their counterpart commonly reported to the facility at evening hours (6 p.m.–12 mid-nights) with >24 h history of diarrheal illness, often had history of cough within the last seven days, and were observed to seek care often for to seek out care for dehydrating diarrhea
Mothers of malnourished cholera children mostly employed in any capacity (20.2% vs. 14.3%) and fathers were most often day laborers (8.4% vs. 5.6%) (Table 1)
Summary
Introduction published maps and institutional affilCholera is a leading public health concern globally, with an estimated 1.3–4.0 million cases occurring each year, worldwide [1]. A significant disease burden of cholera has been reported in young children [2,3]. Malnourished children are at a higher risk of developing severe diarrhea with longer duration that is often associated with a fatal outcome [5]. The disease severity has been found to be associated with nutritional status, body size, and etiologic agents of diarrheal episodes [6,7]. Higher rates of malnutrition among pre-school children have been observed in Bangladesh [8]. A study in Brazil reported that the clinical presentations of early childhood severe diarrhea may vary because of diverse etiologies. Understanding of the differences in the presenting features of severe diarrhea especially in cholera that are associated with varying nutritional status of the iations
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