Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

Sumon Kumar Das,Mohammod Jobayer Chisti,Tahmeed Ahmed,Mohammad Abdul Malek,Sayeeda Huq,Abu Syed Golam Faruque,Mohammed Abdus Salam

doi:10.4236/fns.2013.43031

Sumon Kumar Das, Mohammod Jobayer Chisti + Show 5 more

Open Access

https://doi.org/10.4236/fns.2013.43031

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Abstract

There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score < ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%; urban—15%), Shigella (16%; 9%), Salmonella (1%; 2%) and Campylobacter (3%; 4%); and less likely to have rotavirus (25%; 20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%; 13%) than those of MM (5%; 10%) and WN (2%; 8%) and lower for rotavirus (30%; 31%), (34%; 43%), (35%; 47%) respectively (p < 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p < 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%; p = 0.72) but significantly higher than that in WN (1%; p < 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.

Highlights

Despite reductions in global deaths due to diarrhea in under five children to around 400,000 each year, globally during 2000-2010, the mortality rate is still high [1] and diarrhea remains the second leading cause of childhood deaths [2]
We examined the distribution of the common etiology of diarrhea among severely malnourished under-five children in two distinct geographical locations
Children under 5 years, who were severely underweight, wasted and stunted, were more likely to be infected with Vibrio cholerae, Shigella, Salmonella and Campylobacter; and less likely to be infected with rotavirus in rural Matlab (Table 1)

Summary

Introduction

Despite reductions in global deaths due to diarrhea in under five children to around 400,000 each year, globally (range, 200,000 to 500,000) during 2000-2010, the mortality rate is still high [1] and diarrhea remains the second leading cause of childhood deaths [2]. Malnutrition is associated with both macro-and micronutrient deficiencies [3], and directly or indirectly related to 35% of all deaths among under-five children [4]. Childhood malnutrition remains an important public health problem in Asian subcontinent; most of the countries in this region have experienced rapid economic development in the recent years [3]. A 4-year prospective study among severely acute malnourished children aged 6 months to 12 years, hospitalized with diarrhea experienced higher deaths compared to the children who did not have diarrhea during their hospital stay [7]. A cohort study of 430 Zambian children aged 6 - 59 months with severe acute malnutrition noted 2.5 times higher deaths in those with diarrhea on admission compared to those who did not have diarrhea [8]

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