Abstract
Pediatric diarrheal disease is a significant source of morbidity and mortality in the developing world. While several studies have demonstrated an increased incidence of diarrheal illness in boys compared with girls in low- and middle-income countries (LMIC), the reasons for this difference are unclear. This secondary analysis of the dehydration: assessing kids accurately (DHAKA) derivation and validation studies included children aged <5 years old with acute diarrhea in Dhaka, Bangladesh. The dehydration status was established by percentage weight change with rehydration. Multivariable regression was used to compare percent dehydration, while controlling for differences in age and nutritional status. In this cohort, a total of 1396 children were analyzed; 785 were male (56.2%) and 611 were female (43.8%). Girls presenting with diarrhea were older than boys (median age 17 months vs. 15 months, p = 0.02) and had significantly more malnutrition than boys, even when controlled for age (mean mid-upper arm circumference 134.2 mm vs. 136.4 mm, p < 0.01). The mean percent dehydration did not differ between boys and girls after controlling for age and nutrition status (p = 0.25). Although girls did have higher rates of malnutrition than boys, measures of diarrhea severity were similar between the two groups, arguing against a cultural bias in care-seeking behavior that favors boys.
Highlights
Despite the decreasing global burden of pediatric diarrheal disease over the past few decades, it remains a leading cause of death in children under the age of 5 years [1,2]
This study sought to further understand the overrepresentation of boys compared with girls with acute diarrhea in Bangladesh, which is not explained by census or hospital data [18,22]
Significantly more boys presented with acute diarrheal illness than girls
Summary
Despite the decreasing global burden of pediatric diarrheal disease over the past few decades, it remains a leading cause of death in children under the age of 5 years [1,2]. There are an estimated 957 million cases of diarrheal illness and 499,000 deaths in children under 5 years of age each year [2]. In Bangladesh, despite a 60% decrease in the child mortality rate from 2005 to 2015, over 3800 deaths in children under 5 years of age were attributed to acute diarrheal disease in 2015 [2]. In 2015 more than 45 billion disability-adjusted life years were attributed to diarrheal disease in children under 5 years of age [2]
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