Incidence Of Persistent Diarrhea Research Articles

Characteristics of Persistent Diarrhea in a Community‐Based Cohort of Young US Children

The objective of the study was to define the characteristics and microbiology of persistent diarrhea (PD) in US children. Six-month prospective cohort study of a convenience sample of 604 healthy 6- to 36-month-old children recruited by the Slone Center Office-based Research Network. Of 611 diarrhea episodes, 50 (8.2%) lasted < or = 14 days. The incidence of PD was 0.18 episodes per person-year, and the median duration of episodes was 22.0 days (range, 14-64 days). PD episodes were more likely than acute episodes to result in a medical visit (28.0% vs 8.2%; P = 0.0001). The most commonly used treatments were oral rehydration solution (12.0% of episodes) and antibiotics (6.0%). No bacterial or parasitic pathogens were associated with PD; but norovirus, rotavirus and sapovirus were each significantly more prevalent in PD stools compared with baseline stools, with relative risks of 12.4, 6.9 and 6.2, respectively. Fifty-nine per cent of the PD specimens tested were negative for all studied pathogens. PD occurs with a frequency of approximately 1 case per 5 person-years in US infants and young children. It seems to be a generally benign illness, with only 28% of cases presenting to medical care. Although viral pathogens seem to cause a minority of PD episodes in this population, most are not due to currently known infectious agents.

Determinants of diarrhoeal diseases: a community based study in urban south western Ethiopia

To identify the determinants and describe the extent of diarrhoeal diseases among under-five children in urban Ethiopia. Community based, cross-sectional study. Jimma, a town in south western Ethiopia, is an urban area with multi-ethnic population. The town is divided into 20 kebelles. Each kebelle has a population of about 5000 people. Six hundred and five children under the age of five years were selected by random sampling. There were 142 children with diarrhoeal diseases in selected households. All those without diarrhoea were taken as controls. The incidence at diarrhoeal diseases was 5.48 episodes per child per year. The incidence of persistent diarrhoea was 7.75%. About 24.5% of the acute diarrhoeal diseases (ADD) culminated to persistent diarrhoea. Well source of water, lack of complete immunization, attack of measles and acute respiratory infecions (ARI) in the previous two weeks were found to be significantly associated with occurrence of diarrhoeal disease; however, only ARI and well water were retained in the logistic regression analysis. The incidence of diarrhoeal diseases and the progression to persistent diarrhoea are very high. Many of the socio-environmental factors did not appear as significant determinants independently. The implication of this is that in a homogenous and economically deprived society improvement in a single factor does not reduce the problem of diarrhoeal diseases. Hence, an inter-sectoral approach is recommended to control diarrhoeal diseases.

Zinc Supplementation Reduces the Incidence of Persistent Diarrhea and Dysentery among Low Socioeconomic Children in India

Persistent diarrhea (PD) and dysentery (DD) account for most diarrhea-associated deaths among children in developing countries. Zinc deficiency can cause stunting and impaired immune function, both of which are risk factors for these diarrheal illnesses. We investigated the effect of zinc supplementation on the incidence of PD and DD in a community-based, double-blind randomized trial in children 6–35 mo of age. Increase over baseline in plasma zinc concentrations in the supplemented group compared with a control group (3.61 vs. 0.009 µmol·L-1) indicated successful supplementation. The overall reductions in the zinc supplemented group of 21% in the incidence of PD (95% CI -6 to 42%) and 14% in the incidence of dysentery (95%CI -15 to 36%) were not significant. There was a significant interaction of treatment effect with baseline plasma zinc concentration and age for PD and with gender for DD. In the zinc-supplemented group compared with the control group, the incidence of PD was reduced by 73% (P < 0.05; 95% CI 34 to 91%) in children with a baseline zinc <7.65 µmol·L-1 and by 49% (P < 0.05; 95%CI 24 to 66%) in children > 11 mo of age. Zinc supplementation resulted in a 38% (P < 0.05 95%CI 8 to 59%) reduction in the incidence of DD in boys. There was no effect on PD among children 6–11 mo old or on DD in girls. In conclusion, zinc supplementation had a significant impact on the incidence of persistent diarrhea in children > 1 y old and in children with low plasma zinc, as well as on dysentery in boys. These findings may have important implications for reducing diarrhea-related morbidity and mortality.

A Prospective Study of Diarrhea and HIV-1 Infection among 429 Zairian Infants

Persistent diarrhea is a prominent feature of the acquired immunodeficiency syndrome in adults, but its cause and its effect on children with human immunodeficiency virus (HIV) infection are largely unknown, particularly in Africa. We studied a birth cohort of 429 infants born to HIV-positive or HIV-negative mothers in Zaire to determine the incidence of acute, recurrent (> or = 2 episodes), and persistent (> or = 14 days) diarrhea; outcome; and risk factors. Of the 238 infants whose mothers were HIV-positive, 53 were infected, 139 were uninfected, and the HIV status of 46 could not be determined. As compared with uninfected infants, infected infants had higher incidence rates for acute diarrhea (170 vs. 100 episodes per 100 child-years, P = 0.003), recurrent diarrhea (21 vs. 11, P = 0.12), and persistent diarrhea (19 vs. 4, P < 0.003). Persistent diarrhea developed in 11 HIV-infected infants; all but 1 died. It also developed in 19 uninfected infants; all but 1 survived. The prevalence of stool pathogens was similar in the two groups. In a multivariate model, persistent diarrhea in an infant was independently associated with symptomatic HIV type 1 infection in the mother (relative hazard, 1.5; P = 0.08). The incidence of persistent diarrhea in the uninfected infants of seropositive mothers was nearly double that in the uninfected infants of seronegative mothers (4.9 vs. 2.7 episodes per 100 child-years), and the risk increased if the mother died (relative hazard, 10.4). Significant growth impairment and severe immunosuppression occurred in the six to eight weeks before the onset of persistent diarrhea. In Zaire, infants with HIV infection have an 11-fold increased risk of death from diarrhea, largely persistent diarrhea, which is often preceded by recurrent episodes of acute diarrhea, malnutrition, or immunosuppression. Illness and death of the mother increase that risk, even among her uninfected infants.

Cell-mediated immune deficiency and malnutrition are independent risk factors for persistent diarrhea in Bangladeshi children

A community-based longitudinal study was carried out at Matlab, Bangladesh, to investigate the magnitude of the problem of persistent diarrhea; 705 children aged < 5 y were followed, yielding 7300 child-months of observation in 1 y. Morbidity data were collected every fourth day by home visit, anthropometric status was determined monthly, and cell-mediated immune status was assessed every 3 mo. The incidence of persistent diarrhea was 34 episodes per 100 child-years; rates were highest in infancy and declined through the remainder of childhood. In a logistic-regression model, weight-for-height status and immune status were significant predictors of persistent diarrhea. Compared with those at zero Z score, children with weight-for-height at -2 would have a 3.5 times increased risk of persistent diarrhea. Compared with immunocompetent children, immunodeficient children had about twice the risk of developing persistent diarrhea. Thus, nutritional status and cell-mediated immune status were important independent risk factors for persistent diarrhea.

Early child health in Lahore, Pakistan: VII. Diarrhoea.

This study was carried out to obtain reliable prospective data on the incidence, home management and duration of infantile diarrhoeal disease in a developing and rapidly urbanizing community. Fourteen hundred and seventy six infants from 4 different communities of Lahore, representing different stages of urbanization, were followed prospectively from birth to 2 years of age. Each child had an average of 3.6 episodes of diarrhoea during one year; 4.3 episodes per child per year in the village, 4.4 in the periurban slum, 3.4 in the urban slum and 1.4 in the upper middle (Um) class control group. The maximum incidence of diarrhoeal episodes occurred in children between 9-10 months of age. No sex difference was found. The seasonal variation showed a peak incidence during April-June. Bloody diarrhoea, in 3-5% of the episodes, was predominantly seen in winter months and in older infants. The maximum use of ORS was seen in the Um class (53%). Antibiotics were used in 75% of all diarrhoeal episodes maximally in the Um class, and morphine derivatives in 1% of all cases. The overall incidence of persistent diarrhoea was 14% of all acute cases, being highest in the village (18%), followed by the periurban slum (14%), Um class (10%) and urban slum (8%) with peak incidence occurring in June and July. Our results confirm the magnitude of the problem of diarrhoea.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of persistent diarrhea among Guatemalan rural children.

A prospective, longitudinal two-year study to determine the epidemiology of persistent (> or = 14 days' duration) diarrhea in rural children of Guatemala was undertaken. Three-hundred and twenty-one children aged 0-35 months were kept under surveillance by twice-a-week home visits. The overall incidence of diarrhea was 0.147 per child-week; the incidence of persistent diarrhea was 0.014 per child-week. The peak of persistent diarrhea was observed in infants below six months of age, with a continuous decline thereafter. This trend in incidence of persistent diarrhea was associated with a higher proportion (16%) of illnesses persisting for more than 13 days in children younger than six months of age as compared to children 30-35 months old (4%). Males had more diarrhea (0.156 per child-week) than females (0.139 per child week). Among children above 18 months of age, the proportion of episodes that lasted for more than 13 days was lower in females than in males.

Epidemiological and clinical characteristics of acute and persistent diarrhoea in rural Bangladeshi children.

A community-based longitudinal study of acute and persistent diarrhoea in 705 children less than five years old was carried out for a year in a rural area of Bangladesh. Diarrhoea morbidity data were collected from each study child every fourth day by home visit. Clinical features of diarrhoeal episodes and diarrhoeal management information were documented. The overall diarrhoeal incidence rate in the study children was 4.6 episodes per child per year. The incidence of persistent diarrhoea was 34/100 child-years. Persistent diarrhoea was positively associated with young age and more severe illness, characterized by the presence of clinical dehydration or blood in the stool in the first week. Use of ORT in the first week was positively associated and use of an antibiotic was negatively associated with the occurrence of persistent diarrhoea. Reduced breast-feeding and consumption of cow's milk at some time during the episode were also positively associated with persistence. This would suggest that appropriate fluid and dietary management for all episodes should be the goal. Children with more severe initial illness characterized by the presence of blood in the stool or clinical dehydration should have more careful follow-up to identify persistent episodes and adverse nutritional effects. Breastfeeding should be continued during acute diarrhoea, but the role of ORT, antibiotics and cow's milk deserves further investigation.

Persistent diarrhea in northeast Brazil: etiologies and interactions with malnutrition.

With the improved control of acute diarrheal illness mortality with oral rehydration therapy, persistent diarrhea is now emerging as a major cause of childhood mortality in tropical developing areas like the impoverished populations in Brazil's Northeast. "Graveyard surveillance" in the rural community of Guaiuba in northeastern Brazil revealed fully half of the 70% diarrhea mortality was due to persistent diarrheal illnesses. Furthermore, 11% of 14 or more diarrheal illnesses per child per year in an urban slum in Fortaleza persisted beyond 14 days, a definition that clearly identified the high risk children for heavy diarrhea burdens. Not only did heavy diarrhea burdens ablate the key "catch-up" growth seen in severely malnourished children and in children following previous diarrheal illnesses, but malnutrition significantly predisposed children to a greater incidence and duration of diarrhea as well as a greater incidence of persistent diarrhea. Etiologic studies of 37 children presenting with persistent diarrhea to Hospital das Clinicas in Fortaleza revealed that Cryptosporidium (in 13%) and enteroadherent E. coli (36% with aggregative, 29% with diffuse and 13% with localized adherence to HEp-2 cells) were the predominant potential pathogens found in the stool or upper small bowel. These findings suggest that persistent diarrhea is emerging as an important health problem in Brazil's Northeast, that it identifies a high risk child for heavy diarrhea burdens, that important interactions occur with malnutrition and that Cryptosporidium and enteroadherent E. coli warrant further study as potential etiologies of this major cause of morbidity and mortality.

Persistent diarrhea in children: epidemiology, risk factors, pathophysiology, nutritional impact, and management.

A review of data on the morbidity and mortality caused by persistent diarrhea (more than 14 days' duration) was undertaken from studies in several geographic areas, including Bangladesh, Brazil, Ethiopia, India, Indonesia, and Peru, over the last 3 decades. An estimated 3-5 billion diarrheal illnesses and 5-10 million diarrhea-related deaths occur annually among 3 billion people in Africa, Asia, and Latin America. Mostly the 338 million to 1 billion episodes and 4.6 million deaths annually. A study from India showed that the incidence of persistent diarrhea was greater in the age group 0-11 months (31 episodes/100 child-years) than at age 12-23 months (9 episodes/100 child years) or 24-35 months (6 episodes/100 child-year). Similar results were obtained in periurban Peru, periurban northeastern Brazil, and rural guatemala. Diarrhea is believed to precipitate and exacerbate malnutrition while malnutrition predisposes to diarrhea. 2 studies in both Bangladesh and Peru indicate that the risk of developing diarrhea inversely parallels delayed-type hypersensitivity reactions to standard skin-test antigens. In a cohort of 175 children under 5 years of age over a 28-month period in an urban slum in northeastern Brazil the children had an average of 11 episodes/year and spent 82 days/year with diarrhea. The leading potential pathogens seen with persistent diarrhea in some areas are enteroaggregative E. coli and Cryptosporidium. Other pathogens include Shigella, Salmonella, enteropathogenic (LA (local)) E. coli, and variably Giardia lamblia. Recent nutritional management promotes breast feeding, dietary supplementation with vitamin A, zinc, iron, folate, and vitamin B 12, and improved oral rehydration solutions with glucose polymers (such as rice starch) and possibly neutral amino acids (such as alanine or glycine) and glutamine.

Persistent diarrhoea in a rural area of Bangladesh: a community-based longitudinal study.

As part of a health impact evaluation of a water supply and sanitation project in a rural area of Bangladesh, diarrhoeal morbidity was recorded in children 0-4 years of age using weekly recall in household interviews, during the period March 1984 to December 1987. During the baseline year, 1984, the incidence rate of all diarrhoea episodes (3.8 episodes per child per year), and those defined as persistent, duration greater than 14 days (0.6 episodes per child per year), showed a similar age distribution, peaking in the 12-23 month age group. Sixteen per cent of all episodes were classified as persistent, and this proportion was greatest in the 0-5 month age group (25%). Children suffering at least one episode of persistent diarrhoea in 1984 also experienced a higher incidence of acute diarrhoea (less than = 14 days duration) than those suffering acute diarrhoea only (4.2 versus 3.7 episodes per child per year). Persistent diarrhoea showed a similar seasonal pattern to that of all episodes. Rates of abdominal pain, isolation of Shigella spp and a diagnosis of dysentery were significantly higher in persistent episodes than in acute episodes. Closer follow-up of children during 1986 and 1987, through the recording of all periods of absence of the child from the home, showed that overall diarrhoea incidence rates were little affected when absence was taken into account, but that the incidence of persistent diarrhoea and the proportion of episodes classified as persistent were significantly reduced. The implications of this methodological problem are discussed.