Childhood diarrhoeal deaths in seven low- and middle-income countries

Abstract

ObjectiveTo investigate the clinical characteristics of children who died from diarrhoea in low- and middle-income countries, such as the duration of diarrhoea, comorbid conditions, care-seeking behaviour and oral rehydration therapy use.MethodsThe study included verbal autopsy data on children who died from diarrhoea between 2000 and 2012 at seven sites in Bangladesh, Ethiopia, Ghana, India, Pakistan, Uganda and the United Republic of Tanzania, respectively. Data came from demographic surveillance sites, randomized trials and an extended Demographic and Health Survey. The type of diarrhoea was classified as acute watery, acute bloody or persistent and risk factors were identified. Deaths in children aged 1 to 11 months and 1 to 4 years were analysed separately.FindingsThe proportion of childhood deaths due to diarrhoea varied considerably across the seven sites from less than 3% to 30%. Among children aged 1–4 years, acute watery diarrhoea accounted for 31–69% of diarrhoeal deaths, acute bloody diarrhoea for 12–28%, and persistent diarrhoea for 12–56%. Among infants aged 1–11 months, persistent diarrhoea accounted for over 30% of diarrhoeal deaths in Ethiopia, India, Pakistan, Uganda and the United Republic of Tanzania. At most sites, more than 40% of children who died from persistent diarrhoea were malnourished.ConclusionPersistent diarrhoea remains an important cause of diarrhoeal death in young children in low- and middle-income countries. Research is needed on the public health burden of persistent diarrhoea and current treatment practices to understand why children are still dying from the condition.

Progress in maternal and child health: how has South Asia fared?

“…Similarly, reductions in child mortality (and especially from diarrhoeal diseases) have been notable, but while there have been major gains in use of oral rehydration therapy, care seeking for childhood pneumonia is low and rates of childhood undernutrition are still high. 44 Investments in social determinants and non-health sectors such as education, especially girls' education and female empowerment to reduce early marriages and high fertility rates, as well as effective communication strategies are likely to be especially important to improve and sustain gains in maternal and child health.…”

Molecular Detection of the Carriage Rate of Four Intestinal Protozoa with Real-Time Polymerase Chain Reaction: Possible Overdiagnosis of Entamoeba histolytica in Nigeria

“…It was further revealed that at six of the seven study sites, 70-100% of children with persistent diarrhea who died had been seen in a health-care facility, while more than 50% of them had received oral rehydration solutions or intravenous fluids. 6 Protozoa are important causes of persistent diarrhea, 2 and current emphasis on rehydration fluid is adequate only for acute diarrhea agents such as rotavirus, which is self-limiting if the lost fluid and electrolytes are adequately replaced. These observations raise fundamental questions as to the quality of diagnosis and care provided to these children.…”

Quantitative Microbial Risk Assessment of Drinking Water Quality to Predict the Risk of Waterborne Diseases in Primary-School Children

“…Furthermore, more than 90% of the disease burden is contributed by the developing world [5,6]. Each bout of diarrhea progressively compromises the immune system, indirectly killing many more millions each year [7].In Pakistan, rapid population growth, industrialization, and urbanization have stressed the water resources and compromised water quality, which subsequently negatively impacts children's school performance [8][9][10]. A recent study revealed that 21 million people in Pakistan are deprived of basic access to safe water [11].…”

“…Furthermore, more than 90% of the disease burden is contributed by the developing world [5,6]. Each bout of diarrhea progressively compromises the immune system, indirectly killing many more millions each year [7].…”