Sex and Gender Differences in Acute Pediatric Diarrhea: A Secondary Analysis of the DHAKA Study

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.

Study design for the 2019 baseline survey of newly established longitudinal surveillance woredas as the field lab to serve child health improvement project of Benishangul-Gumuz region, Ethiopia

“…However, the children's health status including mortality and chronic morbidity of the BG region was still relatively poor, which might be aligned with the poor socioeconomic condition of the region. The children's illness incidence experience seemed to be not extremely high or low compared to the illness experience of other similar low-income countries such as Dhaka in Bangladesh, 14 little lower in case of diarrhea incidence than previous studies in Ethiopia. [15][16][17] U5 mortality were similar in other rural areas in neighborhood countries in East Africa 18 while it is a litter lower than previous study period in the BG region even if it is still now low enough to be accepted.…”

“…The average monthly household income was 1,771 Birr (63 USD equivalent). The average number of family members was 6 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Most common material of the roof of the dwelling unit was thatch/mud (53.5%) and the floor of it was earth/sand (88.6%).…”

A Multilevel Analysis of Factors Associated with Childhood Diarrhea in Ethiopia

“…This finding supported a cross-sectional study conducted in Ethiopia that showed boys have 2.52 times higher odds of having acute diarrhea as compared with girls. 39 A recent study from Palestine 40 and Bangladesh 41 also reported similar findings. “Despite several studies demonstrating an increased incidence of diarrheal illness in boys compared with girls in many developing countries, the reason for this difference remains unclear.” 41 Researchers hypothesized that the variance may be due to gender-based factors, such as sex-based biological factors, environmental, and cultural factors.…”

“… 39 , 40 The biological hypothesis assumes that there may exist pathophysiologic sex differences between girls and boys with regard to acute diarrhea that make boys more susceptible. 34 , 41 …”

Spatiotemporal epidemiology of cryptosporidiosis in the Republic of Ireland, 2008–2017: development of a space–time “cluster recurrence” index

“…Most (59.3%) sporadic cases were associated with children ≤ 5 years, which concurs with several previous studies [ 3 , 7 ]. Within the ≤ 5 years cohort, cases were more frequently associated with male children (OR 1.3873), potentially reflecting the tendency of male children to mount weaker immune responses [ 21 ], an enhanced susceptibility to environmental exposures via gender-related outdoor activities [ 22 ], or a gender-related bias in healthcare-seeking behaviours [ 23 ]. Conversely, female children were statistically associated with outbreak-related cryptosporidiosis, potentially reflecting higher levels of direct contact (and subsequent transmission) between parents/family members and female children [ 24 ].…”