The Effects of Malnutrition and Diarrhea Type on the Accuracy of Clinical Signs of Dehydration in Children under Five: A Prospective Cohort Study in Bangladesh

Skrable, Kelly; Bilal, Saadiyah; Sharma, Rashmi; Robertson, Sarah E.; Ashenafi, Yokabed; Nasrin, Sabiha; Alam, Nur; Levine, Adam C.

doi:10.4269/ajtmh.17-0277

Cited by 2 publications

(10 citation statements)

References 24 publications

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“…Of the 2,903 articles identified, three full texts and one abstract met the inclusion criteria (Fig 1). The studies were from India (Nagpal [1992] & Nijhawan [2020]), Bangladesh (Skrable [2017]), and South Africa (Beatty [1974], Table 3). Wasting definitions and inclusion of kwashiorkor patients varied across the studies.…”

Section: Diagnostic Reviewmentioning

confidence: 99%

“…Diagnostic review: Beatty (1974) used Boston weightfor-age percentile (<50 percentile), and Nagpal (1992) used Gomez's weight-for-age grades (grades III&IV), Skrable (2017) used mid-upper arm circumference (MUAC <12.5cmwasted, <11.5cm-severely wasted), while Nijhawan (2020) did not define wasting. Skrable (2017) excluded children with nutritional oedema [10], while the other studies did not comment on the inclusion or prevalence of nutritional oedema. Three of the studies evaluated existing algorithms (IMCI, DHAKA, or the Clinical Dehydration Scale (CDS)) [10][11][12], while Beatty (1974) defined moderate dehydration as any one of the following signs: loss of tissue turgor, sunken eyes, sunken fontanelle, or dry mucous membranes, and severe dehydration as more than one of the those signs or signs of peripheral vascular collapse or shock [13].…”

Section: Diagnostic Reviewmentioning

confidence: 99%

“…Skrable (2017) excluded children with nutritional oedema [10], while the other studies did not comment on the inclusion or prevalence of nutritional oedema. Three of the studies evaluated existing algorithms (IMCI, DHAKA, or the Clinical Dehydration Scale (CDS)) [10][11][12], while Beatty (1974) defined moderate dehydration as any one of the following signs: loss of tissue turgor, sunken eyes, sunken fontanelle, or dry mucous membranes, and severe dehydration as more than one of the those signs or signs of peripheral vascular collapse or shock [13]. Skrable (2017), also evaluated individual clinical signs [10].…”

Section: Diagnostic Reviewmentioning

confidence: 99%

“…IMCI algorithm performance. Skrable (2017) reported the AUC of the IMCI algorithm for predicting any dehydration (weight change �3%) to be 0.71 (95% confidence intervals [95%CI]: 0.66-0.77), with a sensitivity of 0.97 (95%CI: 0.94-1.00) and a specificity of 0.15 (95%CI: 0.08-0.22). The positive predictive value was 0.59 (95%CI: 0.53-0.66), indicating that 41% of children meeting the IMCI some dehydration criteria were false positives [10].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

See 3 more Smart Citations

The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review

Tsegaye,

Pavlinac,

Walson

et al. 2023

PLOS Glob Public Health

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Dehydration is a major cause of death among children with wasting and diarrhea. We reviewed the evidence for the identification and management of dehydration among these children. Two systematic reviews were conducted to assess 1) the diagnostic performance of clinical signs or algorithms intended to measure dehydration, and 2) the efficacy and safety of low-osmolarity ORS versus ReSoMal on mortality, treatment failure, time to full rehydration, and electrolyte disturbances (management review). We searched PubMed/Medline, Embase, and Global Index Medicus for studies enrolling children 0–60 months old with wasting and diarrhea. The diagnostic review included four studies. Two studies found the Integrated Management of Childhood Illness (IMCI) and the Dehydration: Assessing Kids Accurately (DHAKA) algorithms had similar diagnostic performance, but both algorithms had high false positive rates for moderate (41% and 35%, respectively) and severe (76% and 82%, respectively) dehydration. One further IMCI algorithm study found a 23% false positive rate for moderate dehydration. The management review included six trials. One trial directly compared low osmolarity ORS to ReSoMal and found no difference in treatment failure rates, although ReSoMal had a shorter duration of treatment (16.1 vs. 19.6 hours, p = 0.036) and a higher incidence of hyponatremia. Both fluids failed to correct a substantial number of hypokalemia cases across studies. In conclusion, the IMCI dehydration assessment has comparable performance to other algorithms among wasted children. Low osmolarity ORS may be an alternative to ReSoMal for children with severe wasting, but might require additional potassium to combat hypokalemia.

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Section: Diagnostic Reviewmentioning

confidence: 99%

Section: Diagnostic Reviewmentioning

confidence: 99%

Section: Diagnostic Reviewmentioning

confidence: 99%

Section: Plos Global Public Healthmentioning

confidence: 99%

See 2 more Smart Citations

The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review

Tsegaye,

Pavlinac,

Walson

et al. 2023

PLOS Glob Public Health

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“…Since mortality in patients with acute diarrhoea is caused by dehydration, accurately assessing dehydration severity remains a critical step in reducing morbidity and mortality from diarrhoeal diseases [13][14][15][16][17][18]. Though prior research has evaluated the relationship between undernutrition and dehydration in children, literature on the relationship between undernutrition and dehydration assessment specifically in adults [19,20] is scarce. Dehydration by as little as 2% of body weight, which corresponds to ~3-5% reduction in total body water, can lead to cognitive and physical impairment [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Assessing the performance of clinical diagnostic models for dehydration among patients with cholera and undernutrition in Bangladesh

Gainey

Garbern

et al. 2021

Tropical Med Int Health

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Objective Accurately assessing dehydration severity is a critical step in reducing mortality from diarrhoea, but is complicated by cholera and undernutrition. This study seeks to assess the accuracy of two clinical diagnostic models for dehydration among patients over five years with cholera and undernutrition and compare their respective performance to the World Health Organization (WHO) algorithm. Methods In this secondary analysis of data collected from the NIRUDAK study, accuracy of the full and simplified NIRUDAK models for predicting severe and any dehydration was measured using the area under the Receiver Operator Characteristic curve (AUC) among patients over five with/without cholera and with/without wasting. Bootstrap with 1000 iterations was used to compare the m‐index for each NIRUDAK model to that of the WHO algorithm. Results A total of 2,139 and 2,108 patients were included in the nutrition and cholera subgroups respectively with an overall median age of 35 years (IQR = 42) and 49.6% female. All subgroups had acceptable discrimination in diagnosing severe or any dehydration (AUC > 0.60); though the full NIRUDAK model performed best among patients without cholera, with an AUC of 0.82 (95%CI:0.79, 0.85) and among patients without wasting, with an AUC of 0.79 (95%CI:0.76, 0.81). Compared with the WHO’s algorithm, both the full and simplified NIRUDAK models performed significantly better in terms of their m‐index (p < 0.001) for all comparisons, except for the simplified NIRUDAK model in the wasting group. Conclusions Both the full and simplified NIRUDAK models performed less well in patients over five years with cholera and/or wasting; however, both performed better than the WHO algorithm.

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The Effects of Malnutrition and Diarrhea Type on the Accuracy of Clinical Signs of Dehydration in Children under Five: A Prospective Cohort Study in Bangladesh

Cited by 2 publications

References 24 publications

The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review

The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review

Assessing the performance of clinical diagnostic models for dehydration among patients with cholera and undernutrition in Bangladesh

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