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

Ahmed Ehsanur Rahman, Md Moinuddin, Mitike Molla, Alemayehu Worku, Lisa Hurt, Betty Kirkwood, Sanjana Brahmawar Mohan, Sarmila Mazumder, Zulfiqar Bhutta, Farrukh Raza, Sigilbert Mrema, Honorati Masanja, Daniel Kadobera, Peter Waiswa, Rajiv Bahl, Mike Zangenberg, Lulu Muhe, Persistent Diarrhoea Research Group, Seeba Amenga-Etego, Bilal Avan, Nita Bhandari, Kiran Bhatia, Oona Campbell, Samuel Danso, Brinda Dube, Karen Edmond, Shams El Arifeen, Justin Fenty, Olivier Fontaine, Edward Galiwango, Zelee Hill, Chris Hurt, Judith Kaija, Jasmine Kaur, Jose Martines, Seth Owusu-Agyei, Elizeus Rutebemberwa, Peter Kim Streatfield, Sunita Taneja, Charlotte Tawiah, Worku Tefera, Guus ten Asbroek, Etsehiwot Tilahun, Musa Waibi, Charles Zandoh, Ahmed Ehsanur Rahman, Md Moinuddin, Mitike Molla, Alemayehu Worku, Lisa Hurt, Betty Kirkwood, Sanjana Brahmawar Mohan, Sarmila Mazumder, Zulfiqar Bhutta, Farrukh Raza, Sigilbert Mrema, Honorati Masanja, Daniel Kadobera, Peter Waiswa, Rajiv Bahl, Mike Zangenberg, Lulu Muhe, Persistent Diarrhoea Research Group, Seeba Amenga-Etego, Bilal Avan, Nita Bhandari, Kiran Bhatia, Oona Campbell, Samuel Danso, Brinda Dube, Karen Edmond, Shams El Arifeen, Justin Fenty, Olivier Fontaine, Edward Galiwango, Zelee Hill, Chris Hurt, Judith Kaija, Jasmine Kaur, Jose Martines, Seth Owusu-Agyei, Elizeus Rutebemberwa, Peter Kim Streatfield, Sunita Taneja, Charlotte Tawiah, Worku Tefera, Guus ten Asbroek, Etsehiwot Tilahun, Musa Waibi, Charles Zandoh

Abstract

Objective: To 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.

Methods: The 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.

Findings: The 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.

Conclusion: Persistent 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.

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