Risk Factors for Fatal Diarrhea in Hospitalized Children in India

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Abstract
There is scant information on the risk factors for diarrheal deaths in developing countries. A prospective evaluation was therefore conducted on 382 consecutive children (less than 5 years of age), who were hospitalized with diarrhea. A complete profile, including outcome, was available for 357 patients, 37 of whom died (10.4%). In the univariate analysis, four factors were significantly associated (p less than 0.02) with death: associated major infection (pneumonia, septicemia, or meningitis), severe wasting (less than or equal to 50% weight for age), severe stunting (less than or equal to 85% height for age), and protraction of illness (greater than 14 days). In the multivariate analysis, all four factors retained their significance. The adjusted odds ratios (95% confidence interval) were 4.7 (3.9, 5.6), 3.3 (2.7, 4.0), 1.9 (1.6, 2.3), and 1.5 (1.3, 1.8), respectively. In addition, in children less than 19 months of age (n = 241; 29 deaths) breast-feeding had a significant (p less than 0.001) protective effect (adjusted OR--2.3, 95% CI-1.9-2.8). It is concluded that even in a setting with high diarrheal fatality rates, high-risk children can be identified and targeted for intensive intervention.

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