Factors Associated with the Duration of Moderate-to-Severe Diarrhea among Children in Rural Western Kenya Enrolled in the Global Enteric Multicenter Study, 2008–2012

Abstract

Diarrheal disease is a leading cause of death among young children worldwide. As rates of acute diarrhea (AD; 1-6 days duration) have decreased, persistent diarrhea (PD; > 14 days duration) accounts for a greater proportion of the diarrheal disease burden. We describe factors associated with the duration of moderate-to-severe diarrhea in Kenyan children < 5 years old enrolled in the Global Enteric Multicenter Study. We found 587 (58%) children experienced AD, 360 (35%) had prolonged acute diarrhea (ProAD; 7-13 days duration), and 73 (7%) had PD. We constructed a Cox proportional hazards model to identify factors associated with diarrheal duration. Risk factors independently associated with longer diarrheal duration included infection with Cryptosporidium (hazard ratio [HR]: 0.868, P = 0.035), using an unimproved drinking water source (HR: 0.87, P = 0.035), and being stunted at enrollment (HR: 0.026, P < 0.0001). Diarrheal illness of extended duration appears to be multifactorial; given its association with adverse health and development outcomes, effective strategies should be implemented to reduce the duration and severity of diarrheal illness. Effective treatments for Cryptosporidium should be identified, interventions to improve drinking water are imperative, and nutrition should be improved through exclusive breastfeeding in infants £ 6 months and appropriate continued feeding practices for ill children.

Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study

“… 33 We did not distinguish between acute, persistent, or prolonged diarrhoea, yet evidence suggests that Cryptosporidium is associated with an extended duration of diarrhoea and that long-lasting diarrhoea could affect the long-term burden non-linearly. 34 Our findings call for further investigations about the prevalence of asymptomatic infection and how such infections can also lead to morbidity. Although our data suggest that Cryptosporidium infection in the absence of diarrhoea might impede linear growth, quantifying the prevalence of asymptomatic infection was beyond the scope of this work.…”

Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)

“…At enrollment caretakers were (1) asked how many days the case child had been experiencing diarrhea in the week before presenting at the health facility and (2) instructed on how to record the presence/absence of diarrhea for 14 days following enrollment on a Memory Aid form [ 18 ]. The total number of days of diarrhea was calculated as the sum of these durations, with a maximum of 21 possible diarrhea days, which may include multiple episodes [ 8 ]. Acute diarrhea was defined as having 1–6 days of diarrhea in the 21-day period; having 7–13 and ≥14 days refer to prolonged and persistent diarrhea , respectively.…”

“…Cryptosporidium has been associated with decreases in height-for-age z-scores in children, even in the absence of diarrhea symptoms [ 4 ]. Cryptosporidium infections have been associated with persistent diarrhea in Kenya [ 8 , 9 ]. Cryptosporidium is highly tolerant to disinfection with chlorine [ 10 ].…”

Prolonged and persistent diarrhoea is not restricted to children with acute malnutrition: an observational study in Ethiopia

“…We attempted to conduct a phone follow‐up among cases to determine how many progressed to ProPD, but with limited success. A recent study in Kenya reported a higher follow‐up success rate and reported ProD and PD rates of 35% and 7% of the diarrhoea cases, respectively . We suggest that future diarrhoea studies should include follow‐up ; cell phone follow‐up warrants further exploration in particular, as it could be developed into a simple and cost‐effective tool to reach more children with ProPD.…”