Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 8;76(3):e1047-e1053.
doi: 10.1093/cid/ciac561.

Risk Factors for Mortality Among Children Younger Than Age 5 Years With Severe Diarrhea in Low- and Middle-income Countries: Findings From the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks

Rachel M Hartman  1   2 , Adam L Cohen  1 , Sebastien Antoni  1 , Jason Mwenda  3 , Goitom Weldegebriel  4 , Joseph Biey  5 , Keith Shaba  3 , Lucia de Oliveira  6 , Gloria Rey  6 , Claudia Ortiz  6 , Maria Tereza  6 , Kamal Fahmy  7 , Amany Ghoniem  7 , Hossam Ashmony  7 , Dovile Videbaek  8 , Simarjit Singh  8 , Emmanuel Tondo  9 , Mohammed Sharifuzzaman  9 , Jayantha Liyanage  9 , Nyambat Batmunkh  10 , Varja Grabovac  10 , Josephine Logronio  10 , Fatima Serhan  1 , Tomoka Nakamura  1   11   12
Affiliations

Risk Factors for Mortality Among Children Younger Than Age 5 Years With Severe Diarrhea in Low- and Middle-income Countries: Findings From the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks

Rachel M Hartman et al. Clin Infect Dis. .

Erratum in

Abstract

Background: Diarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries.

Methods: Data from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality.

Results: This analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81-4.50), female sex (OR = 1.18; 95% CI, 1.06-1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01-3.25), no vomiting (OR = 1.13; 95% CI, .98-1.30), severe dehydration (OR = 3.79; 95% CI, 3.01-4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92-2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72-422.73), whereas cases from the European Region had the lowest odds of death.

Conclusions: Our findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.

Keywords: diarrhea; diarrheal mortality; global surveillance; pediatric; rotavirus.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Schematic showing creation of dataset used for analysis.
Figure 2.
Figure 2.
Countries that conducted surveillance through the World Health Organization-coordinated Global Rotavirus Surveillance Network (2008–2018) and those that have been included in the analysis.
See this image and copyright information in PMC

References

    1. Diarrhoeal disease . Available at: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease. Accessed 27 January 2020.
    1. Kotloff KL, Platts-Mills JA, Nasrin D, Roose A, Blackwelder WC, Levine MM. Global burden of diarrheal diseases among children in developing countries: incidence, etiology, and insights from new molecular diagnostic techniques. Vaccine 2017; 35:6783–9. - PubMed
    1. Black R, Fontaine O, Lamberti L, et al. . Drivers of the reduction in childhood diarrhea mortality 1980–2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health 2019; 9:020801. - PMC - PubMed
    1. Troeger C, Blacker BF, Khalil IA, et al. . Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018; 18:1211–28. - PMC - PubMed
    1. Acácio S, Mandomando I, Nhampossa T, et al. . Risk factors for death among children 0–59 months of age with moderate-to-severe diarrhea in Manhiça district, southern Mozambique. BMC Infect Dis 2019; 19:322. - PMC - PubMed

Publication types