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. 2022 Oct 3;17(10):e0273148.
doi: 10.1371/journal.pone.0273148. eCollection 2022.

Prolonged diarrhea among under-five children in Bangladesh: Burden and risk factors

Md Iqbal Hossain  1 , A S G Faruque  1 , Monira Sarmin  1 , Mohammod Jobayer Chisti  1 , Tahmeed Ahmed  1
Affiliations

Prolonged diarrhea among under-five children in Bangladesh: Burden and risk factors

Md Iqbal Hossain et al. PLoS One. .

Abstract

Introduction & background: Prolonged (duration >7 to 13 days) diarrhea (ProD) in under-five children is a universal health problem including Bangladesh. Data on epidemiology and associated or risk factors of ProD are limited, particularly in Bangladesh where a high burden of ProD is reported. This study intended to assess the case load of ProD and its associated or risk factors compared to acute diarrhea (AD, duration ≤7 days).

Methods: We analyzed the data collected between 1996-2014 from a hospital-based Diarrheal-Disease-Surveillance-System (DDSS) in the 'Dhaka Hospital' of International Centre for Diarrhoeal Diseases, Bangladesh (icddr,b). The DDSS enrolled a 2% systematic sample, regardless of age, sex, and diarrhea severity. The data included information on socio-demographic factors, environmental history, clinical characteristics, nutritional status, and diarrhea-pathogens. After cleaning of data, relevant information of 21,566 under-five children were available who reported with ≤13 days diarrhea (including AD and ProD), and their data were analyzed. Variables found significantly associated with ProD compared to AD in bi-variate analysis were used in logistic regression model after checking the multicollinearity between independent variables.

Results: The mean±SD age of the children was 14.9±11.7 months and 40.4% were female; 7.6% had ProD and 92.4% had AD. Age <12 months, mucoid- or bloody-stool, warmer months (April-September), drug used at home before seeking care from hospital, and history of diarrhea within last one month were found associated with ProD (p<0.05); however, rotavirus infection was less common in children with ProD (p<0.05). ProD children more often needed inpatient admission than AD children (14.4 vs. 6.3, p<0.001). Case fatality rate of ProD vs. AD was 0.3% (n = 5) vs. 0.1% (n- = 22) respectively (p = 0.051).

Conclusion: A considerable proportion (7.6%) of under-five children reporting to icddr,b hospital suffered from ProD. Understanding the above-mentioned associated or risk factors is likely to help policy makers formulating appropriate strategies for alleviating the burden and effectively managing ProD in under-five children.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Percent of children with different stool organisms by prolonged diarrhea and acute diarrhea.
Fig 2
Fig 2. Percent of children required inpatient admission.
Fig 3
Fig 3. Percent of children with prolonged diarrhea and acute diarrhea required hospital stay for >3 days.
Fig 4
Fig 4. Case fatality rate (%) of children with prolonged diarrhea and acute diarrhea.
Fig 5
Fig 5. Children (%) with prolonged diarrhea and acute diarrhea by year.
Fig 6
Fig 6. Stool isolates (%) in children with prolonged and acute diarrhea by warmer or less warm/cooler season.
See this image and copyright information in PMC

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