Persistent diarrhoea in children admitted to Port Moresby General Hospital

Abstract

A retrospective study of the records of children admitted to Port Moresby General Hospital with diarrhoea during 1992 and 1993 was carried out to determine the morbidity, mortality and risk factors associated with persistent diarrhoea. 858 admissions of children under five years of age who had diarrhoea were identified from the ward admission registers, and case records for 724 were studied. Persistent diarrhoea occurred in 20%, and nearly half of these were in the 12-23 months age group. Children with persistent diarrhoea had a case fatality rate of 4.9%. Seasonality was similar for both persistent and non-persistent diarrhoea. In the crude analysis children of 12 months and older had a greater risk of developing persistent diarrhoea than those less than 12 months (odds ratio for children 12-23 months was 2.0 and for children 24-59 months 1.7; confidence intervals were 1.2-3.1 and 1.0-2.9 respectively); however, this difference was not found after logistic regression analysis. Poor nutritional status was a significant risk factor for persistent diarrhoea and remained so after controlling for confounding variables (odds ratio 2.7; confidence interval 1.8-4.0).

PIP: A retrospective review of the records of 724 children under 5 years of age admitted to Port Moresby General Hospital (Papua New Guinea) in 1992-93 with diarrhea was conducted, with emphasis on risk factors for persistent diarrhea. These cases represented 84% of total under-5 diarrhea admissions during the study period. Of the 720 children for which the duration of diarrhea was recorded, 144 (20%) had persistent diarrhea lasting 14 or more days. 49% of persistent diarrhea cases involved children 12-23 months of age; the largest proportion (40%) of short-term diarrhea cases occurred in infants 0-11 months old. Watery diarrhea, vomiting, cough, and fever were the most common presenting symptoms for diarrhea and acute respiratory tract infection was the most frequent cause of co-morbidity. Seasonal peaks in incidence occurred in May-July and November-January. After adjustment for dehydration-related weight loss, 42% of children with diarrhea were classified as malnourished. The case fatality rate was 4.9% for persistent diarrhea and 3.6% for non-persistent cases. In the univariate analysis, age and nutritional status were the only significant risk factors for persistent diarrhea; sex, past hospital admission, and co-morbidity were only weakly associated with persistent diarrhea. In the logistic regression analysis, only malnutrition remained a significant risk factor (odds ratio, 2.7; 95% confidence interval, 1.8-4.0). It is speculated that malnutrition associated with weaning accounts for the high rate of persistent diarrhea among children 12-23 months of age.