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American Journal of Epidemiology Vol. 128, No. 6: 1322-1329
Copyright © 1988 by The Johns Hopkins University School of Hygiene and Public Health

research-article

RISK FACTORS FOR FATAL DIARRHEA: A CASE-CONTROL STUDY OF AFRICAN CHILDREN

PATRICIA M. GRIFFIN1, CAROLINE A. RYAN2, MAKASE NYAPHISI3, NANCY HARGRETT-BEAN1, RONALD J. WALDMAN4 and PAUL A. BLAKE1

1Enteric Diseases Branch, Division of Bacterial Diseases, Center for Infectious Diseases, Centers for Disease Control Atlanta, GA
2Department of Medicine, Division of Infectious Diseases, University of Washington Seattle, WA
3Nurse Clinician Training Program, Ministry of Health Maseru, Lesotho
4International Health Program Office, Centers for Disease Control Atlanta, GA 30333

Griffin, P. M. (CDC, Atlanta, GA 30333), C. A. Ryan, M. Nyaphisi, N. Hargrett-Bean, R. J. Waldman, and P. A. Blake. Risk factors for fatal diarrhea: a case-control study of African children. Am J Epidemiol 1988; 128:1322–9.

Few studies have determined risk factors for diarrheal deaths in developing areas. The Ministry of Health of Lesotho, southern Africa, reported that 9.5% of children under five years of age who were hospitalized for diarrhea in 1984 died. Of 104 children under five years of age who died during hospitalization for diarrhea, 85% were aged 24 months or younger and had nonbloody diarrhea during the warm season. We conducted two retrospective case-control studies of children aged 24 months or younger admitted for diarrhea at two hospitals in 1983 and 1984, comparing 44 who died with 89 who survived. Eight factors were significantly associated (p < 0.05) with death at one or both hospitals by univariate analysis: diagnosis of a major infection, age under six months, illness for seven days or more before admission, thrush or stomatitis on admission, severe dehydration, history of vomiting, dehydration that had not improved after 12 hours in the hospital, and fever or subnormal temperature. Multivariate analysis of data from one hospital showed the first three factors to be significantly associated with death. Cases and controls were similar in sex and in degree of malnutrition. This study identified children at high risk for death from diarrhea.

child; dehydration; developing countries; diarrhea; diarrhea, infantile; gastroenteritis


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