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Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study

BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with d...

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Autores principales: O'Reilly, Ciara E., Jaron, Peter, Ochieng, Benjamin, Nyaguara, Amek, Tate, Jacqueline E., Parsons, Michele B., Bopp, Cheryl A., Williams, Kara A., Vinjé, Jan, Blanton, Elizabeth, Wannemuehler, Kathleen A., Vulule, John, Laserson, Kayla F., Breiman, Robert F., Feikin, Daniel R., Widdowson, Marc-Alain, Mintz, Eric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3389023/
https://www.ncbi.nlm.nih.gov/pubmed/22802736
http://dx.doi.org/10.1371/journal.pmed.1001256
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author O'Reilly, Ciara E.
Jaron, Peter
Ochieng, Benjamin
Nyaguara, Amek
Tate, Jacqueline E.
Parsons, Michele B.
Bopp, Cheryl A.
Williams, Kara A.
Vinjé, Jan
Blanton, Elizabeth
Wannemuehler, Kathleen A.
Vulule, John
Laserson, Kayla F.
Breiman, Robert F.
Feikin, Daniel R.
Widdowson, Marc-Alain
Mintz, Eric
author_facet O'Reilly, Ciara E.
Jaron, Peter
Ochieng, Benjamin
Nyaguara, Amek
Tate, Jacqueline E.
Parsons, Michele B.
Bopp, Cheryl A.
Williams, Kara A.
Vinjé, Jan
Blanton, Elizabeth
Wannemuehler, Kathleen A.
Vulule, John
Laserson, Kayla F.
Breiman, Robert F.
Feikin, Daniel R.
Widdowson, Marc-Alain
Mintz, Eric
author_sort O'Reilly, Ciara E.
collection PubMed
description BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. METHODS AND FINDINGS: We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours) at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9%) children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118), Campylobacter in 5% (57), and Shigella in 4% (42) of 1,137 stool samples; rotavirus was detected in 19% (196) of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6·8; 95% CI 3·1–14·9), and children <5 years to have Shigella (aOR = 5·5; 95% CI 2·2–14·0) identified than children who survived. Children who died were less likely to be infected with rotavirus (OR = 0·4; 95% CI 0·2–0·8). Further risk factors for death included being malnourished (aOR = 4·2; 95% CI 2·1–8·7); having oral thrush on physical exam (aOR = 2·3; 95% CI 1·4–3·8); having previously sought care at a hospital for the illness (aOR = 2·2; 95% CI 1·2–3·8); and being dehydrated as diagnosed at discharge/death (aOR = 2·5; 95% CI 1·5–4·1). A clinical diagnosis of malaria, and malaria parasites seen on blood smear, were not associated with increased risk of death. This study only captured in-hospital childhood deaths, and likely missed a substantial number of additional deaths that occurred at home. CONCLUSION: Nontyphoidal Salmonella and Shigella are associated with mortality among rural Kenyan children with diarrhea who access a hospital. Improved prevention and treatment of diarrheal disease is necessary. Enhanced surveillance and simplified laboratory diagnostics in Africa may assist clinicians in appropriately treating potentially fatal diarrheal illness. Please see later in the article for the Editors' Summary
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spelling pubmed-33890232012-07-16 Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study O'Reilly, Ciara E. Jaron, Peter Ochieng, Benjamin Nyaguara, Amek Tate, Jacqueline E. Parsons, Michele B. Bopp, Cheryl A. Williams, Kara A. Vinjé, Jan Blanton, Elizabeth Wannemuehler, Kathleen A. Vulule, John Laserson, Kayla F. Breiman, Robert F. Feikin, Daniel R. Widdowson, Marc-Alain Mintz, Eric PLoS Med Research Article BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. METHODS AND FINDINGS: We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours) at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9%) children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118), Campylobacter in 5% (57), and Shigella in 4% (42) of 1,137 stool samples; rotavirus was detected in 19% (196) of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6·8; 95% CI 3·1–14·9), and children <5 years to have Shigella (aOR = 5·5; 95% CI 2·2–14·0) identified than children who survived. Children who died were less likely to be infected with rotavirus (OR = 0·4; 95% CI 0·2–0·8). Further risk factors for death included being malnourished (aOR = 4·2; 95% CI 2·1–8·7); having oral thrush on physical exam (aOR = 2·3; 95% CI 1·4–3·8); having previously sought care at a hospital for the illness (aOR = 2·2; 95% CI 1·2–3·8); and being dehydrated as diagnosed at discharge/death (aOR = 2·5; 95% CI 1·5–4·1). A clinical diagnosis of malaria, and malaria parasites seen on blood smear, were not associated with increased risk of death. This study only captured in-hospital childhood deaths, and likely missed a substantial number of additional deaths that occurred at home. CONCLUSION: Nontyphoidal Salmonella and Shigella are associated with mortality among rural Kenyan children with diarrhea who access a hospital. Improved prevention and treatment of diarrheal disease is necessary. Enhanced surveillance and simplified laboratory diagnostics in Africa may assist clinicians in appropriately treating potentially fatal diarrheal illness. Please see later in the article for the Editors' Summary Public Library of Science 2012-07-03 /pmc/articles/PMC3389023/ /pubmed/22802736 http://dx.doi.org/10.1371/journal.pmed.1001256 Text en This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
spellingShingle Research Article
O'Reilly, Ciara E.
Jaron, Peter
Ochieng, Benjamin
Nyaguara, Amek
Tate, Jacqueline E.
Parsons, Michele B.
Bopp, Cheryl A.
Williams, Kara A.
Vinjé, Jan
Blanton, Elizabeth
Wannemuehler, Kathleen A.
Vulule, John
Laserson, Kayla F.
Breiman, Robert F.
Feikin, Daniel R.
Widdowson, Marc-Alain
Mintz, Eric
Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study
title Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study
title_full Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study
title_fullStr Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study
title_full_unstemmed Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study
title_short Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study
title_sort risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western kenya, 2005–2007: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3389023/
https://www.ncbi.nlm.nih.gov/pubmed/22802736
http://dx.doi.org/10.1371/journal.pmed.1001256
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