Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study

BMC Medicine

Myron M. Levine¹  Karen L. Kotloff²  James P. Nataro³  Dilruba Nasrin⁴  Samba O. Sow⁵  Pedro L. Alonso⁶  Judd L. Walson⁷  Grace C. John-Stewart⁸  Rebecca L. Brander⁹  Marcia R. Weaver^1,10  Patricia B. Pavlinac^1,11  Anita K. M. Zaidi^1,12  Robert F. Breiman^1,13  Abu S. G. Faruque^1,14  M. Jahangir Hossain^1,15  Dipika Sur^1,16 

[1] Center for Vaccine Development and Global Health, Department of Pediatrics and Medicine, Department of Pediatrics, University of Maryland School of Medicine;Center for Vaccine Development and Global Health, Department of Pediatrics and Medicine, University of Maryland School of Medicine;Center for Vaccine Development, Department of Medicine, Department of Pediatrics, University of Maryland School of Medicine;Center for Vaccine Development, Department of Medicine, University of Maryland School of Medicine;Centre pour le Développement des Vaccines;Centro de Investigação em Saúde da Manhiça;Department of Epidemiology, Global Health, Pediatrics, Medicine, Childhood Acute Illness and Nutrition Network, University of Washington;Department of Epidemiology, Global Health, Pediatrics, Medicine, University of Washington;Department of Epidemiology, University of Washington;Department of Global Health, Health Services, Health Metrics Sciences, University of Washington;Department of Global Health, University of Washington;Department of Pediatrics and Child Health, Aga Khan University;Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention;International Centre for Diarrhoeal Disease Research;Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine;National Institute of Cholera and Enteric Diseases;

关键词: Diarrheal diseases;    Malnutrition;    Stunting;    Growth retardation;    Nutritional deterioration;    Diarrhea sequelae;   

DOI  :  10.1186/s12916-019-1441-3

来源: DOAJ

【 摘 要 】

Abstract Background Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD. Methods Using data from the Global Enteric Multicenter Study of children 0–23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model. Results Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50–90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was − 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12–23 months old, those 0–6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6–12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%). Conclusion Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.

【 授权许可】

Unknown