Children at Risk of Developing Dehydration from Diarrhoea: A Case-control Study
Journal of Tropical Pediatrics
Introduction Diarrhoeal diseases have long been recognized as a leading cause of morbidity and mortality, with global diarrhoeal episodes of 1000 million and the death of 4 million children under 5 years old. 1,2 About 2-3 per cent of children with diarrhoea develop life-threatening dehydration which contributes to mortality. 3 A few early signs and symptoms, and socioeconomic, biological, demographic, anthropometric, environmental, dietary and healthcare-related variables were found to be
... re found to be associated with the risk of dehydrating diarrhoea.    Numerous studies have shown that oral rehydration therapy (ORT) with oral rehydration salt (ORS) cures dehydration and prevents death. 7-10 Although 95 per cent of mothers knew about ORS in Bangladesh, 11 more than a quarter of deaths in under-fives are associated with diarrhoea. 12 Little is known about the factors that predispose to dehydration in spite of access to ORS. 11 It becomes imperative to look into the factors that underly the development of life-threatening dehydration from diarrhoea, so that the health workers can identify such children early and keep them under close surveillance and take necessary interventions to alter the course. This study aims to identify the risk factors associated with dehydrating diarrhoea in children. Materials and Methods This was a prospective case-control study. The study was conducted at the Pediatric Department, including the ORT Corner, of Comilla Medical College Hospital, Bangladesh during 1998. It is a 500-bed teaching hospital with a catchment population of 10 million people. The children were selected from the diarrhoea patients who attended the ORT Corner and were admitted to the pediatric ward. The selection was restricted to under-2-year-olds considering their greater vulnerability for mortality and morbidity. The other inclusion criteria were (a) history of acute watery diarrhoea for less than 7 days, and (b) residence in the Comilla district. The cases were eligible children with severe or some dehydration. The controls were children with 'no signs of dehydration' who met the inclusion criteria. The controls were selected to match the cases, two controls per case, by age, i.e. 0-5, 6-11, 12-17, and 18-23 months using a systemic sampling scheme. The sample size was estimated using EPI INFO-6 statistical package, using a 10 per cent prevalence of dehydration amongst the cases (Diarrhoea), a confidence level of 95 per cent (1 -␣), and a power (1 -␤) of 80 per cent. The sample size with a ratio of 1: 2 for case: control showed a requirement of 63 cases and 126 controls. Considering a drop-out rate of 20 per cent, the required sample size for case and controls was taken to be 80 and 160, respectively.