title: Persistent diarrhea signals a critical period of increased diarrhea burdens and nutritional shortfalls: a prospective cohort study among children in northeastern Brazil.
abstract: Persistent diarrhea (PD; duration >/=14 days) is a growing part of the global burden of diarrheal diseases. A 45-month prospective cohort study (with illness, nutritional, and microbiologic surveillance) was conducted in a shantytown in northeastern Brazil, to elucidate the epidemiology, nutritional impact, and causes of PD in early childhood (0-3 years of age). A nested case-control design was used to examine children's diarrhea burden and nutritional status before and after a first PD illness. PD illnesses accounted for 8% of episodes and 34% of days of diarrhea. First PD illnesses were preceded by a doubling of acute diarrhea burdens, were followed by further 2.6-3.5-fold increased diarrhea burdens for 18 months, and were associated with acute weight shortfalls. Exclusively breast-fed children had 8-fold lower diarrhea rates than did weaned children. PD-associated etiologic agents included Cryptosporidium, Giardia, enteric adenoviruses, and enterotoxigenic Escherichia coli. PD signals growth shortfalls and increased diarrhea burdens; children with PD merit extended support, and the illness warrants further study to elucidate its prevention, treatment, and impact.
authors.affiliation: Clinical Research Unit-HUWC, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Cear¿a, 3390-Sala 90, Porangabussu, Fortaleza, CE, Brazil-CEP 60.436-160. alima@secrel.com.br.
authors.forename: A A
authors.initials: AA
authors.lastname: Lima
authors.forename: S R
authors.initials: SR
authors.lastname: Moore
authors.forename: M S
authors.initials: MS
authors.lastname: Barboza
authors.forename: A M
authors.initials: AM
authors.lastname: Soares
authors.forename: M A
authors.initials: MA
authors.lastname: Schleupner
authors.forename: R D
authors.initials: RD
authors.lastname: Newman
authors.forename: C L
authors.initials: CL
authors.lastname: Sears
authors.forename: J P
authors.initials: JP
authors.lastname: Nataro
authors.forename: D P
authors.initials: DP
authors.lastname: Fedorko
authors.forename: T
authors.initials: T
authors.lastname: Wuhib
authors.forename: J B
authors.initials: JB
authors.lastname: Schorling
authors.forename: R L
authors.initials: RL
authors.lastname: Guerrant
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008137:Longitudinal Studies; D009752:Nutritional Status; D010272:Parasitic Diseases / Q000453:epidemiology; D011203:Poverty; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014777:Virus Diseases / Q000453:epidemiology