Changing trend of persistent diarrhoea in young children over two decades: observations from a large diarrhoeal disease hospital in Bangladesh.
OBJECTIVE
We studied the changing trend and factors associated with persistent diarrhoea (PD) in under-five children presenting to a large diarrhoeal disease hospital in urban Dhaka, Bangladesh, over the last two decades.


METHODS
We used an unmatched case-control design, with a case (persistent diarrhoea; n=944) to control (acute diarrhoea; n=2832) ratio of 1:3 attending the Dhaka Hospital of icddr,b between 1991 and 2010.


RESULTS
The proportion of children with PD decreased significantly from 8% in 1991 to 1% in 2010. The proportion of breastfeeding practices, measles vaccination coverage and vitamin A supplementation among 12-59 months old improved from 79% to 85%, 69% to 85% and 26% to 74%, respectively, which were significant. Although the isolation of rotavirus from stool in children with PD and acute diarrhoea increased, the isolation of Shigella spp., and Vibrio cholerae O1 decreased significantly. In a logistic regression analysis, wasting (OR=1.62), use of antibiotic before attending hospital (OR=5.94), absent clinical dehydration (OR=1.53) and bloody/mucoid stool (OR=3.33) were significantly associated with persistent diarrhoea.


CONCLUSIONS
There, thus, is a need to integrate an appropriate and sustainable deterrent strategy to take the benefit of the significant reduction in prevalence as well as risks of PD in such population.
International Centre for Diarrheal Disease Research, Bangladesh             Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Sumon Kumar
SK
Das
Abu Syed Golam
AS
Faruque
Mohammod Jobayer
MJ
Chisti
Mohammad Abdul
MA
Malek
Mohammed Abdus
MA
Salam
David A
DA
Sack
D000890:Anti-Infective Agents / Q000008:administration & dosage; D001459:Bangladesh / Q000453:epidemiology; D001942:Breast Feeding / Q000639:trends; D016022:Case-Control Studies; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008458:Measles Vaccine / Q000627:therapeutic use; D015995:Prevalence; D018570:Risk Assessment; D012401:Rotavirus / Q000302:isolation & purification; D012760:Shigella / Q000302:isolation & purification; D013851:Thinness / Q000453:epidemiology*; D041241:Vibrio cholerae O1 / Q000302:isolation & purification; D014801:Vitamin A / Q000008:administration & dosage
D000890:Anti-Infective Agents; D008458:Measles Vaccine; D014801:Vitamin A