title: An instrument for the assessment of diarrhoeal severity based on a longitudinal community-based study.
abstract: OBJECTIVE
  Diarrhoea is a significant contributer to morbidity and is among the leading causes of death of children living in poverty. As such, the incidence, duration and severity of diarrhoeal episodes in the household are often key variables of interest in a variety of community-based studies. However, there currently exists no means of defining diarrhoeal severity that are (A) specifically designed and adapted for community-based studies, (B) associated with poorer child outcomes and (C) agreed on by the majority of researchers. Clinical severity scores do exist and are used in healthcare settings, but these tend to focus on relatively moderate-to-severe dehydrating and dysenteric disease, require trained observation of the child and, given the variability of access and utilisation of healthcare, fail to sufficiently describe the spectrum of disease in the community setting.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Santa Clara de Nanay, a rural community in the Northern Peruvian Amazon.
  
  
  METHODS
  442 infants and children 0-72 months of age.
  
  
  METHODS
  Change in weight over 1-month intervals and change in length/height over 9-month intervals.
  
  
  RESULTS
  Diarrhoeal episodes with symptoms of fever, anorexia, vomiting, greater number of liquid stools per day and greater number of total stools per day were associated with poorer weight gain compared with episodes without these symptoms. An instrument to measure the severity was constructed based on the duration of these symptoms over the course of a diarrhoeal episode.
  
  
  CONCLUSIONS
  In order to address limitations of existing diarrhoeal severity scores in the context of community-based studies, we propose an instrument comprised of diarrhoea-associated symptoms easily measured by community health workers and based on the association of these symptoms with poorer child growth. This instrument can be used to test the impact of interventions on the burden of diarrhoeal disease.
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
authors.forename: Gwenyth
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA Asociaciόn Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Loreto, Peru.
authors.forename: Pablo
authors.initials: P
authors.lastname: Peñataro Yori
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA Asociaciόn Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Loreto, Peru.
authors.forename: Maribel
authors.initials: M
authors.lastname: Paredes Olortegui
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Caulfield
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Sack
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
authors.forename: Christa
authors.initials: C
authors.lastname: Fischer-Walker
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA Asociaciόn Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Loreto, Peru.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D010568:Peru; D011446:Prospective Studies; D012111:Residence Characteristics; D012423:Rural Health; D012720:Severity of Illness Index