Childhood diarrhoeal deaths in seven low- and middle-income countries.
OBJECTIVE
To investigate the clinical characteristics of children who died from diarrhoea in low- and middle-income countries, such as the duration of diarrhoea, comorbid conditions, care-seeking behaviour and oral rehydration therapy use.


METHODS
The study included verbal autopsy data on children who died from diarrhoea between 2000 and 2012 at seven sites in Bangladesh, Ethiopia, Ghana, India, Pakistan, Uganda and the United Republic of Tanzania, respectively. Data came from demographic surveillance sites, randomized trials and an extended Demographic and Health Survey. The type of diarrhoea was classified as acute watery, acute bloody or persistent and risk factors were identified. Deaths in children aged 1 to 11 months and 1 to 4 years were analysed separately.


RESULTS
The proportion of childhood deaths due to diarrhoea varied considerably across the seven sites from less than 3% to 30%. Among children aged 1-4 years, acute watery diarrhoea accounted for 31-69% of diarrhoeal deaths, acute bloody diarrhoea for 12-28%, and persistent diarrhoea for 12-56%. Among infants aged 1-11 months, persistent diarrhoea accounted for over 30% of diarrhoeal deaths in Ethiopia, India, Pakistan, Uganda and the United Republic of Tanzania. At most sites, more than 40% of children who died from persistent diarrhoea were malnourished.


CONCLUSIONS
Persistent diarrhoea remains an important cause of diarrhoeal death in young children in low- and middle-income countries. Research is needed on the public health burden of persistent diarrhoea and current treatment practices to understand why children are still dying from the condition.
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh .
Ahmed Ehsanur
AE
Rahman
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh .
Md
M
Moinuddin
College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia .
Mitike
M
Molla
College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia .
Alemayehu
A
Worku
London School of Hygiene and Tropical Medicine, London, England .
Lisa
L
Hurt
London School of Hygiene and Tropical Medicine, London, England .
Betty
B
Kirkwood
Centre for Health Research and Development of the Society for Applied Studies, New Delhi, India .
Sanjana Brahmawar
SB
Mohan
Centre for Health Research and Development of the Society for Applied Studies, New Delhi, India .
Sarmila
S
Mazumder
Aga Khan University, Karachi, Pakistan .
Zulfiqar
Z
Bhutta
Aga Khan University, Karachi, Pakistan .
Farrukh
F
Raza
Ifakara Health Institute, Ifakara and Rufiji, United Republic of Tanzania .
Sigilbert
S
Mrema
Ifakara Health Institute, Ifakara and Rufiji, United Republic of Tanzania .
Honorati
H
Masanja
Makerere University, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda .
Daniel
D
Kadobera
Makerere University, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda .
Peter
P
Waiswa
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland .
Rajiv
R
Bahl
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland .
Mike
M
Zangenberg
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland .
Lulu
L
Muhe
D001344:Autopsy; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000401:mortality*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005440:Fluid Therapy; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology