title: Fluid curtailment during childhood diarrhea: a countdown analysis.
abstract: BACKGROUND
  The foundation of recommended diarrhea management in young children is increased fluids and continued feeding. This increase in fluids is necessary to replace those lost during diarrhea and ultimately prevent dehydration. There may be an opportunity to prevent deaths in children under five by discouraging the practice of reducing or curtailing fluids during diarrhea episodes across different settings worldwide.
  
  
  METHODS
  We quantify and describe the extent of fluid curtailment in children with diarrhea in a selection of countries (Burkina Faso, Democratic Republic of Congo, Ethiopia, Nigeria, Tanzania, and Uganda) with high burden of diarrhea-related mortality with national cross sectional survey data. We examine the practice of fluid curtailment in these countries and its relationship to child and household traits and to characteristics of diarrhea management.
  
  
  RESULTS
  The prevalence of fluid curtailment among children under five with diarrhea is strikingly high in these countries: 55 % in Nigeria, 49 % in Ethiopia, 44 % in Uganda, 37 % in Tanzania, 36 % in DR Congo and 32 % in Burkina Faso. Fluid curtailment is associated with giving less food, potentially worsening the impact of this harmful practice. Children who were reported to have had fluids curtailed during diarrhea episodes were also 3.51 (95 % confidence, 2.66 - 4.64) times more likely to be reported to have food withheld (α = 0.05; p < 0.001). Children who received care from non-governmental providers, and those who were breastfed were more likely to have their fluids curtailed, as were children with an unimproved water source. Children of poorer or less educated mothers and those living in rural areas are more likely to have curtailed fluids, compared to children of less poor or more educated mothers, or those living in urban areas.
  
  
  CONCLUSIONS
  The harmful practice of curtailing fluids for a child with diarrhea is highly prevalent, representing an increased risk of dehydration and complications due to diarrhea, including death, especially for children in specific subgroups.
authors.affiliation: Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. jperin@jhu.edu.
authors.forename: Jamie
authors.initials: J
authors.lastname: Perin
authors.affiliation: Division of Data, Research and Policy, Data and Analytics Section UNICEF, UNICEF, 3 UN Plaza, New York, NY, 10017, USA. lcarvajal@unicef.org.
authors.forename: Liliana
authors.initials: L
authors.lastname: Carvajal-Velez
authors.affiliation: Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. ecarter@jhu.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Carter
authors.affiliation: Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA. jbrycedandy@aol.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryce
authors.affiliation: Division of Data, Research and Policy, Data and Analytics Section UNICEF, UNICEF, 3 UN Plaza, New York, NY, 10017, USA. hnewby@unicef.org.
authors.forename: Holly
authors.initials: H
authors.lastname: Newby
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data; D002050:Burkina Faso; D002648:Child; D002675:Child, Preschool; D003223:Congo; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000209:etiology / Q000517:prevention & control*; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control*; D003968:Diarrhea, Infantile / Q000517:prevention & control; D004326:Drinking; D005002:Ethiopia; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009549:Nigeria; D015995:Prevalence; D013636:Tanzania; D014454:Uganda; D014867:Water / Q000008:administration & dosage*
chemical_list: D014867:Water