Date of Award

Fall 11-17-2010

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Richard Rothenberg, MD, MPH, FACP

Second Advisor

Dr. Eric Mintz, MD, MPH

Abstract

Worldwide, diarrheal disease is the second leading cause of death in children under 5 years old. Data on diarrhea of extended duration is limited. We described the characteristics associated with acute, prolonged acute and persistent diarrhea in Kenyan children less than 5 years of age participating in the Global Enterics Multicenter Study. Children presenting at a clinic were enrolled if they met the case definition for acute moderate-to-severe diarrhea defined as >3 loose stools in the last 24 hrs, within 7 days of illness onset, with >1 of the following: sunken eyes, skin tenting, dysentery, IV rehydration, or hospitalization. To determine diarrhea duration, the child’s caretaker was asked to recall the number of days the child had diarrhea in the 7 days pre-enrollment, and to record each day of diarrhea post-enrollment on a form for 14 days. Stool specimens were collected at enrollment, and the post-enrollment form was collected during a home visit. We defined acute diarrhea (AD) as <6 days>duration, prolonged acute diarrhea (ProD) as 7-13 days, and persistent diarrhea (PD) as >14 days. From January 31, 2008 to January 24, 2010, 557 children with acute moderate-to-severe diarrhea were enrolled. Using the Wilcoxon rank-sum test, Kruskal-Wallis test, and Cox Proportional Hazards Model we examined the relationship between the duration of diarrhea by gender, age, and various etiologic agents. We found no association between gender and the duration of diarrhea. Age was associated with diarrhea of extended duration; children less than or equal to 11 months of age were 1.3 times more likely to experience diarrhea of longer duration than their counterparts. We found Cryptosporidium to be more associated with ProAD and PD. Children infected with Cryptosporidium were 1.5 to 1.7 times more likely to have diarrhea with a longer duration than their counterparts. Based on these results, interventions related to diarrhea and diarrhea of extended duration should focus more closely on young children, especially children less than 24 months of age.

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