Episode-specific risk factors for progression of acute diarrhoea to persistent diarrhoea in West African children

The aim of the present study, carried out in Guinea-Bissau, West Africa, wa s to identify episode-specific risk factors for persistent diarrhoea (PD) r elated to clinical observations and management efforts. We followed 319 epi sodes of childhood diarrhoea by repeated household interviews until the epi sode stopped or after 14 days with diarrhoea. Children who still had diarrh oea after 14 days (n=40, 12.5% of episodes) were regarded as suffering from PD. Clinical signs, perceived by the mother, were recorded together with c are-seeking behaviour and management actions. Tired and rapid breathing pri or (OR=6.52 (95% CI 1.69-2.51)), mother had to force breast feeding (OR=8.0 1 (2.99-2.15)) and current infection with Cryptosporidium (OR=5.53 (2.10-14 .6)) were the most important independent risk factors for the development o f PD. Late consultation (>48 h) was associated with PD, reflecting that the se episodes initially were less acute. Use of oral rehydration salts did no t have an impact on development of PD, whereas home medication tended to in crease the risk of PD. Our study confirms the close association between sys temic illness and PD as well as the importance of cryptosporidiosis as a ca use of PD. We were unable to identify management factors with a significant influence on the risk of developing PD.