RISK-FACTORS FOR MORTALITY AMONG HOSPITALIZED CHILDREN WITH PERSISTENT DIARRHEA IN PAKISTAN

We evaluated factors associated with mortality among a cohort of malno urished children with persistent diarrhoea (PD) admitted for nutrition al rehabilitation with a defined rice-lentil (Khitchri) and yoghurt di et. Of 302 children consecutively admitted with PD, 13 (4 per cent) di ed, mostly (62 per cent) within 72 h of admission, Univariate analysis of risk factors at admission associated with mortality indicated sign ificantly increased risk of death with severe stunting [relative risk (RR) 3.1, 95 per cent confidence interval (Ct) 1.1-9.0], hypoalbuminae mia (RR 4.3, 95 per cent CI 1.5-12.3), stool frequency >12/day (RR 6.0 , 96 per cent CI 2.0-17.6), stool volume >100 g/kg/day (RR 10.7, 95 pe r cent CI 3.0-37.6) and severe dehydration (RR 7.5, 95 per cent CI 2.6 -21.8). Children who died also had comparatively shorter duration of d iarrhoea at admission, and were also associated with higher rate of ba cteremia at admission (Fisher's exact test P < 0.01), The logistic reg ression model evaluating multivariate risk of mortality identified wei ght-for-age z-score and sepsis as significant risk factors, Our data s uggest that severe malnutrition and sepsis are associated with signifi cantly increased risk of mortality in children with PD, Stringent scre ening for infections and recognition of subgroups with severe malnutri tion and severe diarrhoea may improve screening and case management st rategies for this disorder.