Persistent Diarrhea Signals a Critical Period of Increased Diarrhea Burdens and Nutritional Shortfalls: A Prospective Cohort Study among Children in Northeastern Brazil

Persistent diarrhea (PD; duration ⩾14 days) is a growing part of the global burden of diarrheal diseases. A 45-month prospective cohort study (with illness, nutritional, and microbiologic surveillance) was conducted in a shantytown in northeastern Brazil, to elucidate the epidemiology, nutritional i...

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Bibliographic Details
Published in:The Journal of infectious diseases 2000-05, Vol.181 (5), p.1643-1651
Main Authors: Lima, A. A. M., Moore, S. R., Barboza, M. S., Soares, A. M., Schleupner, M. A., Newman, R. D., Sears, C. L., Nataro, J. P., Fedorko, D. P., Wuhib, T., Schorling, J. B., Guerrant, R. L.
Format: Article
Language:English
Subjects:
Bacterial Infections - epidemiology
Biological and medical sciences
Brazil - epidemiology
Breast Feeding
Child growth
Child nutrition
Children
Cohort Studies
Cryptosporidiosis
Diarrhea
Diarrhea - epidemiology
Diarrhea - microbiology
Diarrhea - parasitology
Diseases
Epidemiology
Female
Human protozoal diseases
Humans
Incidence
Infant, Newborn
Infections
Infectious diseases
Longitudinal Studies
Major Articles
Malnutrition
Medical sciences
Nutritional Status
Parasitic diseases
Parasitic Diseases - epidemiology
Poverty
Predisposing factors
Prevalence
Prospective Studies
Protozoal diseases
Risk Factors
Socioeconomic Factors
Tropical medicine
Virus Diseases - epidemiology
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Summary:Persistent diarrhea (PD; duration ⩾14 days) is a growing part of the global burden of diarrheal diseases. A 45-month prospective cohort study (with illness, nutritional, and microbiologic surveillance) was conducted in a shantytown in northeastern Brazil, to elucidate the epidemiology, nutritional impact, and causes of PD in early childhood (0–3 years of age). A nested case-control design was used to examine children's diarrhea burden and nutritional status before and after a first PD illness. PD illnesses accounted for 8% of episodes and 34% of days of diarrhea. First PD illnesses were preceded by a doubling of acute diarrhea burdens, were followed by further 2.6–3.5-fold increased diarrhea burdens for 18 months, and were associated with acute weight shortfalls. Exclusively breast-fed children had 8-fold lower diarrhea rates than did weaned children. PD-associated etiologic agents included Cryptosporidium, Giardia, enteric adenoviruses, and enterotoxigenic Escherichia coli. PD signals growth shortfalls and increased diarrhea burdens; children with PD merit extended support, and the illness warrants further study to elucidate its prevention, treatment, and impact.
ISSN:0022-1899
1537-6613
DOI:10.1086/315423