Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study

作者：Ciara E. O’Reilly, Peter Jaron, Benjamin Ochieng, Amek Nyaguara, Jacqueline E. Tate, Michele B. Parsons, Cheryl A. Bopp, Kara Williams, Jan Vinjé, Elizabeth Blanton, Kathleen Wannemuehler, John Vulule, Kayla F. Laserson, Robert F. Breiman, Daniel R. Feikin, Marc‐Alain Widdowson, Eric Mintz · 发表于：PLoS Medicine · 年份：2012 · DOI：10.1371/journal.pmed.1001256 · 被引用次数：133 · 研究领域：Child Nutrition and Water Access、Viral gastroenteritis research and epidemiology、Salmonella and Campylobacter epidemiology

BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. METHODS AND FINDINGS: We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours) at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9%) children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118), Campylobacter in 5% (57), and Shigella in 4% (42) of 1,137 stool samples; rotavirus was detected in 19% (196) of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6·8; 95% CI 3·1-14·9), and children <5 years to have Shigella (aOR = 5·5; 95% CI 2·2-14·0) identified than children who survived. Children who died were less likely to be...