Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study

• Type of Material: Article
• Authors: Rebecca L. Brander, University of Washington; Patricia B. Pavlinac, University of Washington; Judd L. Walson, University of Washington; Grace C. John-Stewart, University of Washington; Marcia R. Weaver, University of Washington; Abu S. G. Faruque, International Centre for Diarrhoeal Disease Research Bangladesh; Anita K. M. Zaidi, Aga Khan University; Dipika Sur, National Institute of Cholera and Enteric Diseases; Samba O. Sow, Centre pour le Développement des Vaccins; M. Jahangir Hossain, Medical Research Council Laboratories; Pedrp L. Alonso, Centro de Investigação em Saúde da Manhiça; Robert F Breiman, Emory University; Dilruba Nasrin, University of Maryland; James P. Nataro, University of Maryland; Myron M. Levine, University of Maryland; Karen L. Kotloff, University of Maryland
• Language: English
• Date: 2019-11-25
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12916-019-1441-3
• Title of Journal or Parent Work: BMC Medicine
• ISSN: 1741-7015
• Volume: 17
• Issue: 1
• Start Page: 214
• End Page: 214
• Grant/Funding Information: R Brander is funded by NIH 1F31HD096776-01.; The parent study (GEMS) was funded by the Bill and Melinda Gates Foundation.
• Keywords: Diarrheal diseases; Clinical prediction; Malnutrition; Growth retardation; Nutritional deterioration; Stunting; Diarrhea sequelae
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD. Methods: Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model. Results: Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50-90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was - 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12-23 months old, those 0-6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6-12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%). Conclusion: Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.