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Author Notes:

Correspondence: Katharine A. Schilling, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30307. E-mail: schil1ka@gmail.com

Acknowledgments: This study includes data generated by the Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC) Health and Demographic Surveillance System (HDSS), which is a member of the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH).

We acknowledge the contributions of and thank the KEMRI/CDC HDSS team; the Global Enteric Multicenter Study (GEMS) Kenya staff for supporting the data collection and processing; the GEMS Kenya laboratory staff; the GEMS Data Coordinating Center, Perry Point Veterans Administration Medical Center, Perry Point, MD.

We are grateful to the caretakers in the Asembo, Gem and Karemo communities who participated in this work.

Disclosure: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.


Research Funding:

The Global Enteric Multicenter Study (GEMS) was funded by the Bill & Melinda Gates Foundation through the University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Tropical Medicine

Factors Associated with the Duration of Moderate-to-Severe Diarrhea among Children in Rural Western Kenya Enrolled in the Global Enteric Multicenter Study, 2008-2012

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Journal Title:

American Journal of Tropical Medicine and Hygiene


Volume 97, Number 1


, Pages 248-258

Type of Work:

Article | Final Publisher PDF


Diarrheal disease is a leading cause of death among young children worldwide. As rates of acute diarrhea (AD; 1-6 days duration) have decreased, persistent diarrhea (PD; > 14 days duration) accounts for a greater proportion of the diarrheal disease burden.Wedescribe factors associated with the duration of moderate-to-severe diarrhea in Kenyan children < 5 years old enrolled in the Global Enteric Multicenter Study. We found 587 (58%) children experienced AD, 360 (35%) had prolonged acute diarrhea (ProAD; 7-13 days duration), and 73 (7%) had PD.Weconstructed a Cox proportional hazards model to identify factors associated with diarrheal duration. Risk factors independently associated with longer diarrheal duration included infection with Cryptosporidium (hazard ratio [HR]: 0.868, P = 0.035), using an unimproved drinking water source (HR: 0.87, P = 0.035), and being stunted at enrollment (HR: 0.026, P < 0.0001). Diarrheal illness of extended duration appears to be multifactorial; given its association with adverse health and development outcomes, effective strategies should be implemented to reduce the duration and severity of diarrheal illness. Effective treatments for Cryptosporidium should be identified, interventions to improve drinking water are imperative, and nutrition should be improved through exclusive breastfeeding in infants ≤ 6 months and appropriate continued feeding practices for ill children.

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© The American Society of Tropical Medicine and Hygiene

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