Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh.
BACKGROUND:To take advantage of emerging opportunities to reduce morbidity and mortality from diarrheal disease, we need to better understand the determinants of life-threatening severe dehydration (SD) in resource-poor settings. METHODOLOGY/FINDINGS:We analyzed records of patients admitted with acu...
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ftdoajarticles:oai:doaj.org/article:acba90dab90a4064a2949e17b2a719ea 2023-05-15T15:13:12+02:00 Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. Jason R Andrews Daniel T Leung Shahnawaz Ahmed Mohammed Abdul Malek Dilruba Ahmed Yasmin Ara Begum Firdausi Qadri Tahmeed Ahmed Abu Syed Golam Faruque Eric J Nelson 2017-04-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0005512 https://doaj.org/article/acba90dab90a4064a2949e17b2a719ea EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC5423662?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0005512 https://doaj.org/article/acba90dab90a4064a2949e17b2a719ea PLoS Neglected Tropical Diseases, Vol 11, Iss 4, p e0005512 (2017) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2017 ftdoajarticles https://doi.org/10.1371/journal.pntd.0005512 2022-12-31T09:35:35Z BACKGROUND:To take advantage of emerging opportunities to reduce morbidity and mortality from diarrheal disease, we need to better understand the determinants of life-threatening severe dehydration (SD) in resource-poor settings. METHODOLOGY/FINDINGS:We analyzed records of patients admitted with acute diarrheal disease over twenty-two years at the International Centre for Diarrhoeal Disease Research, Bangladesh (1993-2014). Patients presenting with and without SD were compared by multivariable logistic regression models, which included socio-demographic factors and pathogens isolated. Generalized additive models evaluated non-linearities between age or household income and SD. Among 55,956 admitted patients, 13,457 (24%) presented with SD. Vibrio cholerae was the most common pathogen isolated (12,405 patients; 22%), and had the strongest association with SD (AOR 4.77; 95% CI: 4.41-5.51); detection of multiple pathogens did not exacerbate SD risk. The highest proportion of severely dehydrated patients presented in a narrow window only 4-12 hours after symptom onset. Risk of presenting with SD increased sharply from zero to ten years of age and remained high throughout adolescence and adulthood. Adult women had a 38% increased odds (AOR 1.38; 95% CI: 1.30-1.46) of SD compared to adult men. The probability of SD increased sharply at low incomes. These findings were consistent across pathogens. CONCLUSIONS/SIGNIFICANCE:There remain underappreciated populations vulnerable to life-threatening diarrheal disease that include adult women and the very poor. In addition to efforts that address diarrheal disease in young children, there is a need to develop interventions for these other high-risk populations that are accessible within 4 hours of symptom onset. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 11 4 e0005512 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Jason R Andrews Daniel T Leung Shahnawaz Ahmed Mohammed Abdul Malek Dilruba Ahmed Yasmin Ara Begum Firdausi Qadri Tahmeed Ahmed Abu Syed Golam Faruque Eric J Nelson Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND:To take advantage of emerging opportunities to reduce morbidity and mortality from diarrheal disease, we need to better understand the determinants of life-threatening severe dehydration (SD) in resource-poor settings. METHODOLOGY/FINDINGS:We analyzed records of patients admitted with acute diarrheal disease over twenty-two years at the International Centre for Diarrhoeal Disease Research, Bangladesh (1993-2014). Patients presenting with and without SD were compared by multivariable logistic regression models, which included socio-demographic factors and pathogens isolated. Generalized additive models evaluated non-linearities between age or household income and SD. Among 55,956 admitted patients, 13,457 (24%) presented with SD. Vibrio cholerae was the most common pathogen isolated (12,405 patients; 22%), and had the strongest association with SD (AOR 4.77; 95% CI: 4.41-5.51); detection of multiple pathogens did not exacerbate SD risk. The highest proportion of severely dehydrated patients presented in a narrow window only 4-12 hours after symptom onset. Risk of presenting with SD increased sharply from zero to ten years of age and remained high throughout adolescence and adulthood. Adult women had a 38% increased odds (AOR 1.38; 95% CI: 1.30-1.46) of SD compared to adult men. The probability of SD increased sharply at low incomes. These findings were consistent across pathogens. CONCLUSIONS/SIGNIFICANCE:There remain underappreciated populations vulnerable to life-threatening diarrheal disease that include adult women and the very poor. In addition to efforts that address diarrheal disease in young children, there is a need to develop interventions for these other high-risk populations that are accessible within 4 hours of symptom onset. |
format |
Article in Journal/Newspaper |
author |
Jason R Andrews Daniel T Leung Shahnawaz Ahmed Mohammed Abdul Malek Dilruba Ahmed Yasmin Ara Begum Firdausi Qadri Tahmeed Ahmed Abu Syed Golam Faruque Eric J Nelson |
author_facet |
Jason R Andrews Daniel T Leung Shahnawaz Ahmed Mohammed Abdul Malek Dilruba Ahmed Yasmin Ara Begum Firdausi Qadri Tahmeed Ahmed Abu Syed Golam Faruque Eric J Nelson |
author_sort |
Jason R Andrews |
title |
Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. |
title_short |
Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. |
title_full |
Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. |
title_fullStr |
Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. |
title_full_unstemmed |
Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. |
title_sort |
determinants of severe dehydration from diarrheal disease at hospital presentation: evidence from 22 years of admissions in bangladesh. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2017 |
url |
https://doi.org/10.1371/journal.pntd.0005512 https://doaj.org/article/acba90dab90a4064a2949e17b2a719ea |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 11, Iss 4, p e0005512 (2017) |
op_relation |
http://europepmc.org/articles/PMC5423662?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0005512 https://doaj.org/article/acba90dab90a4064a2949e17b2a719ea |
op_doi |
https://doi.org/10.1371/journal.pntd.0005512 |
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PLOS Neglected Tropical Diseases |
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11 |
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4 |
container_start_page |
e0005512 |
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1766343783645970432 |