Persistent diarrhea signals a critical period of increased diarrhea burdens and nutritional shortfalls: A prospective cohort study among children in northeastern Brazil

A. A.M. Lima, S. R. Moore, M. S. Barboza, A. M. Soares, M. A. Schleupner, R. D. Newman, C. L. Sears, J. P. Nataro, D. P. Fedorko, T. Wuhib, J. B. Schorling, R. L. Guerrant

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1643-1651
Number of pages9
JournalJournal of Infectious Diseases
Volume181
Issue number5
DOIs
StatePublished - 2000

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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