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Predictors of death in under-five children with diarrhoea admitted to a critical care ward in an urban hospital in Bangladesh

Authors

  • Mohammod J Chisti,

    1. Clinical Sciences Division, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
    2. Executive Directors Division (EDD), International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
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  • Mark AC Pietroni,

    1. Executive Directors Division (EDD), International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
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  • Jonathan H Smith,

    1. Executive Directors Division (EDD), International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
    2. Portex Unit of Anaesthesia, University College London Institute of Child Health, London, UK
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  • Pradip K Bardhan,

    1. Executive Directors Division (EDD), International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
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  • Mohammed A Salam

    1. Clinical Sciences Division, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
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  • This study was conducted at the Special Care Ward of the Dhaka Hospital of ICDDR,B.

Mohammod J Chisti, CSD & EDD, ICDDR,B; 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
Tel.: 880-2-8860523-32; extn: 2334 |
Fax: 880-2-8823116 |
Email:chisti@icddrb.org

Abstract

Aim : To evaluate the clinical and laboratory predictors of death in hospitalized under-five children with diarrhoea.

Methods : This is a prospective cohort study carried out in the Special Care Ward (SCW) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh. All admitted diarrhoeal children of both sexes, aged 0–59 months, from September 2007 through December 2007 were enrolled. We compared and analysed factors among diarrhoeal children who died (n = 29) with those who survived (n = 229).

Results : In logistic regression analysis, after adjusting for potential confounders (infusion of intravenous fluid and immature PMN), absent peripheral pulse even after complete rehydration (OR 10.9, 95% CI 2.1–56.8; p < 0.01), severe malnutrition (OR 7.9, 95% CI 1.8–34.8; p < 0.01), hypoxaemia (OR 8.5, 95% CI 1.0-75.0; p = 0.05), radiological lobar pneumonia (OR 17.8, 95% CI 3.7–84.5; p < 0.01) and hypernatraemia (OR 15.8, 95% CI 3.0–81.8; p < 0.01) were independently associated with deaths among diarrhoeal children admitted to SCW.

Conclusions:  Thus, the absence of peripheral pulses even after full rehydration, severe malnutrition, hypoxaemia, lobar pneumonia and hypernatraemia are independent predictors of death among the under-five children with diarrhoea admitted to critical care ward of a resource-limited setting in Bangladesh.

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