Disease Severity and Common Etiology of Diarrhea among Children Under-five in Mirzapur, Rural Bangladesh

Aim: There is lack of information on the severity of diarrheal disease with etiology. Thus the study aimed to compare the etiology of under-five children with moderate-to-severe disease (MSD) and mild disease (MD).
Study Design: Diarrheal disease surveillance.
Place and Duration of Study: Mirzapur Kumudini Hospital, Tangail, rural Bangladesh, January 2010 – December 2011.
Methodology: Overall, 2,324 under-5 diarrhea children were enrolled in the hospital who came from the demographic surveillance system (DSS) catchment area. Whole stool samples were collected from each enrolled child to detect rotavirus, Shigella, ETEC and V. cholerae. Information on socio-demographic and clinical characteristics was also collected.
Results: Among all the study children, 1,098 (47%) were aged 0-11 months; 789 (34%) were 12-23 months, and 437 (19%) were 24-59 months. Rotavirus (33%) was mainly responsible for diarrhea amongst children under-5 and 90% of them were less than 2 years. Shigella represented 14%; of which, 45% were 24-59 months old. However, ETEC and V. cholerae represented only 3% and 2% respectively. Shigella was the most commonly detected pathogen (27%) for MSD followed by rotavirus (16%). Conversely, rotavirus (43%) was responsible for MD. MSD were most likely to be infected with Shigella flexneri [OR-9.81; 95% CI (6.38, 15.18)] and Shigella sonnei [6.29; (3.67, 10.87)] compared to their counterparts with MD. In logistic regression analysis, Shigella was responsible for a 2.25 times higher risk for MSD. Children with Shigella were 3.28 times at higher risk for bloody stool and 2.45 times more likely to have fever. However, rotavirus diarrhea was more likely to be presented with vomiting (OR-2.46) and fever (OR-1.28), and Vibrio cholerae, most often with watery diarrhea (OR-4.35). None of the clinical features were significantly associated with ETEC.
Conclusion: Shigella was the leading pathogen that was detected most often in MSD, whereas rotavirus was often associated with MD.