ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Risk Factors for Mortality Among Children Younger Than Age 5 Years With Severe Diarrhea in Low- and Middle-income Countries: Findings From the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 50 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Adherence to oral zinc supplementation in the management of acute diarrhoeal disease among under-5 children: A systematic review and meta-analysis.Epidemiology and infection · 2025Pooled it
- Treatment-seeking practices of caregivers for children aged less than five years old with diarrhoea in low- and middle-income countries: a systematic review and meta-analysis.Journal of global health · 2025Pooled it
- Identifying risk factors for vomiting during diarrhea: A secondary analysis of a randomized trial of zinc supplementation.Journal of pediatric gastroenterology and nutrition · 2025Trial
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- Antiviral Potential of Green-Synthesized Zinc Oxide and Copper Oxide Nanoparticles: Integrated In Vitro and In Silico Study.Nanomaterials (Basel, Switzerland) · 2026Article
- Seasonal Trends, Environmental Drivers, and Lessons Learned From the 2023 Cholera Outbreak in Chattogram, Bangladesh: A Descriptive Study.Health science reports · 2026Article
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- New Insights into Diarrhea Caused by High-Fat Diet and Fatigue: Gut Microbiota Dysbiosis-Driven Bile Acid Metabolism Disorder.Nutrients · 2026Article
- Large-genome phage vB_Eco_ZCEC15 targets gastrointestinal MDR E. coli: evidence from in vitro and Caco-2 cell models.BMC microbiology · 2026Article
- Multi-objective machine learning framework for welfare-optimized health insurance design in infectious disease management (Gastroenteritis).BMC public health · 2026Observational
- Modeling diarrhea in children under five in Somaliland: A machine learning analysis using SLDHS 2020 data.PloS one · 2026Article
- Estimating the global burden of diarrhea among young children with wasting and stunting and its projection to 2050: evidence from the Global Burden of Disease 2021 study.Frontiers in pediatrics · 2026Article
- User perceptions of a point-of-use water filtration device: Qualitative, focus group study.PloS one · 2026Article
- Multilevel analysis of improved water utilization and associated factors in Yemen: using 2013 DHS Yemen national dataset.BMC public health · 2025Article
- Genotype Distribution of Rotavirus Strains and Its Association with Severity of Diarrhea Among Children Under Five Hospitalized with Acute Gastroenteritis in Odisha, India.Indian journal of pediatrics · 2025Article
- Cumulative Incidence of Dysentery Among Under-Five Children in Underprivileged Urban Areas of Bhopal: A One-Year Cohort Study.Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine · 2025Article
- 2024 Bangladesh Floodwaters Harbour Regional Hotspots of Pathogens and Antimicrobial Resistance.Environmental microbiology reports · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
24 authors at 9 institutions in 11 countries.
Funding
Abstract
backgroundDiarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries.
methodsData from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality.
resultsThis analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81-4.50), female sex (OR = 1.18; 95% CI, 1.06-1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01-3.25), no vomiting (OR = 1.13; 95% CI, .98-1.30), severe dehydration (OR = 3.79; 95% CI, 3.01-4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92-2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72-422.73), whereas cases from the European Region had the lowest odds of death.
conclusionsOur findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.
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