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The Journal of Health, Population and Nutrition
icddr,b
ISSN: 1606-0997
EISSN: 1606-0997
Vol. 23, No. 3, 2005, pp. 259-265
Bioline Code: hn05033
Full paper language: English
Document type: Research Article
Document available free of charge

The Journal of Health, Population and Nutrition, Vol. 23, No. 3, 2005, pp. 259-265

 en Risk Factors for Mortality Due to Shigellosis: A Case-Control Study Among Severely-malnourished Children in Bangladesh
van den Broek, J.M.; Roy, S.K.; Khan, W.A.; Ara, G.; Chakraborty, B.; Islam, S. & Banu, B.

Abstract

To determine the risk factors for death of severely-malnourished Bangladeshi children with shigellosis, a case-control study was conducted at the Clinical Research and Service Centre of ICDDR,B: Centre for Health and Population Research in Dhaka, Bangladesh. One hundred severely-malnourished children (weight-for-age <60% of median of the National Center for Health Statistics), with a positive stool culture for Shigella dysenteriae check for this species in other resources type 1 or S. flexneri, who died during hospitalization, were compared with another 100 similar children (weight-for-age <60% and with S. dysenteriae type 1 or S. flexneri-associated infection) discharged alive. Children aged less than four years were admitted during December 1993 - January 1999. The median age of the cases who died or recovered was 9 months and 12 months respectively. Bronchopneumonia, abdominal distension, absent or sluggish bowel sound, clinical anaemia, altered consciousness, hypothermia, clinical sepsis, low or imperceptible pulse, dehydration, hypoglycaemia, high creatinine, and hyperkalaemia were all significantly more frequent in cases than in controls. In multivariate regression analysis, altered consciousness (odds ratio [OR]=2.6, 95% confidence interval [CI] 1.0-6.8), hypoglycaemia (blood glucose <3 mmol/L (OR= 7.8, 95% CI 2.9-19.6), hypothermia (temperature <36 °C) (OR = 5.7, 95% CI 1.5-22.1), and bronchopneumonia (OR = 2.5, 95% CI 1.1-5.5) were identified as significant risk factors for mortality. Severely-malnourished children with shigellosis having hypoglycaemia, hypothermia, altered consciousness and/or bronchopneumonia were at high risk of death. Based on the findings, the study recommends that early diagnosis of shigellosis in severely-malnourished children and assertive therapy for proper management to prevent development of hypothermia, hypoglycaemia,bronchopneumonia, or altered consciousness and its immediate treatment are likely to reduce Shigella-related mortality in severely-malnourished children.

Keywords
Shigella; Dysentery, Bacillary; Infant nutrition disorders; Child nutrition disorders; Infant mortality; Child mortality; Risk factors; Case-control studies; Bangladesh

 
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