1625. Epidemiology of childhood diarrhea in rural north Pakistan: 20 year follow-up from 1989-1996 to 2012-2014
Session: Poster Abstract Session: Global Health
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDSA Diarrhea Poster FIC NIH (small).png (453.6 kB)
  • Background: In NE Pakistan previous work demonstrated that diarrhea was the second main cause of childhood mortality in Oshikhandass village, Gilgit, from 1989-1996. A follow-up study was conducted after the introduction of water and sanitation interventions (water filtration plants, pit latrines and flush toilets) from 2012-2014 to determine changes in diarrhea epidemiology. Methods: Female health workers trained in diarrhea management using WHO IMCI guidelines conducted weekly surveillance of children <5 years.  Each episode was classified by severity and treatment/referral given, including antibiotics for bloody diarrhea. Results:   Table 1. From September 1989-September 1996, incidence was 65/100 child years (CY), and declined over time from a high of 130/100 CY in Yr 1 to 35/100 CY in Yr 7. From April 2012-March 2014, incidence was 69/100 CY.  In both studies, most episodes occurred in the summer months from May to September, when temperatures are much higher.  While most cases were categorized as acute (<7 days), the percentage of episodes which were prolonged (7-13 days), and persistent (>=14 days) was much higher in the first study; the percentage of bloody episodes was much lower in the second study.  The mortality rate per 1000 episodes was 13.3 times higher in the first study. Conclusion: While incidence of diarrhea did not change, mortality decreased substantially, as did mean duration.  The percentage of children receiving extra fluids from mothers remained high, as did ORS dispensing from health workers.

    Table  SEQ Table \* ARABIC 1

    Study 1: 1989-1996

    Study 2: 2012-2014

    Avg number of children followed per month

    680

    809

    Total Child Years of follow up

    4309

    1545

    Total episodes

    2802

    1065

    Total deaths

    35

    1

    Mortality rate per 1000 episodes

    12.5

    0.9

    Median age

    17.7

    22

    % Bloody

    12.5

    6.5

    % With some dehydration

    6.3

    15.3

    % with moderate-severe dehydration

    0.8

    0.7

    % given extra fluids by mother

    84.1

    92.8

    % given ORS by mother

    55.6

    81.9

    % given ORS packet by health worker

    77.4

    90.3

    % given nutritional advice

    90.5

    100

    % referred

    N/A

    2.6

    Duration in days mean (SD)

    6.9 (6.0)

    3.4(2.1)

    % Acute (<7 d)

    58.0

    95.2

    % Prolonged (7-13 d)

    33.4

    4.4

    % Persistent (>=14 d)

    7.9

    0.4

    Zeba Rasmussen, MD, MPH1, Elizabeth D. Thomas, MSPH1, Nahida Bano, MA2, Julia M. Baker, MPH1, Assis Jahan, MSc1, Syed Iqbal Azam, MSc3, Mohammad H. Jafri, HSD1, Arielle Hartz, HSD1, Ejaz Hussain, MA1, Wasiat H. Shah, MA1, Saba Wasim, MSc3 and Khalil Ahmed, PhD, MSc4, (1)Division of International Epidemiology and Population Studies, National Institutes of Health, Fogarty International Center, Bethesda, MD, (2)Private Consultant, Delhi, ON, Canada, (3)Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan, (4)Department of Biological Sciences, Karakoram International University, Gilgit, Pakistan

    Disclosures:

    Z. Rasmussen, None

    E. D. Thomas, None

    N. Bano, None

    J. M. Baker, None

    A. Jahan, None

    S. I. Azam, None

    M. H. Jafri, None

    A. Hartz, None

    E. Hussain, None

    W. H. Shah, None

    S. Wasim, None

    K. Ahmed, None

    See more of: Global Health
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.