Methods: We have conducted a systematic review of published and unpublished cohort studies and performed meta-analyses of the impact of childhood diarrhea on physical growth and cognitive development, including the varying effects of different pathogens. We are preparing to include these sequelae in future iterations of GBD.
Results: Our results show that diarrhea significantly increases the risk of subsequent physical growth and cognitive development impairment. Each day of diarrhea was associated with a decrease in height-for-age z-score (HAZ) of 0.003 and a weight-for-age z-score (WAZ) of 0.006. The effect is not uniform by pathogen. Cryptosporidium diarrhea is strongly associated with stunting (-0.06 HAZ per episode) and underweight (-0.11 WAZ per episode). Further, physical growth is significantly associated with childhood cognitive development. Each unit increase in HAZ was associated with an increase in standardized intelligence z-scores of 0.08. However, diarrhea was not significantly associated with cognitive development in our analysis, suggesting that malnutrition may be a modifier in this relationship.
Conclusion: Our findings call for including long-term sequelae in GBD and other analyses and better quantifying the non-fatal consequences of childhood diarrhea for a more complete understanding of the burden of diarrhea.
I. Abdel-Messih Khalil,
P. Rao, None
M. Forouzanfar, None
D. Columbara, None
K. Misra, None
A. Mokdad, None