A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community-Based Cohort Study
Autor: | Estomih R. Mduma, Ram Krishna Chandyo, Eric R. Houpt, Mats Steffi Jennifer, Laura L. Pendergast, Laura E. Caulfield, Jessica C. Seidman, Zulfiqar A Bhutta, Emanuel Nyathi, Margaret Kosek, Md. Iqbal Hossain, Ila F. N. Lima, Gagandeep Kang, Tahmeed Ahmed, Richard L. Guerrant, John M. Pascal, Aldo Am Lima, Robert E. Black, Gwenyth O. Lee, Pascal Bessong, Stephanie A. Richard, Bodhidatta Ladaporn, Sajid Bashir Soofi |
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Rok vydání: | 2016 |
Předmět: |
Diarrhea
Male Pediatrics medicine.medical_specialty 030231 tropical medicine Original Articles: Gastroenterology Context (language use) macromolecular substances Severity of Illness Index Cohort Studies 03 medical and health sciences 0302 clinical medicine parasitic diseases Severity of illness Epidemiology medicine Humans 030212 general & internal medicine Child Prospective cohort study Developing Countries Community based Extramural business.industry Gastroenterology Infant Hospitalization pediatric ROC Curve Child Preschool Pediatrics Perinatology and Child Health ComputingMethodologies_DOCUMENTANDTEXTPROCESSING epidemiology Female business Cohort study |
Zdroj: | Journal of Pediatric Gastroenterology and Nutrition |
ISSN: | 1536-4801 0277-2116 |
Popis: | Supplemental Digital Content is available in the text Objectives: There is a lack of consensus on how to measure diarrheal severity. Within the context of a multisite, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), 2 previously published scores (Clark and CODA [a diarrheal severity score (Community DiarrheA) published by Lee et al]), and a modified definition of moderate-to-severe diarrhea (MSD) based on dysentery and health care worker diagnosed dehydration. Methods: Scores were built using maternally reported symptoms or fieldworker-reported clinical signs obtained during the first 7 days of a diarrheal episode. The association between these and the risk of hospitalization were tested using receiver operating characteristic analysis. Severity scores were also related to illness etiology, and the likelihood of the episode subsequently becoming prolonged or persistent. Results: Of 10,159 episodes from 1681 children, 143 (4.0%) resulted in hospitalization. The area under the curve of each score as a predictor of hospitalization was 0.84 (95% confidence interval: 0.81, 0.87) (Clark), 0.85 (0.82, 0.88) (MAL-ED), and 0.87 (0.84, 0.89) (CODA). Severity was also associated with etiology and episode duration. Although families were more likely to seek care for severe diarrhea, approximately half of severe cases never reached the health system. Conclusions: Community-based diarrheal severity scores are predictive of relevant child health outcomes. Because they require no assumptions about health care access or utilization, they are useful in refining estimates of the burden of diarrheal disease, in estimating the effect of disease control interventions, and in triaging children for referral in low- and middle-income countries in which the rates of morbidity and mortality after diarrhea remain high. |
Databáze: | OpenAIRE |
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