Characteristics and outcomes of children 2–23 months of age with prolonged diarrhoea: A secondary analysis of data from the ‘Antibiotics for Children with Diarrhea’ trial

Background Approximately 12% of all diarrhoeal episodes last for 7–13 days. As such, they are termed prolonged diarrhoea, and are associated with over two-thirds of all diarrhoeal deaths. Due to a lack of robust data, we aimed to evaluate a comparative background characteristics of young children with acute and prolonged diarrhoea, and their outcomes at day 90 follow-up. Methods We performed a secondary analysis of data from the Antibiotics for Children with Diarrhea (ABCD) trial. Children aged 2–23 months were enrolled between July 2017 and July 2019 from seven Asian and sub-Saharan African countries. For this analysis, we divide diarrhoea into two categories: acute diarrhoea (duration <7 days) and prolonged diarrhoea (duration ≥7–13 days). We used logistic regression to observe baseline crude and adjusted associations and linear regression to compare post-discharge outcomes. Results We analysed data on 8266 children, of whom 756 (9%) had prolonged diarrhoea and 7510 (91%) had acute diarrhoea. Pakistan had the highest proportion of children with prolonged diarrhoea (n/N=178/1132, 16%), while Tanzania had the lowest (n/N=12/1200, 1%). From an analysis that adjusted for sex, breastfeeding, nutritional status, clinical presentation, housing, water supply, sanitation, and country, we observed that presentation at a health facility with prolonged diarrhoea was associated with low age (2–12 months) (adjusted odds ratio (aOR)=1.25; 95% confidence interval (CI)=1.02, 1.53; P=0.028), presence of three or more under-five children in the family (aOR=1.54; 95% CI=1.26, 1.87; P<0.001), maternal illiteracy (aOR=1.45; 95% CI=1.21, 1.74, P<0.001), moderate underweight (aOR=1.25; 95% CI=1.01, 1.55; P=0.042) and pathogen (Campylobacter) (aOR=1.27; 95% CI=1.12, 1.44; P<0.001). At day 90 follow-up, children with prolonged diarrhoea had significantly lower weight-for-age z-score compared to children with acute diarrhoea (−1.62, standard deviation (SD)=1.11 vs −1.52, SD=1.20; P=0.032), as well as significantly higher frequency of hospital admission (6.1% vs 4.5%; P=0.042). Conclusions Prolonged diarrhoea was more common in children of younger age, those who were moderately underweight, those with Campylobacter in stool, those with three or more under-five children in a family, and those with illiterate mothers compared to those who had acute diarrhoea. Children with prolonged diarrhoea more often required hospitalisation during the three-month follow-up period compared to their counterparts.