Characteristics and Etiology of Moderate-to-Severe Diarrhea of Acute, Prolonged Acute, and

50 Pages·2017·0.32 MB·English

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Public Health Theses School of Public Health
Fall 11-17-2010
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Katharine A. Schilling
Georgia State University
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Schilling, Katharine A., "Characteristics and Etiology of Moderate-to-Severe Diarrhea of Acute, Prolonged
Acute, and Persistent Duration among Children Less than 5 Years Old in Rural Western Kenya, 2008-2010."
Thesis, Georgia State University, 2010.
doi: https://doi.org/10.57709/1664807
This Thesis is brought to you for free and open access by the School of Public Health at ScholarWorks @ Georgia
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Institute of Public Health
Public Health Theses

Georgia State University Year 2010

Characteristics and Etiology of Moderate-To-Severe Diarrhea of Acute,
Prolonged Acute, and Persistent Duration among Children Less Than 5
Years Old in Rural Western Kenya, 2008-2010

Katharine A. Schilling
Georgia State University, [email protected]
ii

Abstract
Katharine Schilling
Characteristics and Etiology of Moderate-To-Severe Diarrhea of Acute, Prolonged Acute, and
Persistent Duration among Children Less Than 5 Years Old in Rural Western Kenya, 2008-2010
(Under the direction of Dr. Richard Rothenberg, MD, MHP, FACP and Dr. Eric Mintz, MD,
MPH.)
Worldwide, diarrheal disease is the second leading cause of death in children under 5 years old.
Data on diarrhea of extended duration is limited. We described the characteristics associated
with acute, prolonged acute and persistent diarrhea in Kenyan children less than 5 years of age
participating in the Global Enterics Multicenter Study. Children presenting at a clinic were
enrolled if they met the case definition for acute moderate-to-severe diarrhea defined as >3 loose
stools in the last 24 hrs, within 7 days of illness onset, with >1 of the following: sunken eyes,
skin tenting, dysentery, IV rehydration, or hospitalization. To determine diarrhea duration, the
child’s caretaker was asked to recall the number of days the child had diarrhea in the 7 days pre-
enrollment, and to record each day of diarrhea post-enrollment on a form for 14 days. Stool
specimens were collected at enrollment, and the post-enrollment form was collected during a
home visit. We defined acute diarrhea (AD) as <6 days duration, prolonged acute diarrhea
(ProD) as 7-13 days, and persistent diarrhea (PD) as >14 days. From January 31, 2008 to January
24, 2010, 557 children with acute moderate-to-severe diarrhea were enrolled. Using the
Wilcoxon rank-sum test, Kruskal-Wallis test, and Cox Proportional Hazards Model we examined
the relationship between the duration of diarrhea by gender, age, and various etiologic agents.
We found no association between gender and the duration of diarrhea. Age was associated with
diarrhea of extended duration; children less than or equal to 11 months of age were 1.3 times
more likely to experience diarrhea of longer duration than their counterparts. We found
Cryptosporidium to be more associated with ProAD and PD. Children infected with
Cryptosporidium were 1.5 to 1.7 times more likely to have diarrhea with a longer duration than
their counterparts. Based on these results, interventions related to diarrhea and diarrhea of
extended duration should focus more closely on young children, especially children less than 24
months of age.
iii

Characteristics and Etiology of Moderate-To-Severe Diarrhea of Acute, Prolonged
Acute, and Persistent Duration among Children Less Than 5 Years Old in Rural
Western Kenya, 2008-2010
By Katharine A. Schilling

Bachelor of Science in Health Education and Health Promotion, minor Nutrition
from Central Michigan University, December 2007

A Thesis Submitted to the Graduate Faculty of Georgia State University in Partial Fulfillment of
the Requirements for the Degree

Master of Public Health
Atlanta, GA 30303
2010
iv

Characteristics and Etiology of Moderate-To-Severe Diarrhea of Acute, Prolonged Acute, and
Persistent Duration among Children Less Than 5 Years Old in Rural Western Kenya, 2008-2010
By

Katharine A. Schilling

Approved:
Dr. Richard Rothenberg, MD, MPH, FACP
Committee Chair

Dr. Eric Mintz, MD, MPH
Committee Member

November 17, 2010
Date
v

Acknowledgements

I would like to thank my committee members, Dr. Richard Rothenberg and Dr. Eric Mintz
for their continued support and guidance throughout this process. Additionally, I would like to
acknowledge the support and assistance from Dr. Ciara O’Reilly, Tracy Ayers, Richard Omore,
Salome Omondi, and the entire GEMS staff. Finally, I would like to thank my family and friends,
especially my Mom and Dad for their continued patience, support, and love.
vi

Authors’ Statement

In presenting this thesis as a partial fulfillment of the requirements for an advanced degree from
Georgia State University, I agree that the Library of the University shall make it available for
inspection and circulation in accordance with its regulations governing materials of this type. I
agree that permission to quote from, to copy from, or to publish this thesis may be granted by the
author or, in her absence, by the professor under whose direction it was written, or in his
absence, by the Associate Dean, College of Health and Human Sciences. Such quoting, copying,
or publishing must be solely for scholarly purposes and will not involve any potential financial
gain. It is understood that any copying from or publication of this dissertation which involves
potential financial gain will not be allowed without written permission of the author.

Katharine A. Schilling__
Signature of the Author
vii

Notice to Borrowers

All these deposited in the Georgia State University Library must be used in accordance with the
stipulations described by the author in the preceding statement.

The author of this thesis is:
Katharine A. Schilling
3444 North Druid Hills Rd Apt I
Decatur, GA 30033

The Chair of the committee for this thesis is:
Dr. Richard Rothenberg, MD, MPH, FACP
Institute of Public Health
Georgia State University
P.O. Box 4018
Atlanta, GA 30302-4018

Users of this thesis who are not regularly enrolled as a student at Georgia State University are
required to attest acceptance of the preceding stipulation by signing below. Libraries borrowing
this thesis for the use of their patrons are required to see that each user records here the
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(EXAMINATION ONLY
FOR COPYING
viii

Curriculum Vitae
Katharine A. Schilling
3444 North Druid Hills Rd Apt I
Decatur, GA 30033
989-944-5093
[email protected]

Education
December 2010 Master of Public Health, Prevention Sciences, In progress
Georgia State University, Atlanta, GA

December 2007 Bachelor of Science in Public Health Education and Health Promotion
with minor in Nutrition
Central Michigan University, Mt. Pleasant, MI

Professional Work Experience
March 2008-present Centers for Disease Control and Prevention, Waterborne Diseases
Prevention Branch, Global WASH Epidemiology Team
ORISE Research Program Participant
Technical Research Assistant,

January 2006- Office Manager, Central Rehabilitation Services, Inc.
March 2008

August 2007- Health Education Internship, Bridges Center for Healthy Life
December 2007 Transitions

August 2007- Teachers Assistant, Biostatistics
December 2007 Central Michigan University

Publications and Presentations
November 2010 Oral presentation: American Society for Tropical Medicine and Hygiene
59th Annual Meeting
Research presented: “Characteristics and etiology of moderate-to-severe
diarrhea of prolonged or persistent duration among children less than 5
years old in rural western Kenya, 2008-2009”

July 2009 Mintz, E, Schilling, K. (2009) Shigellosis. In CDC Health Information for
International Travel 2010 (384-386). Atlanta: Elservier.

December 2007 Oral presentation:2007 National HIV Prevention Conference, Atlanta,GA.
Research presented: “HIV Testing among Women in the United States”

Computer Skills JMP, SPSS, EndNote, Microsoft Access, Excel, Word, Power Point, and
Publisher,

Certifications October 2007 Certified Health Education Specialist (CHES)
ix

TABLE OF CONTENTS

ACKNOWLEDGEMENTS .............................................................................................................v

LIST OF TABLES ...........................................................................................................................x

LIST OF FIGURES ....................................................................................................................... xi

INTRODUCTION ...........................................................................................................................1
1.1 Background ............................................................................................................................1
1.2 Purpose of Study ....................................................................................................................2
1.3 Research Questions ................................................................................................................2

REVIEW OF THE LITERATURE .................................................................................................3
2.1 Diarrheal diseases ...................................................................................................................3
2.2 Duration of diarrheal illness ...................................................................................................5
2.3 Factors influencing the duration of diarrhea ..........................................................................7
2.4 Diarrheal disease in Kenya ...................................................................................................14

METHODS ....................................................................................................................................16
3.1 Study population ..................................................................................................................16
3.2 Enrollment ............................................................................................................................16
3.3 Data Sources .........................................................................................................................17
3.4 Procedures ............................................................................................................................20
3.5 Analysis ................................................................................................................................20
3.6 Ethical consideration ............................................................................................................22

RESULTS ......................................................................................................................................23
4.1 Inclusion of cases .................................................................................................................23
4.2 Descriptive Statistics ............................................................................................................25
4.3 Test of Median .....................................................................................................................28
4.4 Cox’s Proportional-Hazards Model......................................................................................29
4.5 Summary of Results .............................................................................................................30

DISCUSSION AND CONCLUSION ...........................................................................................31
5.1 Gender ..................................................................................................................................31
5.2 Age .......................................................................................................................................31
5.3 Etiologic agents ....................................................................................................................32
5.4 Study limitations ..................................................................................................................32
5.3 Recommendations ................................................................................................................33
5.4 Conclusion ............................................................................................................................34

REFERENCES ..............................................................................................................................35