Diarrheal children with concurrent severe wasting and stunting compared to severe wasting or severe stunting

OBJECTIVE: Children with both severe wasting and severe stunting (SWSS) represent an extreme form of malnutrition and are prone to develop severe infection. The study aims to demonstrate clinical features and etiology of diarrhea among children with SWSS compared to those with either severe wasting (SW) or severe stunting (SS), which may help in early identification of high-risk children. METHODS: Data were extracted from the database of the Diarrheal Disease Surveillance System (DDSS) of Dhaka Hospital, icddr,b from 2008 to 2017. Among 14,403 under-five diarrheal children, 149 had concurrent SWSS (WLZ/WHZ ˂-3 with LAZ/HAZ ˂-3), 795 had SW (WLZ/WHZ ˂-3 but LAZ/HAZ ≥-3) alone, and 1000 had only SS (LAZ/HAZ ˂-3 but WLZ/WHZ ≥-3). RESULTS: In logistic regression analysis after adjusting for potential confounders, dehydrating diarrhea and slum dwelling were independently associated with SWSS versus SW (p<0.05). When compared with SS, dehydration and maternal illiteracy were independently associated with SWSS (p<0.05). In comparison to SW or SS, SWSS less often included infection with rotavirus (p<0.05). Dehydration was independently associated with SW vs. SS after adjusting for potential confounders (p<0.05). CONCLUSION: Children with SWSS more often presented with dehydrating diarrhea (69%) than children who had either SW (55%) or SS (43%). However, SWSS patients less frequently presented with rotavirus-associated diarrheal illnesses. This result underscores the importance of early detection and prompt management of dehydrating diarrhea in children with concomitant severe wasting and severe stunting to reduce morbidity and mortality in these children, especially in poor settings.