Factors associated with hospitalization of children aged 6-35 months presenting with diarrhea in six low- and middle-income countries: a cohort analysis in the Enterics for Global Health (EFGH) study, 2022 - 2024

BackgroundAround 1.7 billion cases of diarrhea are reported globally, with the highest burden in Africa and South-East Asia, where higher hospitalization rates are observed among children under five years of age. Hospitalized children with diarrhea often experience serious complications and a higher risk of death. Although various known risk factors contribute to these hospitalizations, they may vary by country. The purpose of this analysis was to identify host, clinical, and sociodemographic factors associated with hospitalization among children presenting with diarrhea in the Enterics for Global Health (EFGH) Shigella surveillance study, conducted from June 2022 to October 2024. MethodologyWe conducted a secondary data analysis of longitudinal cohorts from six EFGH study sites. Hospitalization was defined as the child being admitted from at least 12 am to 6 am or self- discharged before that timeframe. Information on risk factors, clinical episodes, and hospital management was collected. We used descriptive statistics to summarize frequencies and proportions, and robust Poisson regression to estimate risk ratios (RRs) for hospitalization, adjusting for age and study site, to examine the associations with risk factors. ResultsOverall, 5% of children experienced diarrhea-related hospitalizations at enrollment or during the three months of follow-up. Several risk factors were significantly associated with higher likelihood of diarrhea-related hospitalization, including vomiting (adjusted RR [aRR], 2.53; 95% CI, 1.98- 3.22; p<0.001), severe dehydration (aRR, 17.40; 95% CI, 12.74-23.78; p<0.001), severe wasting (aRR, 2.62; 95% CI, 1.78-3.87; p<0.001) and severe diarrhea (aRR, 4.79; 95% CI, 3.69-6.20; p<0.001). Older age was associated with a lower risk of hospitalization, with children 24-35 months experiencing 57% lower risk compared to 6-11 months (aRR 0.43; 95% CI, 0.29-0.64); p<0.001). ConclusionThese findings highlight the need for integrated approaches to reduce hospitalization rates for diarrhea in young children and to develop policies and interventions to mitigate the impact of childhood diarrhea.