Incidence of and Household Responses to Pediatric Diarrheal Disease and Acute Respiratory Infections over Time: Protocol for a Cohort Study

Abstract Introduction: Diarrheal diseases and acute respiratory infections (ARI) disproportionately affect young children and families facing disadvantages at the individual, household, and neighborhood level. This unequal burden especially impacts children in low-and middle-income countries, such as Nepal. Data limitations impede the ability to understand children's illness episodes and treatment trajectories across the course of early childhood and their relationship to household- and neighborhood-level social determinants of health. The Chitwan Valley Family Study (CVFS) is a 30-year panel study providing a wealth of information about household- and neighborhood-level social determinants in Southern Nepal. Drawing on a cohort of young children in CVFS households, this study will measure incidents of acute illness among children under five and leverage existing data from the panel study to understand how intergenerational disadvantages, place, and other social determinants affect the frequency and duration of childhood illness and subsequent healthcare utilization. Methods and Analysis: This study will use daily symptom diaries to track children's illness symptoms (diarrhea, fever, cough, runny nose, difficulty breathing or wheezing, fatigue, loss of appetite) over the course of a year. Mother respondents will complete a baseline interview, daily symptom diaries, and a weekly phone interview with a trained interviewer to describe the prior week's symptoms and, in the case of any symptoms, healthcare utilization, treatment, expenditures, and related information. All eligible children aged 3-59 months may participate in two waves of 52 weeks of data collection. We will measure the frequency and duration of diarrhea and ARI, healthcare utilization outcomes, socio-economic status, and distance to healthcare facilities, then merge these measures with prior CVFS data related to parents' childhood circumstances, health facility characteristics, and neighborhood characteristics. Ethics and Dissemination: We received IRB approval from the Nepal Health Research Council and the University of Michigan. Informed consent will be obtained from respondents for all aspects of data collection. Identifying information will be restricted to the data collection team in Nepal and stored separately from survey data. Interviewers will check that all children with danger signs identified according to WHO/UNICEF Integrated Management of Childhood Illness clinical guidelines have received adequate treatment; a study nurse will follow up and refer those who have not. We will disseminate study findings to respondents, local partners, and nationally in Nepal, as well as in academic journals and at conferences. Datasets will be available for public and restricted-use through the Data Sharing for Demographic Research program at the Inter-university Consortium for Political and Social Research at the University of Michigan.