Peer-reviewed article
Impact of Wasting on the Severity of Rotavirus and Non-rotavirus Diarrhea in Children Aged Under 5 Years Hospitalized with Acute Gastroenteritis in Kerala, India.
Rose Xavier, Aparna Namboodiripad, Madona Devassikutty Fiji, Vellani Thamunni Ajithkumar, Shermin Nasreen Abdul Jaleel et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how malnutrition (wasting) affects the severity of diarrhea caused by rotavirus and other pathogens in children under 5 hospitalized in Kerala, India. Among 666 children admitted with acute gastroenteritis, 17.7% tested positive for rotavirus. Children with wasting who had rotavirus infection were significantly more likely to develop severe disease compared to those without rotavirus. The research highlights that malnourished children are particularly vulnerable to severe diarrhea and require targeted prevention and treatment strategies.
Key points
- Of 643 children tested, 115 (17.7%) were positive for rotavirus
- Children without wasting were significantly more likely to have received rotavirus vaccine (69.5% vs. 60.2%)
- In wasted children, rotavirus-positive cases were 5.31 times more likely to develop severe to very severe disease compared to rotavirus-negative cases
- High rotavirus vaccination coverage and measures to reduce wasting are necessary to prevent severe diarrhea
- Study enrolled children from North, Central, and South Kerala between November 2020 and December 2023
Limitations
The study is observational and cannot establish causation between wasting and disease severity. The analysis focuses on hospitalized children, so findings may not represent community-level patterns or milder cases managed at home.
Abstract
OBJECTIVES: This analysis assessed the relationship between wasting and severity of rotavirus and non-rotavirus diarrhea among children hospitalized with acute gastroenteritis in Kerala. METHODS: Children aged under 5 y admitted to sentinel hospitals in North, Central, and South Kerala with acute gastroenteritis between November 2020 and December 2023 were prospectively enrolled. Sociodemographic, anthropometric, and clinical data were collected using a case report form, and stool samples were tested for rotavirus using an enzyme-linked immunosorbent assay. Anthropometry was performed according to World Health Organization guidelines. RESULTS: Of the 1,142 children aged under 5 y admitted to the sentinel hospitals with acute gastroenteritis during the study period, 666 were enrolled in the study. Of the 643 children with stool samples tested for rotavirus, 115 (17.7%) were positive for rotavirus. Compared with children with wasting, children without wasting were (significantly more likely to have received ≥ 1 dose of rotavirus vaccine (69.5% vs. 60.2%; p = 0.022). In a subgroup analysis of children with wasting, compared with rotavirus-negative children, rotavirus-positive children were significantly more likely to develop severe to very severe disease (odds ratio: 5.31, 95% confidence interval: 2.28-12.34; p = 0.001). CONCLUSIONS: In children with wasting, rotavirus diarrhea was more severe than non-rotavirus diarrhea. Strategies to prevent and treat diarrhea should target children with wasting, who are at greater risk of severe disease. Maintaining high rotavirus vaccination coverage and measures to reduce the incidence of wasting are necessary to reduce incidence of severe diarrhea.