OBJECTIVE: The study aims to demonstrate clinical features among children with severe wasting and stunting (SWSS) compared to those with diverse severe malnutrition in the form of severe wasting (SW) or severe stunting (SS) and among children with SW compared with SS that may help in early identification of high-risk children as well as help provision of quality care to them.
METHOD: Data were extracted from 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 children had SW (WLZ/WHZ ?-3 but LAZ/HAZ ?-3) alone and 1000 had only SS (LAZ/HAZ ?-3 but WLZ/WHZ ?-3). We compared presenting features of diarrheal children with SWSS with either of SW or SS and SW vs SS using unmatched case-control design.
RESULT: Significantly more children were aged 0-24 months in SW or SS alone compared to children of that age in SWSS group. SWSS children were often residents of slums, compared to SW (p<0.05) or SS (p<0.05). Moreover, parental illiteracy, dehydrating (some or severe) diarrhea were significantly more common in SWSS group compared to children with SW or SS alone. Dehydrating diarrhea was more frequently associated in SW children compared to SS children. Rotavirus diarrhea was observed less often in SWSS children (p<0.05) than SW or SS alone. V. cholerae was detected more commonly in SWSS children compared to children with SW alone.
CONCLUSION: Children with concomitant severe wasting and severe stunting more frequently sought care with dehydrating diarrhea compared to those with severe wasting or severe stunting alone. However, they less often presented with rotavirus associated diarrhea. Results underscore importance of early detection and prompt management of these children with concomitant severe wasting and severe stunting to reduce morbidity especially in resource poor settings.