Breast-feeding, nutritional status, and other prognostic factors for dehydration among young children with diarrhoea in Brazil.

Early identification of children at high risk of diarrhoea-associated dehydration would be of great value to health care workers in developing countries. To identify prognostic factors for life-threatening dehydration, we carried out a case-control study among under-2-year-olds in Porto Alegre, Brazil. Cases were 192 children admitted to hospital with moderate or severe dehydration, while controls were children matched to controls by neighbourhood and age, who experienced nondehydrating diarrhoea in the week preceding the interview. The following variables were significantly associated with an increased risk of dehydration, after adjustment for age and other confounding variables: absence of the father from the home; low paternal education level; young age; maternal age 25-29 years or less than 20 years; mother of mixed race; high birth order; short birth interval; low birth weight; stunting, underweight and wasting; lack of breast-feeding; presence of other under-5-year-olds in the home; families with 4-5 members; lack of antenatal care; less than three doses of diphtheria-pertussis-tetanus or poliomyelitis vaccine; previous admission to hospital; use of medicines during the fortnight prior to the episode; and living in an unclean home. The associations were particularly strong (P less than 0.001) for the child's age, birth weight and other anthropometric indicators, birth interval, and feeding mode. In terms of their sensitivity and specificity, however, these prognostic factors were not as effective as early signs and symptoms for predicting the outcome of the episode.