Beyond the Initial Illness: Factors Associated with Recurrent Diarrhea in Malnourished Kenyan Children

Abstract

Children recovering from diarrhea and acute malnutrition may remain at high risk for recurrent illness, but predictors during the post-acute period are poorly understood. We conducted a secondary analysis of 598 children aged 6-24 months with acute malnutrition enrolled in the Boresha Afya trial in western Kenya and followed for 24 weeks. Cox proportional hazards models evaluated associations between baseline characteristics and time to first new diarrhea episode. Overall, 47.3% of children experienced at least one new diarrhea episode and 26.9% experienced moderate-to-severe diarrhea (MSD), with incidence rates of 236 and 87.1 episodes per 100 child-years, respectively. Incidence varied across enrollment sites. Few baseline characteristics were clearly associated with either outcome. Current breastfeeding was associated with a lower hazard of any diarrhea, while lower caregiver education and lower or unknown household income were unexpectedly associated with lower estimated hazards of diarrhea. Wasting severity was not associated with either outcome. These findings demonstrate a substantial burden of recurrent diarrhea among acutely malnourished children and suggest that post-acute interventions may need to be offered broadly in select geographic areas rather than targeted using baseline characteristics alone.