Pathogen‐specific risk of seizure in children with moderate‐to‐severe diarrhoea: Case control study with follow‐up

Farzana Afroze, Sumon Das, Shahnawaz Ahmed, Monira Sarmin, Nusrat Jahan Shaly, Soroar Hossain Khan, Abu Sadat Mohammad Sayeem Bin Shahid, Lubaba Shahrin, Haimanti Saha, Tahmina Alam, Abu Syed Golam Faruque, K. M. Shahunja, Mohammod Jobayer Chisti, Tahmeed Ahmed

Research output: Contribution to journalArticlepeer-review


Objective: To determine the pathogen‐specific risk of seizure in under‐five children hospitalised with moderate‐to‐severe diarrhoea (MSD) in rural settings.

Method: This was a prospective case–control study with follow‐up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0–59 months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50–90 days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset.

Results: The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR = 5.34, 95% CI = 2.37–12.04) particularly S . flexneri (OR = 3.34, 95% CI = 1.48–7.57), S . flexneri 6 (OR = 23.24, 95% CI = 2.79–193.85), S . sonnei (OR = 6.90, 95% CI = 2.34–19.85); norovirus (OR = 6.77, 95% CI = 1.69–27.11), fever (OR = 16.75, 95% CI = 1.81–154.70) and loss of consciousness (OR = 35.25, 95% CI = 1.71–726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P = 0.006) compared to their peers, follow‐up anthropometrics showed significant improvement in WHZ (P < 0.001) and WAZ (P < 0.05), whereas deterioration in HAZ (P < 0.001) in both cases and controls.

Conclusion: Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.
Original languageEnglish
Pages (from-to)1032-1042
Number of pages11
JournalTropical Medicine and International Health
Issue number8
Early online date19 May 2020
Publication statusPublished - Aug 2020


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