Quarterly Patterns and Delivery-Type Differences in Infant Diarrheal Disease: A Survival Analysis in India
DOI:
https://doi.org/10.47203/IJCH.2025.v37i06.031Keywords:
Diarrhea, Infancy, Survival Analysis, Delivery Mode, Complementary Feeding, Rural IndiaAbstract
Background: Diarrheal diseases remain a leading cause of morbidity and mortality in children under five, with infants particularly vulnerable during their first year of life. Age-related variations and biological factors such as delivery type may influence diarrheal risk. Aim & Objective: To examine quarterly patterns of diarrheal morbidity in infancy and assess whether delivery mode modifies the risk during infancy. Methodology: A prospective community-based cohort study was conducted in rural Varanasi, India, from November 2022 to February 2024. A total of 150 infants were enrolled at birth and followed for one year through structured quarterly assessments. Generalized Estimating Equations (GEE) with Poisson regression were applied to evaluate associations between delivery type, infant age, and diarrhea incidence. Results: The cohort experienced an average of 2.92 diarrheal episodes per child-year. GEE analysis revealed a significant age-dependent increase in diarrheal risk: OR = 1.58 (95% CI: 1.12-2.23) for 4-6 months, OR = 3.13 (95% CI: 2.23-4.40) for 7-9 months, and OR = 2.67 (95% CI: 1.85-3.87) for 10-12 months, compared with 0-3 months. Conclusion: Diarrheal morbidity in infancy is strongly age-dependent. Strengthening exclusive breastfeeding promotion, safe complementary feeding practices, and WASH interventions is essential to reduce the diarrheal burden in early childhood.
Downloads
References
Kyu HH, Vongpradith A, Villanueva Dominguez RM, et al. Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect Dis. 2025;25(5):519-36.
World Health Organization. Fact sheet: Diarrhoeal disease. https:// www.who. int/ news- room/ fact- sheets/ detail/ diarr hoeal- disease (Last accessed on 15/05/2025).
United Nations Children’s Fund. Levels and trends of Child mortality:by United Nations Inter-agency Group for Child Mortality Estimation.UNICEF, 2019. https:// www. unicef. org/ media/ 60561/ file/ UN- IGME- childmortality- report- 2019. pdf. (Last accessed on 22/03/2025.
Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O’Brien KL, Campbell H, Black RE. Global burden of childhood pneumonia and diarrhoea.The Lancet. 2013;381(9875):1405 16.
Anand K, Sundaram KR, Lobo J, Kapoor SK. Are diarrheal incidence and malnutrition related in under five children? A longitudinal study in an area of poor sanitary conditions. Indian Pediatr. 1994;31(8):943-8.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T. Global, regional, and national causes of child mortality in 2008: a systematic analysis. The lancet.2010;375(9730):1969-87.
Ghosh K, Gupta SS, Chakraborty AS. Childhood Morbidity and its Association with Socio-economic and Health Care Condition among Under 5 Years Children in West Bengal: An Evidence from NFHS-5, 2019-20. Int J Med Public Health. 2021;11(3):160-3.
Freeman, M.C.; Clasen, T. Assessing the impact of a school-based safe water intervention on household adoption of point-of-use water treatment practices in southern India. Am. J. Trop. Med. Hyg. 2011, 84, 370-378.
Government of India. National Health Mission 2016. Available online: http://vikaspedia.in/health/nrhm/ national-health-mission (Last accessed on 22/03/2025).
Government of India. Childhood Diarrhoea and its management 2019. Available online: http://vikaspedia.in/health/child-health/diarrhoea (Last accessed on 22/03/2025).
Government of India. National Nutrition Strategy 2017: NITI Aayog. 2017. Available online: http://vikaspedia.in/health/nrhm/national-health-policies/national-nutrition-strategy-2017 (Last accessed on 22/03/2025).
Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381(9875):1405-16.PMC 7159282. PMID 23582727.
Bhutta Z, Syed S. Diarrheal Diseases. Encyclopedia of Food and Health. 2016:361-72. doi: 10.1016/B978-0-12-384947-2.00223-3. Epub 2015 Sep 22. PMCID: PMC7173460.
Mitchell CM, Mazzoni C, Hogstrom L, Bryant A, Bergerat A, Cher A, Pochan S, Herman P, Carrigan M, Sharp K, Huttenhower C, Lander ES, Vlamakis H, Xavier RJ, Yassour M. Delivery Mode Affects Stability of Early Infant Gut Microbiota. Cell Rep Med. 2020 Dec 22;1(9):100156. doi: 10.1016/j.xcrm.2020.100156. PMID: 33377127; PMCID: PMC7762768.
Zhang C, Li L, Jin B, Xu X, Zuo X, Li Y, Li Z. The Effects of Delivery Mode on the Gut Microbiota and Health: State of Art. Front Microbiol. 2021 Dec 23;12:724449. doi: 10.3389/fmicb.2021.724449. PMID: 35002992; PMCID: PMC8733716.
Tefera, M., Assefa, N., Mengistie, B., Abrham, A., Teji, K., & Worku, T. (2020). Elective cesarean section on term pregnancies has a high risk for neonatal respiratory morbidity in developed countries: A systematic review and meta-analysis. In Frontiers in Pediatrics (Vol. 8). Frontiers Media S.A. https://doi.org/10.3389/fped.2020.00286
Victora CG, Bryce J, Fontaine O, Monasch R. Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ. 2000;78(10):1246-55.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969-87.
Bhan MK, Bhandari N, Sazawal S, Clemens JD, Raj P, Levine MM. Descriptive epidemiology of persistent diarrhoea among young children in rural northern India. Bull World Health Organ. 1989;67(3):281-8.
Bhandari N, Bhan MK, Sazawal S, Clemens JD, Bhatnagar S, Saxena M, et al. Association of diarrhoeal morbidity and mortality with infant feeding practices in urban slums. Indian Pediatr. 1989;26(9):883-9.
Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health. 2012;12:220.
Guerrant RL, DeBoer MD, Moore SR, Scharf RJ, Lima AA. The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease. Nat Rev Gastroenterol Hepatol. 2013;10(4):220-9.
Sevelsted A, Stokholm J, Bønnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Pediatrics. 2015;135(1):e92-8.
Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, Goldacre MJ, et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies. Diabetologia. 2008;51(5):726-35.
Azad MB, Konya T, Persaud RR, Guttman DS, Chari RS, Field CJ, et al. Impact of cesarean delivery on the infant gut microbiome and risk of overweight in childhood. CMAJ. 2016;188(13):E373-82.
Dewey KG, Mayers DR. Early child growth: how do nutrition and infection interact? Matern Child Nutr. 2011;7 Suppl 3:129-42.
Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, et al. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol. 2008;37(4):816-30.
Schmidt WP, Cairncross S, Barreto ML, Clasen T, Genser B. Recent diarrhoeal illness and risk of lower respiratory infections in children under the age of 5 years. Int J Epidemiol. 2009;38(3):766-72.
Downloads
Published
How to Cite
License
Copyright (c) 2026 Ayub Khan, Hari Shankar, Dhananjay Kumar Singh

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.