Acute Gastroenteritis (AGE) continues to be one of the most menacing threats to the mainstream health of the global pediatric population, especially among children below the age of five years. AGE is a major cause of morbidity and mortality in developing countries due to its sudden onset of diarrhea, which is usually followed by vomiting, fever, and abdominal pain. Nevertheless, regardless of the considerable medical progress, such as the mass production and availability of Oral Rehydration Salts (ORS) and the use of rotavirus vaccines, millions of children experience recurrent episodes every year [1]. The condition is a clinical problem, not only a socioeconomic one, since it flourishes in settings where there is poor sanitation, lack of access to clean water, and food insecurity [2]. The episodes of pathophysiology of AGE in young children are of special concern because of their physiological susceptibility [3]. Infants and toddlers contain a greater body water, and their metabolic rate is higher than that of adults, hence they become vulnerable to life-threatening dehydration in several hours after the onset of the symptoms [4]. The diarrhea-malnutrition vicious cycle is a well-known process: the enteric infection disrupts the nutrient uptake and appetite, and the malnutrition undermines the gut mucosal barrier and the systemic immune response, causing increased and more severe bouts of diarrhea [5]. Such synergy has a long-term developmental effect that is manifested by stunting and cognitive impairment [6]. The AGE landscape has a multifaceted etiology. There is a huge prevalence of viruses, especially Rotavirus, Norovirus, and Adenovirus that cause most infections in developed and developing areas. Nevertheless, Escherichia coli, Shigella, and Salmonella are common bacterial pathogens in places with poor infrastructure [7]. The infection is of the typical feco-oral route, which is often caused by contaminated water, dirty hands, or flies. Determining the particular "patterns" of such infections, e.g., seasonal peaks of the winter season during which viruses occur, and rainy-season peaks during which bacteria occur, is critical to the planning of public health [8]. The AGE risk factors are multifactorial. Host factors are age, 6 -24 months range is the most significant, nutrition, and immunizations. Behavioral aspects, in this case, breastfeeding, have a protective effect; exclusive breastfeeding offers secretory IgA and other immunological elements that protect the gut of the infant. On the other hand, the transition to the introduction of contaminated complementary foods during the weaning period is a high-risk transition. Environmental conditions, such as the source of water used and mode of excreta disposal, are the most significant predictors of the community-wide outbreaks [9]. Management of AGE has also changed to a more minimal intervention approach, with rapid rehydration preferred over pharmacological treatment. The World Health Organization (WHO) and UNICEF focus on the application of low-osmolality ORS and zinc supplementation, which have been proven to shorten the episode and decrease its severity [10]

Study Design and Setting

A cross-sectional study was conducted in the Department of Pediatrics, Saidu Medical College/Saidu Group of Teaching Hospitals swat from1st Jan 2024 to 31st Dec 2024.

Participants

A total of 100 children aged 1 month to 5 years presenting with acute diarrhea were enrolled from the outpatient and emergency departments. Informed consent was obtained from parents or legal guardians. Data on nutritional status and vaccination history were also collected.

Sample Size Calculation

The sample size of 100 was calculated using a prevalence-based formula with a 95% confidence interval, 10% margin of error, and an assumed prevalence of 50% to maximize sample adequacy for detecting significant associations.

Inclusion and Exclusion Criteria

Children under 60 months presenting with ≥3 loose stools within 24 hours and duration <14 days were included. Children with chronic diarrhea (>14 days), known gastrointestinal malformations, or lack of parental consent were excluded.

Diagnostic and Management Strategy

Diagnosis was based on clinical history and examination. Dehydration was classified using World Health Organization criteria. Management included low-osmolality oral rehydration solution (ORS), continued feeding, and zinc supplementation (20 mg daily). Stool microscopy was performed to identify parasitic and bacterial indicators.

Statistical Analysis

Data were analyzed using SPSS version 25. Descriptive statistics (mean, standard deviation, frequencies) were applied. Associations between risk factors and dehydration severity were assessed using Chi-square tests and Pearson correlation. A p-value <0.05 was considered statistically significant

A total of 100 children were included, with a mean age of 18.5 ± 10.2 months. Males constituted 58% of the cohort. The highest disease frequency (42%) was observed in infants aged 6–11 months. Clinically, watery diarrhea was the most common presentation (72%), followed by vomiting (65%) and fever (54%). Dehydration assessment revealed that 60% of children had some dehydration, 15% had severe dehydration, and 25% had no dehydration. Risk factor analysis demonstrated significant associations between environmental and behavioral factors and disease severity. Lack of exclusive breastfeeding was significantly associated with severe disease (p = 0.012). Proper caregiver hand hygiene showed a protective effect (p = 0.004). Consumption of untreated well water was significantly associated with increased likelihood of bacterial-type diarrhea (p = 0.031). Additionally, 68% of severe cases occurred in children who had not completed rotavirus vaccination.

Intervention Outcomes

Implementation of standardized rehydration protocols resulted in successful rehydration in 95% of patients within 24 hours. Zinc supplementation was associated with a reduction in stool frequency by the second day of treatment. No mortality was recorded during the study period, indicating effective clinical management.

A total of 100 children were included, with a mean age of 18.5 ± 10.2 months. Males constituted 58% of the cohort. The highest disease frequency (42%) was observed in infants aged 6–11 months. Clinically, watery diarrhea was the most common presentation (72%), followed by vomiting (65%) and fever (54%). Dehydration assessment revealed that 60% of children had some dehydration, 15% had severe dehydration, and 25% had no dehydration. Risk factor analysis demonstrated significant associations between environmental and behavioral factors and disease severity. Lack of exclusive breastfeeding was significantly associated with severe disease (p = 0.012). Proper caregiver hand hygiene showed a protective effect (p = 0.004). Consumption of untreated well water was significantly associated with increased likelihood of bacterial-type diarrhea (p = 0.031). Additionally, 68% of severe cases occurred in children who had not completed rotavirus vaccination.

Intervention Outcomes

Implementation of standardized rehydration protocols resulted in successful rehydration in 95% of patients within 24 hours. Zinc supplementation was associated with a reduction in stool frequency by the second day of treatment. No mortality was recorded during the study period, indicating effective clinical management.

Table 1: Socio-Demographic Characteristics of the Study Population ()

This table illustrates the demographic distribution of the 100 patients. The mean age was 18.5 months (), with a significant concentration in the 6–11-month age bracket. *WAZ = Weight-for-Age Z-score.

Table 2: Clinical Presentation and Dehydration Status

Clinical patterns of AGE in the cohort. Watery diarrhea was the predominant symptom (72%), and the majority of patients presented with "some dehydration," necessitating immediate ORS intervention.

Table 3: Analysis of Environmental and Behavioral Risk Factors

Association between risk factors and disease presence/severity. Statistical significance () was found across all three primary variables, with lack of breastfeeding showing the strongest correlation to illness.

Table 4: Vaccination Status and Pathogen Correlation

This table highlights the protective effect of the Rotavirus vaccine. Children with incomplete vaccination accounted for a disproportionate number of "Severe Dehydration" cases compared to the fully vaccinated group

The results of the proposed research include a critical picture of the epidemiological and clinical situation in Acute Gastroenteritis (AGE) among 100 children aged below five. The mean reported age of 18.5 months (10.2) is very similar to the latest world statistics, in which the maximum burden of diarrheal disease often switches from the period of early infancy to that of weaning and early toddlerhood. In the most recent systematic reviews (20212026), it is confirmed that the 624-month period is still the most vulnerable as the maternal antibodies decrease in quantity and the child is more exposed to the environment, crawling, and introduction of new complementary foods [11].

One of the major research results was that exclusive breastfeeding showed a strong protective impact (p=0.012). This supports a massive meta-analysis of more than 48,000 children who stated that infants who are not exclusively breastfed are two-and-a-half times at higher risk of getting severe AGE [12]. This biological plausibility is based on the fact that it transfers secretory IgA and promotes a healthy microbiome of the gut, which serves as a barrier against the common forms of pathogens such as Rotavirus and E. coli [13].

The clinical history is typical with the predominance of watery diarrhea (72 percent) and vomiting (65 percent), which is evidence of a viral etiology, which is why many regions have shifted into the post-vaccine era. Although traditionally Rotavirus has been the overwhelming leader, recent research in high-vaccination coverage regions indicates that Norovirus is becoming a dominant cause of attended AGE in the healthcare industry, although Rotavirus continues to claim more severe cases of dehydration and increased hospitalization [14, 15].

The rate of dehydration (15% severe) in our study is a little lower than reported in the sub-Saharan areas, where, at times, up to 38% of instances of dehydration were severe, probably because of differences in delay in seeking healthcare services [16].The risk factors in the environment, identified especially utilization of untreated water, which has a p-value of 0.031, are an indication of a long-standing problem. Current data in Ethiopia and India indicate that unprotected water and lack of improved latrines are the greatest predictors of bacterial AGE, including Shigella and Salmonella [17, 18]. Moreover, the correlation between hand hygiene of the caregiver and the rate of infection is significant in our research (=0.004), which is comparable to the results of 2024, where the lack of handwashing at the critical moments increased the risk of AGE nearly three times [19].

Finally, the place of vaccination cannot be overestimated. The information shows that incomplete vaccination against rotavirus is a characteristic of severe cases despite the development of other viruses. Investigations within the Eastern Mediterranean area demonstrate that despite changing genotypes, the vaccine has an enormous role in the decreasing number of diarrhea cases that have to be hospitalized [20].

Limitations

The cross-sectional design and sample size (n=100) do not allow for concluding on the causal relationships. Hygiene and feeding practices may have reporting bias due to the dependence on the recalls of caregivers. Moreover, the absence of an effective molecular diagnosis (such as PCR) restricted the detection of all the viral types and Ohio parasitic infections

Household hygiene, absence of exclusive breastfeeding, and weaning age predispositions mainly contribute to acute gastroenteritis in children below the age of five. Caregiver education and water treatment should be specified as the targeted interventions because of the mean age, which is 18.5 months. The cornerstone of the reduction of severe cases of dehydration and hospitalization is enhancing the coverage of rotavirus vaccines.

Disclaimer: Nil

Conflict of Interest: Nil

Funding Disclosure: Nil

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