Diarrhoea is defined as the passage of unusually loose or watery stools, typically occurring at least three times within a 24-hour period. The frequency of formed stools does not qualify as diarrhoea; rather, stool consistency is the primary distinguishing factor. Acute diarrhoea is a common condition in infants and young children and is the second most prevalent bacterial infection. Diagnostic classifications broadly categorize diarrhoea as either infectious or non-infectious. Infectious diarrhoea results from direct invasion of the gastrointestinal tract by microorganisms, while non-infectious causes are often overlooked in cases where systemic infections or diseases affecting other organ systems lead to diarrheal symptoms [1].

Acute diarrhoea remains one of the leading causes of morbidity and mortality in children under five years of age, particularly in developing countries. It is estimated that diarrheal diseases contribute to over two million deaths annually among children below five years, with approximately 80% of these fatalities occurring within the first two years of life. The primary causes of mortality include dehydration, complications arising from dysentery, malnutrition, and secondary infections such as pneumonia. The incidence of diarrheal episodes is highest in children aged 6 to 11 months and is influenced by factors such as low socioeconomic status, lack of breastfeeding, coexisting measles infection, severe malnutrition, and immunodeficiency [2].

The objective of this study was to assess the clinical profile of children under five years presenting with acute diarrhoea and to analyse associated risk factors.

This descriptive, hospital-based study was conducted in the Department of Paediatrics at a tertiary care hospital in the southern district of Odisha, Berhampur. A total of 190 children admitted to the paediatric ward with diarrhoea during the study period were included. Children aged 6 months to 5 years who met the inclusion criteria and whose parents or primary caregivers provided informed consent were enrolled. Exclusion criteria included children with congenital anorectal malformations, metabolic disorders, or those who had received antibiotics within 48 hours prior to admission [3].

Following informed consent, each child underwent a detailed clinical examination, and the findings were recorded in a preformatted data sheet. Stool samples were collected from all participants for analysis. Hydration status was assessed according to WHO guidelines, and malnutrition was classified based on the Indian Academy of Paediatrics (IAP) classification system. Data collection was systematically performed using a structured format to ensure completeness, consistency, and accuracy. The recorded data were analysed using R software.

A total of 190 children presenting with acute diarrhoea were included in the study. The highest number of cases were observed in the 1–3 years age group (39.5%), followed by children aged 6 months to 1 year (36.8%), and the lowest proportion was in the 3–5 years age group (23.7%) (Table 1).

Males accounted for the majority of cases (61.1%), while females comprised 38.9% (Table 2).

Among the study participants, 62.6% had normal nutritional status, whereas 32.1% had Grade 1 Protein-Energy Malnutrition (PEM), 3.7% had Grade 2 PEM, and 1.6% had Grade 3 PEM (Table 3).

The majority of children (77.4%) showed no signs of dehydration at the time of presentation. However, 16.3% had some dehydration, and 6.3% had severe dehydration (Table 4).

A large proportion of children (81.6%) maintained good bowel and bladder hygiene, while 18.4% had poor hygiene practices (Table 5).

On abdominal examination, 71.6% of children had normal findings. Hepatosplenomegaly was detected in 5.8% of cases, diffuse tenderness in 14.2%, and suprapubic tenderness in 8.4% (Table 6).

Stool analysis revealed that 87.4% of children had normal findings. The presence of pus cells was observed in 8.4% of cases, while 4.2% had stools containing blood and mucus (Table 7).

Vomiting was the most commonly reported symptom, present in 49.5% of cases. Fever was seen in 8.4% of children, and abdominal pain alone was noted in 2.6%. Additionally, 21.6% of cases had both vomiting and fever, 6.3% had vomiting with abdominal pain, 1.6% had fever with abdominal pain, and 10% presented with fever, vomiting, and abdominal pain (Table 8).

The relationship between malnutrition and dehydration was analysed (Table 9). Among children without PEM, 87.4% had no dehydration, 6.7% had some dehydration, and 5.9% had severe dehydration. Among those with Grade 1 PEM, 60.7% had no dehydration, 32.8% had some dehydration, and 6.5% had severe dehydration. In cases with Grade 2 PEM, none had severe dehydration, but 100% had no or some dehydration. In Grade 3 PEM, 75% had severe dehydration, while 25% had some dehydration.

The severity of diarrheal illness ranges from mild symptoms to life-threatening systemic complications. In our study, the majority of children admitted with diarrhoea were between 1–3 years of age 75 (39.5 %), followed by infants 70 (36.8%). These findings are consistent with a study conducted by Haricharan et al., where 87% of affected children were below two years of age [4].

The most frequently reported associated symptoms were vomiting, fever, and abdominal pain. Among these, vomiting was the most common, observed in 94 (49.5%) of cases, followed by fever 16 (8.4 %) and abdominal pain 5 (2.6 %). Additionally, 19 (10 %) of the study population experienced all three symptoms simultaneously. A similar observation was made by Elzanki et al., who reported vomiting as a frequent symptom accompanying diarrhoea.

In this study, 71 of children had malnutrition, suggesting its role as a predisposing factor for diarrheal episodes. The relationship between malnutrition and diarrheal disease is bidirectional—nutritional deficiencies weaken immune defences, increasing susceptibility to infections, while diarrheal illnesses exacerbate malnutrition by impairing nutrient absorption and increasing losses. One proposed mechanism for diarrhoea in malnourished children is reduced secretory IgA levels at mucosal surfaces or underlying vitamin A deficiency. Malnourished children are more prone to multiple diarrheal episodes, although no significant difference in episode duration was observed [5].

Dehydration remains one of the most frequent complications of acute diarrhoea. In this study, 43 out of 190 children presented with dehydration, with severe dehydration occurring in 12 (6.3%) of cases. This prevalence aligns with findings from other studies, where dehydration in acute diarrhoea ranged from 5% to 10%. A significant correlation was observed between the degree of malnutrition and dehydration (p<0.001), indicating that children with severe malnutrition were more likely to experience higher levels of dehydration [6]. Skrablek et al. similarly reported that malnourished children face a greater risk of severe morbidity and mortality due to diarrheal disease, emphasizing the need for accurate diagnostic tools to assess dehydration in such vulnerable populations.

Dysentery was identified in seven malnourished children, three of whom also had dehydration [7]. These children presented with fever, which has been frequently reported as an associated symptom in dysenteric cases, as noted by Khalili et al. No mortality was recorded in this study.

One limitation of the study was the inability to perform stool culture and organism isolation due to financial constraints, making it difficult to determine the exact etiological agents responsible for diarrhoea [8]. However, all children were managed according to WHO protocols, with antibiotics administered only to those with dysentery [9].

Overall, a significant association was found between diarrhoea and factors such as age, nutritional status, and dehydration. Given that diarrhoea remains a major health concern in children under five, often leading to complications like dehydration and malnutrition, timely treatment and preventive measures are crucial. Educating caregivers about the social determinants of diarrhoea can help reduce recurrent episodes and improve child health outcomes [10].

Acute diarrhoea remains a major health concern among children under five, with younger age groups being the most affected. The study underscores the significant role of malnutrition in predisposing children to diarrhoea and increasing the risk of dehydration. Early identification and management of dehydration and nutritional deficiencies are crucial in reducing complications. Strengthening preventive measures such as exclusive breastfeeding, improved sanitation, and timely rehydration therapy can help lower disease burden. Community-based awareness programs focusing on hygiene, nutrition, and prompt medical care are essential in preventing recurrent diarrheal episodes and improving child health outcomes in resource-limited settings.

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