ورقة علمية / Research Paper

1. Introduction Diarrheal diseases remain one of the leading causes of illness and death among children under five years of age in many low-income countries. Children in resource-limited settings frequently present with complications such as dehydration, malnutrition, and electrolyte disturbances, which significantly increase the risk of mortality. Although oral rehydration therapy and standardized treatment guidelines have substantially reduced deaths globally, diarrhea continues to pose a major health burden in Sudan. Several contextual factors contribute to this persistent burden. Limited access to clean water, inadequate sanitation, poor nutritional status, and low vaccination coverage increase children’s vulnerability to severe diarrheal illness. In addition, delayed healthcare seeking behavior and socioeconomic factors such as maternal education may influence disease severity and treatment outcomes. Northern State in Sudan faces additional healthcare challenges related to infrastructure limitations and disparities in preventive healthcare services. Children admitted to hospitals with acute diarrhea often present with advanced dehydration or underlying malnutrition, which complicates management and increases the risk of adverse outcomes. Despite the clinical importance of these factors, there is limited local evidence identifying the specific determinants of mortality and severe dehydration among hospitalized children with diarrhea in this region. Understanding these determinants is essential for improving triage, clinical management, and preventive interventions. Identifying high-risk groups can support targeted nutritional programs, vaccination campaigns, and improved clinical protocols to reduce preventable deaths. Therefore, this study aims to investigate the clinical, socioeconomic, and preventive health factors associated with mortality and severe dehydration among children hospitalized with acute diarrhea in Northern State, Sudan. 2. Methodology Study Design A hospital-based prospective observational cross-sectional study will be conducted to identify determinants of mortality and severe dehydration among children admitted with acute diarrhea. Study Setting The study will be conducted in the pediatric wards of major hospitals in Northern State, Sudan, which serve as referral centers for the management of pediatric illnesses including severe diarrheal diseases. Study Population The study population will include children aged 0–59 months admitted to pediatric wards with acute diarrhea during the study period. Inclusion Criteria • Children aged 0–59 months • Hospital admission with acute diarrhea (≥3 loose stools per day with duration less than 14 days) • Parent or guardian willing to provide informed consent Exclusion Criteria • Chronic diarrhea lasting more than 14 days • Children admitted with severe unrelated medical conditions requiring intensive care • Refusal of caregiver consent Sample Size A total sample size of 400 children will be targeted. This sample size is expected to provide adequate statistical power to detect significant associations between potential risk factors and the outcomes of interest. Sampling Technique A consecutive sampling method will be used. All eligible children admitted with acute diarrhea during the study period will be recruited until the required sample size is reached. Data Collection Data will be collected using a structured questionnaire administered to caregivers and clinical examination of the child. Trained data collectors will record information on: • Demographic characteristics • Socioeconomic factors • Environmental conditions • Vaccination history • Clinical presentation • Nutritional status • Treatment provided • Clinical outcomes Data will be collected using electronic forms via Kobo Toolbox, allowing both online and offline data entry. Study Variables Independent Variables • Age • Sex • Maternal education • Source of drinking water • Rotavirus vaccination status • Nutritional status • Duration of diarrhea • Presence of vomiting • Fever • Blood in stool • Suspected etiology Outcome Variables 1. Severe dehydration 2. Mortality during hospitalization Clinical Assessment • Dehydration will be classified using WHO dehydration guidelines: o No dehydration o Some dehydration o Severe dehydration • Nutritional status will be assessed using Mid-Upper Arm Circumference (MUAC): o Severe Acute Malnutrition (<11.5 cm) o Moderate Acute Malnutrition (11.5–12.4 cm) o Normal (≥12.5 cm) Data Analysis Data will be analyzed using statistical software (such as Python or SPSS). Analysis will include: 1. Descriptive statistics o Frequencies and percentages for categorical variables o Means or medians for continuous variables 2. Bivariate analysis o Chi-square tests to examine associations between variables 3. Multivariable logistic regression o To identify independent predictors of:  Severe dehydration  Mortality Results will be presented as adjusted odds ratios (aOR) with 95% confidence intervals. Statistical significance will be considered at p < 0.05. Ethical Considerations Ethical approval will be obtained from the Research Ethics Committee of the Ministry of Health in Northern State, Sudan. • Written informed consent will be obtained from parents or guardians. • Participation will be voluntary. • All data will be collected anonymously and stored securely. • The study will follow ethical principles for research involving human participants.

First, no personal identifiers such as the child’s name, caregiver’s name, address, or phone number will be recorded in the data collection forms. Instead, each participant will be assigned a unique study identification number that will be used for all records and analyses. Second, all data will be collected using secure electronic forms on password-protected devices. Access to the data will be restricted only to the principal investigator and authorized research team members involved in the study.

The study will generate local epidemiological evidence on the determinants of mortality and severe dehydration among children hospitalized with acute diarrhea. Such evidence is currently limited in Northern State, and the findings will help identify the most significant clinical and socioeconomic risk factors affecting disease outcomes. Also,the results may contribute to improving early identification of high-risk children at hospital admission. Recognizing predictors such as malnutrition, vaccination status, or specific clinical symptoms will allow healthcare workers to prioritize monitoring and treatment for children at greater risk of complications or death.