∗ Co esponding au ho : Dwi Ap ilawa i
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Risk ac o s o mo ali y on dia hea child en unde i e yea s old hospi alized in D .
Soe omo Gene al Academic Hospi al Su abaya 2023
Aulia Najma Adhyana Ku niawan 1, Dwi Ap ilawa i 2, *, Dwiyan i Puspi asa i 3 and Alpha Fa dah A hiyyah 3
1 Facul y o Medicine, Uni e si as Ai langga, Su abaya, Indonesia.
2 Dépa emen o Public Heal h Sciences, Facul y o Medicine, Uni e si as Ai langga, Su abaya, Indonesia.
3 Dépa emen o Pedia ics, Facul y o Medicine, Uni e si as Ai langga, Su abaya, Indonesia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 2752-2757
Publica ion his o y: Recei ed on 14 Ma ch 2025; e ised on 19 Ap il 2025; accep ed on 21 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.1.1391
Abs ac
Th ough he yea s, dia hea has been one o he signi ican causes o mo ali y among child en unde he age o i e
yea s old all o e he wo ld. Th oughou 2021, app oxima ely 444,000 child en unde i e yea s old died due o
dia hea, making up abou 9% o all child en unde i e yea s old’s mo ali y. Dia hea is a gas oin es inal disease
cha ac e ized by inc eased bowel mo emen s causing h ee o mo e s ool episodes along wi h a loose o wa e y
consis ency wi hin 24 hou s. The e a e se e al isk ac o s ha con ibu e o he mo ali y o child en wi h dia hea
unde he age o i e yea s old. This s udy aimed o de e mine which isk ac o s a e signi ican enough o cause he
mo ali y o child en unde he age o i e yea s old su e ing om dia hea. This e ospec i e analy ic s udy was
conduc ed by obse ing he medical eco ds o child en unde i e yea s old hospi alized in D . Soe omo Gene al
Academic Hospi al Su abaya due o dia hea du ing 2023. Da a we e analyzed by using chi-squa e bi a ia e analysis
wi h he SPSS e sion 30 applica ion. The esul s show ha sep ic shock and sep icaemia a e signi ican ac o s
con ibu ing o he mo ali y o child en unde i e yea s old su e ing om dia hea. Fu he mo e, dehyd a ion, and s
p o en o no signi ican ly a ec mo ali y in dia heal pa ien s unde he age o i e yea s old, ye his ac o is p o en
o be signi ican o con ibu e o he pa ien ’s leng h o s ay in he hospi al wa d a RSUD D . Soe omo Su abaya. On he
o he hand, a pa ien ’s gende and age a e p o en o be no signi ican o cause mo ali y in child en unde i e yea s
old su e ing om dia hea.
Keywo ds: Dia hea; Child en; Sep ic Shock; Sep icaemia; Dehyd a ion
1. In oduc ion
Th ough he yea s, dia hea is s ill one o he leading cause o child en mo ali y wo ldwide, especially in child en unde
he age o i e yea s old. Da a epo ed by he Indonesian Minis y o Heal h on 2018 epo ed ha he e we e a ound
ou millions epo ed dia hea cases o child en unde he age o i e yea s old, o a ound 17% p e alence a e[1]
Dia hea is a gas oin es inal disease cha ac e ized by inc eased bowel mo emen s esul ing o abno mal s ool episode,
h ee o mo e s ool episode pe 24 hou s [2]. Dia hea migh be caused by se e al e iologies, based on i s oo causes i
classi ies in o in ec ious dia hea and non-in ec ious dia hea. Non-in ec ious dia hea is usually caused by
malabso p ion, ana omical de ec , malignancies, alle gies, ood poisoning, and o he s. While in ec ious dia hea is
caused by in ec ious pa hogen[3]
No able isk ac o s con ibu ing o dia hea among child en below 5 yea s old include nu i ional condi ion such as
was ing and malnu i ion[4]. S udy in child en wi h low nu i ional s a us shows an al e ed immune sys em, as a
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 2752-2757
2753
consequence, he e is an ele a ed ulne abili y o in asi e in ec ions, including hose a ec ing he u ina y and
gas oin es inal sys ems, as well as an inc eased isk o sep icemia[5].
A s udy done by Ha man e al., 2023 p esen s ha in an s below he age o 6 mon hs has he highes isk o mo ali y,
wice as high i compa ed o child en be ween 2 and 5 yea s o age, his is happens because in an s is mo e ulne able
o in ec ions. Addi ionally, he s udy shows ha emale is a ibu ed wi h a highe likelihood o mo ali y due o dia hea
as i is a ibu ed o he lack o p ope nu i ion in emale child en.
Dia hea causes excessi e wa e loss, making dehyd a ion o be he mos common complica ion o dia hea pa ien s.
App oxima ely 20% o peadia ic dea hs is associa ed wi h dehyd a ion ela ed o gas oen e i is[6]. Some publica ions
also men ioned sep ic shock is ea u ed in he dea h o pa ien s wi h in ec ious diseases, including dia hea [7]. The
p ima y complica ion o dia hea is dehyd a ion leading o se e e sepsis, and sep ic shock[7, 8]
This s udy aimed o de e mine isk ac o s o mo ali y among dia hea pa ien s unde he age o i e yea s old
hospi alized in RSUD D . Soe omo 2023. P ope unde s anding o he isk ac o s ha may co ela es wi h he mo ali y
dia hea is impo an , in o de o gi e a comp ehensi e app oach o pa ien wi h dia hea. Thus, unwan ed
complica ion can be p e en ed and inc eases pa ien ’s quali y o li e and dec ease mo ali y a e o pa ien s wi h
dia hea.
2. Ma e ial and me hods
This s udy is a e ospec i e analy ic s udy done by obse ing medical eco ds o pa ien s unde i e yea s old who we e
hospi alized o dia hea in RSUD D . Soe omo, Su abaya in 2023. The pu pose o his s udy is o de e mine whe he
ce ain a iables, such as age, gende , nu i ional s a us, dehyd a ion, sep icaemia, and sep ic shock a e a signi ican
con ibu o s o he mo ali y o child en unde he age o i e yea s old hospi alized o dia hea in RSUD D . Soe omo,
Su abaya. This s udy was conduc ed o 5 mon hs, om June o Oc obe 2024.
Popula ions sample o his s udy a e 175 pa ien s selec ed wi h consecu i e sampling in acco dance wi h he inclusion
and exclusion c i e ia equi ed o his esea ch. Inclusion c i e ia o his s udy a e pa ien s om age 0 mon hs – 60
mon hs, hospi alized in RSUD D . Soe omo Su abaya wi h diagnosis o dia hea as he medical indica ion o inpa ien .
While he exclusion c i e ia o his esea ch a e pa ien s wi h congeni al abno mali ies, gene ic diso de s,
immunocomp omised pa ien s, and pa ien s wi h me abolic diso de s, such as diabe es.
Da a o pa ien s’ age and gende we e ga he ed om he demog aphic da a w i en on pa ien s’ medical eco d. Da a
o dehyd a ion, sep icaemia, and sep ic shock on pa ien s’ a e ga he ed om he diagnosis eco ded medical eco d
and labo a o y examina ions esul a ached in pa ien s’ medical eco d du ing hei hospi aliza ions o dia hea.
The collec ed da a a e analyzed wi h S a is ical P oduc and Se ice Solu ion (SPSS) 30 e sion applica ion. Bi a ia e
analysis was done o de e mine whe he he e is a signi ican ela ionships be ween he a iables (age, gende ,
dehyd a ion, sep icaemia, and sep ic shock) and mo ali y wi h chi-squa e hypo hesis es .
3. Resul s and discussion
Th oughou 2023, he e we e 253 child en unde 5 yea s old pa ien s hospi alized o dia hea in RSUD D . Soe omo
ha me inclusion and exclusion c i e ia o his esea ch. Howe e , 78 pa ien s a e excluded as i me he exclusion
c i e ia o his esea ch as explained i n he p ious chap e . Thus, lea ing 175 pa ien s wi h eligible da a ha me he
inclusion c i e ia o his esea ch. E hical clea ance o da a collec ion p ocess o his esea ch has been g an ed by he
E hical Commi ee o RSUD D . Soe omo, Su abaya.
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Table 1 The Dis ibu ion and Cha ac e is ic o Resea ch’s Subjec s
Cha ac e is ic
To al
%
Gende
Male
99
56
Female
76
44
Age
0-12 mon hs old (in an s)
86
49
13- 60 mon hs old (child en)
89
51
Nu i ional S a us
Unde nu i ion
78
44.5
No mal
97
55.5
Dehyd a ion
Wi hou dehyd a ion
48
28
Mild/mode a e/se e e dehyd a ion
127
72
Sep icaemia
Wi hou sep icaemia
169
96.5
Sep icaemia
6
3.5
Sep ic Shock
Wi hou sep ic shock
2
1.14
Sep ic shock
173
98.86
Pa ien s’ Discha ged S a us
Reco e ed
172
98.2
Dea h
3
1.71
Each a iable o he da a p esen ed in Table 1 we e hen analyzed by using bi a ia e chi-squa e es acknowledge
whe he he e is a signi ican co ela ion be ween he es ed a iable and he mo ali y o dia hea pa ien s unde i e
yea s old.
Table 2 Bi a ia e Chi-Squa e Tes Analysis o Pa ien s’ Gende and Mo ali y
Gende
Discha ged S a us
OR (CI 95%)
P alue
Reco e ed
Dea h
To al
Male
97 (55.4%)
2 (1.14%)
99(56.5%)
2.18 (0.18-23.53)
0.127
Female
75 (42.8%)
1 (0.57%)
76 (43.4%)
To al
172 (98.2%)
3 (1.71%)
175 (100%)
Table 2 p esen s he esul o bi a ia e chi-squa e analysis o pa ien s’ gende and mo ali y. Da a shown in abo e
indica e ha he e is no signi ican co ela ions be ween pa ien s’ gende and mo ali y on dia hea pa ien s unde i e
yea s old. This can be p o en by he p alue sco e o 0.127 and wide con idence in e al ange ha includes 1o odd
a io, anging om ha indica es no signi ican co ela ion.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 2752-2757
2755
Table 3 Bi a ia e Chi-Squa e Tes Analysis o Pa ien s’Age and Mo ali y
Age
Discha ged S a us
OR (CI 95%)
P alue
Reco e ed
Dea h
To al
In an s (0-12 mon hs)
84 (48%)
2 (1.14%)
86(49.15%)
2.095 (0.186 – 23.539)
0.375
Child en (13-60 mon hs)
88 (50.2%)
1 (0.57%)
89 (50.85%)
To al
172(98.29%)
3 (1.71%)
175 (100%)
Table 3 p o ides he bi a ia e analysis esul be ween pa ien s’ age and mo ali y o dia hea pa ien s unde he age o
i e yea s old. Howe e , he esul shows no signi ican co ela ion be ween pa ien s’ age and mo ali y on child en
unde i e yea s old wi h dia hea.
Table 4 Bi a ia e Chi-Squa e Tes Analysis o Deg ee o Dehyd a ion and Mo ali y; Deg ee o Dehyd a ion and Hospi al
Leng h o S ay
Deg ee o Dehyd a ion
Discha ged S a us
OR (CI 95%)
P
alue
Leng h o S ay
P
alue
Reco e ed
Dea h
≥5 days
<5 days
Mild/ Mode a e/ Se e e
Dehyd a ion
124
(70.8%)
3
(1.14%)
1.024 (0.997 –
1.052)
1.154
80
(45.7%)
47
(26.8%)
0.022
Wi hou Dehyd a ion
48
(27.5%)
0
(0.57%)
21 (12%)
27
(15.4%)
To al
172
(98.3%)
3(1.71%)
101
(57.7%)
74
(42.2%)
Table 4 p esen s he esul o bi a ia e analysis be ween deg ee o dehyd a ion and mo ali y o dia hea pa ien s unde
he age o i e yea s old and he bi a ia e analysis esul be ween deg ee o dehyd a ion and pa ien s’ du a ion o
hospi aliza ion. The chi-squa e bi a ia e analysis o he ela ionship be ween deg ee o dehyd a ion and mo ali y
shows he e is no signi ican co ela ion be ween he wo, his is suppo ed by he p alue sco e o 1.154. Howe e ,
he e is a signi ican co ela ion be ween deg ee o dehyd a ion and pa ien s’ hospi aliza ion leng h o s ay. Pa ien wi h
dehyd a ion ends o ha e longe hospi aliza ion du a ion compa ed pa ien s wi hou dehyd a ion. This is suppo ed
by he p alue sco e o 0.022.
Table 5 Bi a ia e Chi-Squa e Tes Analysis o Sep icaemia and Mo ali y
Sep icaemia
Discha ged S a us
OR (CI 95%)
P alue
Reco e ed
Dea h
To al
Sep icaemia
4 (2.3%)
2 (1.2%)
6 (3.5%)
84.00 (6.257 – 1127.785)
<0.001
Wi hou Sep icaemia
168 (96%)
1 (0.57%)
169 (96.5%)
To al
172 (98.3%)
3 (1.71%)
175 (100%)
Table 5 p o ides he esul o bi a ia e analysis be ween sep icemia and mo ali y o dia hea pa ien s unde i e yea s
old. This able p o e ha sep icaemia is a s a is ically signi ican ac o ha co ela es wi h mo ali y o dia hea
pa ien s unde he age o i e yea s old. Pa ien s wi h sep icaemia ha e highe isk o mo ali y compa ed o pa ien s
wi hou sap icaemia his is suppo ed wi h high odds a io sco e, 84.00 and p alue sco e o <0.001.
Table 6 p esen s he esul o bi a ia e analysis chi-squa e es be ween sep ic shock and mo ali y o dia hea pa ien s
unde he age o i e yea s old. Based on he esul s, i can be concluded ha pa ien s wi h sep ic shock has a
signi ican ly highe odds o mo ali y a e compa ed o pa ien s wi hou sep ic shock, his is suppo ed wi h he low
odds a io o 0.06 ha sugges s he nega i e impac o sep ic shock on eco e y and he p alue sco e o <0.001.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 2752-2757
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Table 6 Bi a ia e Chi-Squa e Tes Analysis o Sep ic Shock and Mo ali y
Sep ic shock
Discha ged S a us
OR (CI 95%)
P alue
Reco e ed
Dea h
To al
Sep ic shock
0
2 (1.2%)
2 (1.2%)
0.06 (0.001-0.041)
<0.001
Wi hou Sep ic shock
173 (98.8%)
0
173 (98.8%)
To al
173 (98.8%)
2 (1.2%)
175 (100%)
Following an in-dep h analysis examina ion o possible isk ac o s in luencing mo ali y o dia hea on pa ien s’ unde
he age o i e yea s old hospi alized in RSUD D . Soe omo Su abaya, se e al ema kable obse a ions can be
highligh ed. The e we e se e al ac o s ha a e s a is ically signi ican o a ibu es on mo ali y on pa ien s wi h
dia hea unde he age o i e yea s old hospi alized in RSUD D . Soe omo. These ac o s a e sep icaemia and sep ic
shock. I is well known ha dia hea is one o he mos common cause o sep icaemia among child en unde he age o
i e yea s old. Sep icaemia in child en is li e- h ea ening o gan dys unc ion (Phoenix Sepsis Sco e ≥2) due o in ec ion,
wi h sep ic shock in ol ing ca dio ascula dys unc ion (sco e ≥1), hus pa ien wi h sep icaemia has highe odds o
de eloping sep ic shock ha may esul s o dea h [9]This is in line wi h he esea ch conduc ed by Sa min e al., 2019
done in Bangladesh wi h subjec s o 1000 dia hea pa ien s wi hin he age o 0-59 mon hs whe e ou o 1000 pa ien s
ea ed o dia hea, 191 su e ed om sep icaemia, and 70 dies ou o sep ic shock [7]
Ne e heless, some ac o s such as deg ee o dehyd a ion is p o en o be s a is ically signi ican ac o s ha con ibu es
no ably o he du a ion o hospi al s ay o pa ien s wi h dia hea, ye hose ac o s is no signi ican ly a ec mo ali y
o dia hea on he dependen a iable o his esea ch. Dehyd a ion is he mos common complica ion o dia hea, his
cascade happens as a esul o luid loss du ing he equen s ool episode[8]. A s udy done in Wangaya Gene al Hospi al
Denpasa suppo ed his esea ch as i p o es ha he e we e co ela ions be ween deg ee o dehyd a ion and pa ien ’s
leng h o s ay. Pa ien s who expe ienced dehyd a ion has longe hospi al s ay compa ed o pa ien s who a e no
dehyd a ed[10] indings is in line wi h his esea ch, whe e he p alue sco e o he co ela ion be ween dehyd a ion
and pa ien ’s leng h o s ay.
In his esea ch, age and gende a e no s a is ically co ela ed wi h he mo ali y o dia hea pa ien s unde i e yea s
old in his s udy. S udy done in Dhaka by Ja man, e al., 2018 ega ding he co ela ion be ween gende and he se e i y
o dia hea mani es a ion be ween boys and gi ls a e qui e simila [11] Ha man e al., 2023, ound ha emale child en
ha e a highe likelihood o mo ali y due o dia hea, which is a ibu ed o he lack o p ope nu i ion. Mo eo e ,
Ha man e al., 2013, epo ed ha in an s unde six mon hs o age a e a he highes isk o mo ali y compa ed o olde
child en [4]. In an s a e mo e suscep ible o in ec ions due o he imma u i y o hei immune sys ems[12]Howe e , in
his esea ch, no signi ican co ela ion be ween age, gende , and mo ali y was obse ed. This inding may be
a ibu ed o esea ch limi a ions, such as a small sample size o a low e en a e (mo ali y).
4. Conclusion
Sep ic shock and sep icemia we e ound o be signi ican ly associa ed wi h mo ali y among child en unde i e yea s
old hospi alized wi h dia hea a RSUD D . Soe omo in 2023. In con as , no s a is ically signi ican associa ion was
obse ed be ween gende , age, o deg ee o dehyd a ion and mo ali y in his s udy popula ion. I is impo an o no e,
howe e , ha p e ious s udies ha e epo ed a signi ican ela ionship be ween he deg ee o dehyd a ion and
mo ali y. The lack o such an associa ion in his s udy may be in luenced by imp o emen s in public heal h
in e en ions, such as enhanced sani a ion, inc eased b eas eeding a es, ea ly ecogni ion o dia hea, and g ea e
household use o o al ehyd a ion solu ions and zinc supplemen a ion. Fu he mo e, while he deg ee o dehyd a ion
was no associa ed wi h mo ali y, i was ound o signi ican ly co ela e wi h he leng h o hospi al s ay.
Compliance wi h e hical s anda ds
Acknowledgemen s
Au ho s would like o hank he Head and S a s o Medical Reco d and ITKI (Ins alasi Teknologi Komunikasi dan
In o masi) Di ision o RSUD D . Soe omo o p o iding he da a needed o his esea ch ac i i y.

Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 2752-2757
2757
Disclosu e o Con lic o in e es
The e is no con lic o in e es o be disclosed.
S a emen o e hical app o al
This esea ch ecei ed e hical app o al om he Heal h Resea ch E hics Commi ee o he Facul y o Medicine,
Uni e si as Ai langga, Su abaya, Indonesia.
Re e ences
[1] A Thoba i J, Su a man, Mulyadi AWE, e al. Di ec and indi ec cos s o acu e dia hea in child en unde i e yea s
o age in Indonesia: Heal h acili ies and communi y su ey. Lance Reg Heal h Wes Pac; 19. Epub ahead o p in
2022. DOI: 10.1016/j.lanwpc.2021.100333.
[2] Schille LR, Pa di DS, Sellin JH. Ch onic Dia hea: Diagnosis and Managemen . Clinical Gas oen e ology and
Hepa ology; 15. Epub ahead o p in 2017. DOI: 10.1016/j.cgh.2016.07.028.
[3] Imanadhia A, Ranuh IRG, Nuswan o o D. E iology Based on Clinical Mani es a ion o Acu e Dia hea Incidence o
Child en Hospi alized in D . Soe omo Gene al Hospi al Su abaya Pe iod 2011-2013. Biomolecula and Heal h
Science Jou nal; 2. Epub ahead o p in 2019. DOI: 10.20473/bhsj. 2i1.12744.
[4] Ha man RM, Cohen AL, An oni S, e al. Risk Fac o s o Mo ali y Among Child en Younge Than Age 5 Yea s
Wi h Se e e Dia hea in Low- and Middle-income Coun ies: Findings F om he Wo ld Heal h O ganiza ion-
coo dina ed Global Ro a i us and Pedia ic Dia hea Su eillance Ne wo ks. Clinical In ec ious Diseases; 76.
Epub ahead o p in 2023. DOI: 10.1093/cid/ciac561.
[5] Dipasquale V, Cucino a U, Romano C. Acu e malnu i ion in child en: Pa hophysiology, clinical e ec s and
ea men . Nu ien s; 12. Epub ahead o p in 2020. DOI: 10.3390/nu12082413.
[6] P isco A, Capalbo D, Gua ino S, e al. How o in e p e symp oms, signs and in es iga ions o dehyd a ion in
child en wi h gas oen e i is. A ch Dis Child Educ P ac Ed; 106. Epub ahead o p in 2021. DOI:
10.1136/a chdischild-2019-317831.
[7] Sa min M, A oze F, Sha i uzzaman, e al. P edic o o Dea h in Dia heal Child en Unde 5 Yea s o Age Ha ing
Se e e Sepsis in an U ban C i ical Ca e Wa d in Bangladesh. Glob Pedia Heal h; 6. Epub ahead o p in 2019.
DOI: 10.1177/2333794X19862716.
[8] Pu i DNA, Ongo MRD, And iany S. Acu e dia hoea wi h se e e dehyd a ion and complica ions in a 1-yea -old
child: a case epo in a hospi al wi h low esou ce se ing. In J Res Med Sci; 11. Epub ahead o p in 2023. DOI:
10.18203/2320-6012.ij ms20233725.
[9] Wa son RS, Ca ol ED, Ca e MJ, e al. The bu den and con empo a y epidemiology o sepsis in child en. The
Lance Child and Adolescen Heal h 2024; 8: 670–681.
[10] Budiha djo SN, Su yawan IWB, Sucip a AAM. The ela ionship be ween nu i ional s a us wi h leng h o s ay in
1-5 yea s old child en wi h dia hea a Wangaya Gene al Hospi al Denpasa . Indonesia Jou nal o Biomedical
Science 2020; 14: 113–117.
[11] Ja man AF, Long SE, Robe son SE, e al. Sex and gende di e ences in acu e pedia ic dia hea: A seconda y
analysis o he Dhaka s udy. J Epidemiol Glob Heal h; 8. Epub ahead o p in 2018. DOI:
10.2991/j.jegh.2018.08.102.
[12] Aulia M, T i a na S, I iani Y, e al. Pedia ic so a sco e o de ec ing sepsis in child en. Paedia ica
Indonesiana(Paedia ica Indonesiana); 61. Epub ahead o p in 2021. DOI: 10.14238/pi61.1.2021.1-7.