Watson Institute for International and Public Affairs
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Management of Cholera and Severe Diarrheal Disease

This project was awarded funding from 2012-2017.

Despite tremendous progress over the past several decades, diarrheal disease remains a leading cause of death in children worldwide. Annually, children under five experience an estimated 1·7 billion diarrheal episodes, leading to 124 million outpatient visits, 9 million hospitalizations, and 520,000 deaths. Accurate and rapid assessment of dehydration status is critical to preventing morbidity and mortality in children with diarrheal disease, yet no clinical tools for assessing dehydration have been validated in resource-limited settings, where the vast majority of diarrhea morbidity and mortality occur each year. With funding support from the NIH and private foundations, Dr. Levine has carried out a series of studies over the past seven years focused on improving the delivery of emergency care for children with acute diarrhea worldwide. His early research in Rwanda focused on assessing the performance of currently recommended international guidelines for management of diarrhea in children, including the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) guidelines. In Bangladesh, Dr. Levine launched the twin Dehydration: Assessing Kids Accurately (DHAKA) studies, which together derived and validated the very first clinical prediction model for assessing dehydration in children with diarrhea in a resource-limited setting: the DHAKA score. Taken together, these two studies enrolled nearly 1400 children, more than all previous diagnostic studies of dehydration in children combined together, and found the DHAKA score to be both more accurate and reliable than the current IMCI guidelines.