Quarterly Patterns and Delivery-Type Differences in Infant Diarrheal Disease: A Survival Analysis in India
Keywords:
Diarrhea, Infancy, Survival Analysis, Delivery Mode, Complementary Feeding, Rural IndiaAbstract
Background: Diarrheal diseases remain a leading cause of morbidity and mortality in children under five, with infants particularly vulnerable during their first year of life. Age-related variations and biological factors such as delivery type may influence diarrheal risk, yet evidence from rural India is limited. Objective: To examine quarterly patterns of diarrheal morbidity in infancy and assess whether delivery mode modifies the risk during the first year of life. Material and methods: A prospective community-based cohort study was conducted in rural Varanasi, India, from November 2022 to February 2024. A total of 150 infants were enrolled at birth and followed for one year through structured quarterly assessments. Diarrhea incidence rates of were calculated, and survival probabilities were estimated using Kaplan-Meier analysis. Generalized Estimating Equations (GEE) with Poisson regression were applied to evaluate associations between delivery type, infant age, and diarrhea incidence. Results: The cohort experienced an average of 2.92 diarrheal episodes per child-year. Incidence was lowest during the first quarter (0-3 months) but rose sharply after six months, peaking at 0.43 episodes per child-month in the eighth month. GEE analysis revealed a significant age-dependent increase in diarrheal risk: OR = 1.58 (95% CI: 1.12-2.23) for 4-6 months, OR = 3.13 (95% CI: 2.23-4.40) for 7-9 months, and OR = 2.67 (95% CI: 1.85-3.87) for 10-12 months, compared with 0-3 months. Delivery mode was not significantly associated with diarrhea incidence (OR = 0.98, 95% CI: 0.72-1.34, p = 0.896). Conclusion: Diarrheal morbidity in infancy is strongly age-dependent, coinciding with the introduction of complementary feeding. Mode of delivery did not influence diarrheal incidence in this high-exposure rural setting, suggesting that environmental and behavioral factors outweigh delivery-related biological differences. Strengthening exclusive breastfeeding promotion, safe complementary feeding practices, and WASH interventions is essential to reduce the diarrheal burden in early childhood.
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