Hypotension and dehydration status in children aged 28 days to 5 years with acute watery diarrhoea at Kisanji Health Centre iv.

Abstract

Background: Acute watery diarrhoea (AWD) remains a leading cause of morbidity and mortality in children under five in low-resource settings. Severe dehydration from AWD can precipitate hypotension, a late but highly specific sign of shock. Despite established management protocols, blood pressure measurement is rarely integrated into diarrhoea assessment in Uganda. Objective: To determine the prevalence of hypotension, assess dehydration status, and examine the relationship between dehydration and hypotension in children aged 28 days to 5 years with AWD at Kisenyi Health Centre IV. Methods: A descriptive cross-sectional study was conducted among 280 systematically selected children presenting with AWD. Data on socio-demographic, clinical, and anthropometric variables were collected. Blood pressure was measured using a certified and calibrated automated sphygmomanometer, and dehydration was assessed per Uganda Basic Paediatric Protocols. Logistic regression was used to explore associations. Results: The mean age of participants was 29 months (SD = 17), with 51.1% female. The mean systolic blood pressure was 91.75 mmHg (SD = 7.54; range 51-108.7 mmHg). The prevalence of hypotension was 2.5%. Most children were alert (93.2%), 35.7% had sunken eyes, 57.5% were restless/irritable, and 47.1% presented with cold extremities. Skin pinch returned within 2 seconds for 79.3% of participants, and 95.4% had a capillary refill time of 2 seconds. Severe dehydration was notable in 6.8% of the children, while 33.9% had some dehydration. Severe dehydration was strongly associated with hypotension (COR = 30.9; 95% CI: 3.0-315; p = 0.004), but this was not significant after adjusting for referral status (AOR = 8.3; 95% CI: 0.5-138.4; p = 0.141). Conclusion: Hypotension was strongly linked to severe dehydration, pointing to the need for integrating routine blood pressure measurement into AWD assessment. This could complement physical examination to identify children at risk of decompensated shock and improve management outcomes. Keywords: Acute watery diarrhoea, hypotension, dehydration, paediatrics, Uganda, blood pressure monitoring.