Predictors of Severe Dehydration Among Children Presenting With Acute Diarrhea at Sheikhan General Hospital, Nineveh, Iraq

Background: Acute diarrhea remains one of the leading causes of morbidity and mortality among children worldwide. Severe dehydration is the most serious complication and a major cause of hospitalization and death, particularly in developing countries. Objectives: To identify predictors of severe dehydration among children presenting with acute diarrhea at Sheikhan General Hospital, Nineveh, Iraq. Methods: This hospital-based cross-sectional study was conducted at Sheikhan General Hospital between August 2025 and May 2026. A total of 240 children aged 1 month to 5 years presenting with acute diarrhea were included. Demographic and clinical data were collected through interviews, clinical examinations, and medical records. Dehydration status was assessed according to World Health Organization criteria. Statistical analysis was performed using SPSS version 31. Logistic regression analysis was used to identify independent predictors of severe dehydration. Results: Children younger than 24 months represented 62.5% of the study population, and males accounted for 56.3%. Severe dehydration was observed in 54 children (22.5%), while some dehydration occurred in 120 (50.0%). Vomiting (68.3%) and fever (61.7%) were the most common presenting symptoms. Severe dehydration was significantly associated with age below 12 months (P value = 0.004), rural residence (P value = 0.018), vomiting (P value < 0.001), diarrhea lasting more than three days (P value < 0.001), severe malnutrition (P value < 0.001), and stool frequency exceeding six episodes per day (P value = 0.001). Multivariate logistic regression analysis identified severe malnutrition (OR = 5.62, 95% CI: 2.34–13.48, P value < 0.001), vomiting (OR = 4.11, 95% CI: 1.69–9.98, P value = 0.002), diarrhea lasting more than three days (OR = 3.58, 95% CI: 1.62–7.92, P value = 0.001), and age below 12 months (OR = 2.89, 95% CI: 1.24–6.71, P value = 0.014) as independent predictors of severe dehydration. Conclusions: Severe dehydration remains a common complication among children with acute diarrhea. Severe malnutrition, vomiting, prolonged diarrhea, and young age were identified as the most important predictors. Early recognition of high-risk children and prompt rehydration therapy may reduce morbidity and improve clinical outcomes.