Case fatality rate for diarrhoea

Percent of child deaths in the facility due to diarrhoea.

The number of deaths of children aged 0-59 months due to diarrhoea, in past 3 months.

Total number of children aged 0-59 months admitted for diarrhoea in past 3 months.

Place of residence, age, sex, socioeconomic status.

The data for calculating this indicator can be derived from a review of clinic registers or patient charts or through periodic reporting of data on suspected cases of diarrhoea (i.e. cases that meet the clinical case definition) from health facilities to districts, or from districts to the provincial/regional level.

The indicator divides the total number of all deaths from diarrhoea during a specific period by the total number of cases of the disease in the same period, and multiplying the answer by 100.

Facility records

Clinic registers

Patient charts

Surveillance reporting forms

Diarrhoeal diseases remain one of the major causes of mortality among children under 5. The case fatality rate is a measure of severity of illness. The indicator aims at measuring progress towards the reduction of mortality from diarrhoeal diseases at the health facility level. It expresses the likelihood that a child with diarrhoea will live after entering the health facility. A case fatality rate helps to indicate whether a case is identified promptly, and any problems with case management once the disease has been diagnosed. It also helps to identify a more virulent, new, or drug-resistant pathogen and indicate poor quality of care or no medical care.

Once data on cases are being collected, this indicator is relatively easy to calculate. It can also respond to changes over a relatively short period, for example, 6-12 months. This indicator mostly helps service management at the level of each facility. 

When interpreting this indicator, one should consider that it is sometimes difficult to distinguish deaths from a particular disease from deaths from other causes. Thus, the numerator can be as affected by errors in diagnosis, as by changes in classification.

The case fatality rate is also affected by the quality and promptness of medical care provided in the facility, the condition of the child upon arrival, and distance from the health facility. Case-fatality rates may be underestimates because of incomplete reporting of deaths. For example, a CFR under 5% for diarrhoea may suggest an epidemic is just beginning, or “over-diagnosis,” or the fact that severely ill cases may not be reaching health facilities.

One way to disentangle the components of the CFR is to gather information on other indicators of the quality of care, such as the admission-to-treatment time interval. Another approach would be to gather information about the condition of the child at the time of admission. This could help disentangle the effect of patients’ condition from that of quality of care.

It may not be valid to compare case fatality rates between facilities, especially between health centers and hospitals, since children with serious illness could be referred to the hospital at the last moment, where they may die. This would lower the CFR at the health center and raise it at the hospital. Thus, interpretation requires comparing the CFR for a particular facility over time and not comparison between facilities. When using this indicator to monitor trends over time in the quality of care, one caveat worth mentioning is that data from a recent year may be incomplete if there is a significant lag time in reporting.

Pediatric care, Child health, Diarrheal disease, Mortality

World Health Organization (WHO). Consultation on Improving Measurement of the Quality of Maternal, Newborn and Child Care in Health Facilities.; 2013.

World Health Organization. Nutrition Landscape Information System (NLIS). Country Profile Indicators: Interpretation Guide. Geneva, Switzerland; 2010.

Gage AJ, Ali D, Suzuki C. A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill.; 2005.

Filed under: Child health , Diarrheal disease , Mortality , Pediatric care