Quarterly Patterns and Delivery-Type Differences in Infant Diarrheal Disease: A Survival Analysis in India

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. Aim & Objective: To examine quarterly patterns of diarrheal morbidity in infancy and assess whether delivery mode modifies the risk during infancy. Methodology: 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. 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. 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. Conclusion: Diarrheal morbidity in infancy is strongly age-dependent. Strengthening exclusive breastfeeding promotion, safe complementary feeding practices, and WASH interventions is essential to reduce the diarrheal burden in early childhood.