Diarrheal diseases remain one of the leading causes of death and disability in both children and adults worldwide. While the vast majority of diarrheal episodes follow a relatively benign course, approximately 35% of cases in younger children and 5% of cases in older children and adults lead to moderate or severe disease requiring advanced medical management. Appropriate rehydration with either oral or intravenous fluids remains the most important step for treating acute diarrhea. Accurate assessment of dehydration status has been shown to reduce the morbidity and mortality that results from inappropriate rehydration of patients and can also improve the cost-effectiveness of diarrhea management, especially in low resource settings. Yet no validated tools exist for estimating dehydration severity in patients with acute diarrhea across the lifespan.

In 2024, Dr. Adam Levine received a $2.7 million NIH grant to validate FluidCalc, a cutting-edge mobile health application (mHealth) clinical decision support tool (CDST) that can be used by frontline providers to guide management for patients with acute diarrhea. This project builds on foundational work in Bangladesh, where Dr. Levine and his collaborators developed and internally validated clinical diagnostic models for assessing dehydration severity in both children under five (DHAKA models) and patients over five (NIRUDAK models). DHAKA and NIRUDAK models were found to be more accurate and reliable than the World Health Organization guidelines, which is currently the standard of care for managing acute diarrhea in most settings worldwide. The current phase aims to externally validate FluidCalc in both a high-resource setting (United States) and a low-resource setting (Tanzania). Once validated, FluidCalc has the potential to enhance diagnostic accuracy, minimize unnecessary treatments, and prevent life-threatening complications among the hundreds of millions of patients who seek care for acute diarrhea each year.

International Collaborators

Implementation in Tanzania

In February 2025, the study officially launched in Dar es Salaam at Muhimbili University of Health and Allied Sciences (MUHAS), marking the first collaboration between faculty at Brown University and MUHAS. The U.S.-based team including Principal Investigator Dr. Adam Levine, Project Coordinator Joan Chepngeno, and Co-Investigator Dr. C. Duggan traveled to Tanzania to meet with local Principal Investigator Dr. Karim Manji and the Tanzanian research team. Together, they trained the research staff and visited study sites. A second training in April 2025, following the start of qualitative data collection, further strengthened local qualitative research capacity and reinforced the foundations for long-term collaboration. Qualitative data collection has been completed in Tanzania, consisting of five focus group discussions conducted with various health providers and six interviews with key stakeholders.