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Lundin V, Lam F, Akinjeji A, Kabunga L, Eriksen J. Prevalence of antibiotic use for childhood diarrhoea in Uganda after an ORS scale-up intervention: a repeated cross-sectional study. BMC Public Health 2024; 24:2084. [PMID: 39090599 PMCID: PMC11295441 DOI: 10.1186/s12889-024-19613-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Diarrhoea kills 500,000 children every year despite availability of cheap and effective treatment. In addition, a large number are inappropriately treated with antibiotics, which do not benefit the patient but can contribute to the development of antibiotic resistance. We investigated whether the prevalence of antibiotic use among children under the age of five with diarrhoea in Uganda changed following a national intervention to increase the use of oral rehydration salts (ORS), and whether any socioeconomic characteristics were associated with antibiotic use. METHODS A cross-sectional survey was conducted among caregivers of children under the age of five and among private health care providers and drug sellers in Uganda in 2014. This was compared to a similar survey among private health care providers, and the national demographic and health survey in Uganda in 2016. Logistic regression was used to find associations between antibiotic use and socioeconomic characteristics, and chi-square test and independent sample t-test were used to find significant differences between groups. RESULTS The prevalence of antibiotic use among children under the age of five with diarrhoea in Uganda decreased from 30.5% in 2014 to 20.0% (p < 0.001) in 2016. No associations between socioeconomic characteristics and the use of antibiotics were significant in both 2014 and 2016. CONCLUSIONS The use of antibiotics in children with diarrhoeal disease decreased significantly in Uganda between 2014 and 2016. However, the extent of the contribution of the ORS scale-up programme to this decrease cannot be determined from this study.
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Affiliation(s)
- Viktor Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Felix Lam
- Clinton Health Access Initiative, Boston, USA
| | - Adewale Akinjeji
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- ICAP Global Health Nigeria, Abuja, Nigeria
| | | | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Unit of infectious diseases/Venhälsan, Stockholm South Hospital, Stockholm, Sweden.
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Gayawan E, Cameron E, Okitika T, Egbon OA, Gething P. A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria. PLoS One 2024; 19:e0303963. [PMID: 38776302 PMCID: PMC11111079 DOI: 10.1371/journal.pone.0303963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/04/2024] [Indexed: 05/24/2024] Open
Abstract
We assess progress towards improved case management of childhood diarrhea in Nigeria over a period of targeted health systems reform from 2013 to 2018. Individual and community data from three Demographic and Health Survey rounds are leveraged in a geospatial model designed for stratified estimation by venue of treatment seeking and State. Our analysis reveals a highly regionalised health system undergoing rapid change. Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44-0.69; 95% CI] in 2008; 0.70 [0.54-0.83] in 2018) or chemist/pharmacy (0.28 [0.17-0.42] in 2008; 0.48 [0.31-0.64] in 2018). Yet State-level variations in venue attendance and performance by venue have conspired to hold the overall proportion receiving this potentially life-saving therapy (0.45 [0.35-0.55] in 2018) to well-below ideal coverage levels. High performing states that have demonstrated significant improvements include Kano, Jigawa and Borno, while under-performing states that have suffered declines in coverage include Kaduna and Taraba. The use of antibiotics is not recommended for mild cases of childhood diarrhea yet remains concerningly high nationally (0.27 [0.19-0.36] in 2018) with negligible variation between venues. Antibiotic use rates are particularly high in Enugu, Kaduna, Taraba, Kano, Niger and Kebbi, yet welcome reductions were identified in Jigawa, Adamawa and Osun. These results support the conclusions of previous studies and build the strength of evidence that urgent action is needed throughout the multi-tiered health system to improve the quality and equity of care for common childhood illnesses in Nigeria.
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Affiliation(s)
- Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Ewan Cameron
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Tolu Okitika
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Osafu Augustine Egbon
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Peter Gething
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
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Pavlinac PB, Platts-Mills JA, Liu J, Atlas HE, Gratz J, Operario D, Rogawski McQuade ET, Ahmed D, Ahmed T, Alam T, Ashorn P, Badji H, Bahl R, Bar-Zeev N, Chisti MJ, Cornick J, Chauhan A, De Costa A, Deb S, Dhingra U, Dube Q, Duggan CP, Freyne B, Gumbi W, Hotwani A, Kabir M, Islam O, Kabir F, Kasumba I, Kibwana U, Kotloff KL, Khan SS, Maiden V, Manji K, Mehta A, Ndeketa L, Praharaj I, Qamar FN, Sazawal S, Simon J, Singa BO, Somji S, Sow SO, Tapia MD, Tigoi C, Toure A, Walson JL, Yousafzai MT, Houpt ER. Azithromycin for Bacterial Watery Diarrhea: A Reanalysis of the AntiBiotics for Children With Severe Diarrhea (ABCD) Trial Incorporating Molecular Diagnostics. J Infect Dis 2024; 229:988-998. [PMID: 37405406 PMCID: PMC11011181 DOI: 10.1093/infdis/jiad252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/25/2023] [Accepted: 07/03/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Bacterial pathogens cause substantial diarrhea morbidity and mortality among children living in endemic settings, yet antimicrobial treatment is only recommended for dysentery or suspected cholera. METHODS AntiBiotics for Children with severe Diarrhea was a 7-country, placebo-controlled, double-blind efficacy trial of azithromycin in children 2-23 months of age with watery diarrhea accompanied by dehydration or malnutrition. We tested fecal samples for enteric pathogens utilizing quantitative polymerase chain reaction to identify likely and possible bacterial etiologies and employed pathogen-specific cutoffs based on genomic target quantity in previous case-control diarrhea etiology studies to identify likely and possible bacterial etiologies. RESULTS Among 6692 children, the leading likely etiologies were rotavirus (21.1%), enterotoxigenic Escherichia coli encoding heat-stable toxin (13.3%), Shigella (12.6%), and Cryptosporidium (9.6%). More than one-quarter (1894 [28.3%]) had a likely and 1153 (17.3%) a possible bacterial etiology. Day 3 diarrhea was less common in those randomized to azithromycin versus placebo among children with a likely bacterial etiology (risk difference [RD]likely, -11.6 [95% confidence interval {CI}, -15.6 to -7.6]) and possible bacterial etiology (RDpossible, -8.7 [95% CI, -13.0 to -4.4]) but not in other children (RDunlikely, -0.3% [95% CI, -2.9% to 2.3%]). A similar association was observed for 90-day hospitalization or death (RDlikely, -3.1 [95% CI, -5.3 to -1.0]; RDpossible, -2.3 [95% CI, -4.5 to -.01]; RDunlikely, -0.6 [95% CI, -1.9 to .6]). The magnitude of risk differences was similar among specific likely bacterial etiologies, including Shigella. CONCLUSIONS Acute watery diarrhea confirmed or presumed to be of bacterial etiology may benefit from azithromycin treatment. CLINICAL TRIALS REGISTRATION NCT03130114.
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Affiliation(s)
- Patricia B Pavlinac
- Department of Global Health
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jie Liu
- School of Public Health, Qingdao University, Qingdao, China
| | | | - Jean Gratz
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Darwin Operario
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tahmina Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Per Ashorn
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Henry Badji
- Centre pour le Développement des Vaccines, Bamako, Mali
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jen Cornick
- Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
| | | | - Ayesha De Costa
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Saikat Deb
- Center for Public Health Kinetics, New Delhi, India
| | - Usha Dhingra
- Center for Public Health Kinetics, New Delhi, India
| | - Queen Dube
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Christopher P Duggan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Nutrition, Boston Children's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bridget Freyne
- Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Women and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
| | - Wilson Gumbi
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mamun Kabir
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ohedul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Irene Kasumba
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Upendo Kibwana
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shaila S Khan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Victor Maiden
- Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ashka Mehta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Latif Ndeketa
- Clinical Research Programme, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
| | - Ira Praharaj
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Jonathon Simon
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Benson O Singa
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samba O Sow
- Centre pour le Développement des Vaccines, Bamako, Mali
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Caroline Tigoi
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Aliou Toure
- Centre pour le Développement des Vaccines, Bamako, Mali
| | - Judd L Walson
- Department of Global Health
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Infectious Diseases, Department of Pediatrics and Medicine, University of Washington, Seattle
| | | | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Dang HT, Tran DM, Phung TTB, Bui ATP, Vu YH, Luong MT, Nguyen HM, Trinh HT, Nguyen TT, Nguyen AH, Van Nguyen AT. Promising clinical and immunological efficacy of Bacillus clausii spore probiotics for supportive treatment of persistent diarrhea in children. Sci Rep 2024; 14:6422. [PMID: 38494525 PMCID: PMC10944834 DOI: 10.1038/s41598-024-56627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
Persistent diarrhea is a severe gastroenteric disease with relatively high risk of pediatric mortality in developing countries. We conducted a randomized, double-blind, controlled clinical trial to evaluate the efficacy of liquid-form Bacillus clausii spore probiotics (LiveSpo CLAUSY; 2 billion CFU/5 mL ampoule) at high dosages of 4-6 ampoules a day in supporting treatment of children with persistent diarrhea. Our findings showed that B. clausii spores significantly improved treatment outcomes, resulting in a 2-day shorter recovery period (p < 0.05) and a 1.5-1.6 folds greater efficacy in reducing diarrhea symptoms, such as high frequency of bowel movement of ≥ 3 stools a day, presence of fecal mucus, and diapered infant stool scale types 4-5B. LiveSpo CLAUSY supportive treatment achieved 3 days (p < 0.0001) faster recovery from diarrhea disease, with 1.6-fold improved treatment efficacy. At day 5 of treatment, a significant decrease in blood levels of pro-inflammatory cytokines TNF-α, IL-17, and IL-23 by 3.24% (p = 0.0409), 29.76% (p = 0.0001), and 10.87% (p = 0.0036), respectively, was observed in the Clausy group. Simultaneously, there was a significant 37.97% decrease (p = 0.0326) in the excreted IgA in stool at day 5 in the Clausy group. Overall, the clinical study demonstrates the efficacy of B. clausii spores (LiveSpo CLAUSY) as an effective symptomatic treatment and immunomodulatory agent for persistent diarrhea in children.Trial registration: NCT05812820.
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Affiliation(s)
- Ha Thuy Dang
- Department of Gastroenterology, Vietnam National Children's Hospital, No. 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Dien Minh Tran
- Department of Surgical Intensive Care Unit, Vietnam National Children's Hospital, No. 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Thuy Thi Bich Phung
- Department of Molecular Biology for Infectious Diseases, Vietnam National Children's Hospital, No. 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Anh Thi Phuong Bui
- Spobiotic Research Center, ANABIO R&D Ltd. Company, No. 22, Lot 7,8 Van Khe Urban, La Khe, Ha Dong, Hanoi, Vietnam
| | - Yen Hai Vu
- Department of Gastroenterology, Vietnam National Children's Hospital, No. 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Minh Thi Luong
- Department of Gastroenterology, Vietnam National Children's Hospital, No. 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Hang Minh Nguyen
- Department of Molecular Biology for Infectious Diseases, Vietnam National Children's Hospital, No. 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Huong Thi Trinh
- Department of Molecular Biology for Infectious Diseases, Vietnam National Children's Hospital, No. 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Tham Thi Nguyen
- Spobiotic Research Center, ANABIO R&D Ltd. Company, No. 22, Lot 7,8 Van Khe Urban, La Khe, Ha Dong, Hanoi, Vietnam
| | - Anh Hoa Nguyen
- Spobiotic Research Center, ANABIO R&D Ltd. Company, No. 22, Lot 7,8 Van Khe Urban, La Khe, Ha Dong, Hanoi, Vietnam.
- LiveSpo Pharma Ltd. Company, N03T5, Ngoai Giao Doan Urban, Bac Tu Liem, Hanoi, Vietnam.
| | - Anh Thi Van Nguyen
- Spobiotic Research Center, ANABIO R&D Ltd. Company, No. 22, Lot 7,8 Van Khe Urban, La Khe, Ha Dong, Hanoi, Vietnam.
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Lanyero H, Ocan M, Obua C, Stålsby Lundborg C, Nanzigu S, Katureebe A, N Kalyango J, Eriksen J. Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study. BMC Public Health 2021; 21:1254. [PMID: 34187421 PMCID: PMC8244156 DOI: 10.1186/s12889-021-11254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diarrhea is the second leading cause of mortality in children under 5 years of age globally, and the risk of death increases with practices such as restriction of fluid intake and inappropriate use of antibiotics. We determined the prevalence of antibiotic use in managing diarrhea in children under 5 years of age in rural communities of Gulu district, northern Uganda. Method A cross-sectional study among children under 5 years with diarrhea, from households selected using multi-stage sampling. A researcher administered questionnaire was used to obtain data from caregivers of these children. Results Of the 856 children recruited, 318 (37.1%, 318/856) had experienced diarrhea, where 263 (82.7%, 263/318) had diarrhea with acute respiratory infections (ARIs), and 55 (17.3%, 55/318) had diarrhea without ARIs. The majority (89.6%, 285/318) of the children had non-bloody diarrhea. A high proportion (82.8%) of the children with non-bloody diarrhea also had ARIs. Bloody diarrhea was reported for 33 (10.4%) children including those with ARIs, and only 6 of these (18.2%) children had bloody diarrhea without ARIs. Of the 318 children with diarrhea, over half (52%, CI: 46–57) were administered antibiotics. Of the 55 children who had diarrhea without ARIs, over a third (38%, CI: 26–51) were administered antibiotics. Similarly, of the 263 children with diarrhea and ARIs, 54% (CI: 48–60) were treated with antibiotics. The determinants of antibiotic use included; children living in peri-urban settings (AOR: 3.41, CI: 1.65–7.08, P = 0.001), getting treatment from health facility (AOR: 1.76, CI: 1.06–2.93, P = 0.029), and having diarrhea with ARIs (AOR: 3.09, CI: 1.49–6.42, P = 0.003). Conclusion Antibiotic use is common among children under 5 years with diarrhea in rural communities of northern Uganda.
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Affiliation(s)
- Hindum Lanyero
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Sarah Nanzigu
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Joan N Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda.,Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Department of infectious diseases, South General Hospital, 118 83, Stockholm, Sweden
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