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Nuzhat S, Alam B, Hasan SMT, Shaima SN, Chisti MJ, Faruque ASG, Das R, Ahmed T. Are young and older children with diarrhea presenting in the same way? PLoS One 2024; 19:e0300882. [PMID: 38739609 PMCID: PMC11090295 DOI: 10.1371/journal.pone.0300882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Diarrhoea is a global health problem. More than a quarter of diarrhoeal deaths occur among children less than five years. Different literatures analyzed presentation and outcomes of less than five diarrhoeal children. The world has made remarkable progress in reducing child mortality. So, older children are growing in number. Our aim was to identify clinical differentials and variations of pathogens among younger (less than five) and older (five to nine years) diarrhoeal children. METHOD Data were extracted from the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital (urban site) and Matlab Hospital (rural site) of the International Centre for Diarrhoeal Disease Research, Bangladesh for the period of January 2012 to December 2021. Out of 28,781 and 12,499 surveillance patients in Dhaka and Matlab Hospital, 614 (2.13%) and 278 (2.22%) children were five to nine-years of age, respectively. Among under five children, 2456 from Dhaka hospital and 1112 from Matlab hospital were selected randomly for analysis (four times of five to nine years age children, 1:4). RESULTS Vomiting, abdominal pain, and dehydrating diarrhoea were significantly higher in older children in comparison to children of less than five years age (p-value <0.05) after adjusting study site, gender, antibiotic use before hospitalization, diarrhoeal duration < 24 hours, intake of oral rehydration fluid at home, parental education, WASH practice and history of cough. Vibrio. cholerae, Salmonella, and Shigella were the common fecal pathogen observed among older children compared to under five after adjusting for age, gender and study site. CONCLUSION Although percentage of admitted diarrhoeal children with five to nine years is less than under five years children but they presented with critical illness with different diarrhoeal pathogens. These observations may help clinicians to formulate better case management strategies for children of five to nine years that may reduce morbidity.
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Affiliation(s)
- Sharika Nuzhat
- Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Baharul Alam
- Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - S. M. Tafsir Hasan
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Shamsun Nahar Shaima
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - A. S. G. Faruque
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Rina Das
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, GA, United States of America
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
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Afroz M, Bhuia MS, Rahman MA, Hasan R, Islam T, Islam MR, Chowdhury R, Khan MA, Antas E Silva D, Melo Coutinho HD, Islam MT. Anti-diarrheal effect of piperine possibly through the interaction with inflammation inducing enzymes: In vivo and in silico studies. Eur J Pharmacol 2024; 965:176289. [PMID: 38158111 DOI: 10.1016/j.ejphar.2023.176289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
Piperine is a natural alkaloid that possesses a variety of therapeutic properties, including anti-inflammatory, antioxidant, antibacterial, and anticarcinogenic activities. The present study aims to assess the medicinal benefits of piperine as an anti-diarrheal agent in a chick model by utilizing in vivo and in silico techniques. For this, castor oil was administered orally to 2-day-old chicks to cause diarrhea. Bismuth subsalicylate (10 mg/kg), loperamide (3 mg/kg), and nifedipine (2.5 mg/kg) were used as positive controls, while the vehicle was utilized as a negative control. Two different doses (25 and 50 mg/kg b.w.) of the test sample (piperine) were administered orally, and the highest dose was tested with standards to investigate the synergistic activity of the test sample. In our findings, piperine prolonged the latent period while reducing the number of diarrheal feces in the experimental chicks during the monitoring period (4 h). At higher doses, piperine appears to reduce diarrheal secretion while increasing latency in chicks. Throughout the combined pharmacotherapy, piperine outperformed bismuth subsalicylate and nifedipine in terms of anti-diarrheal effects with loperamide. In molecular docking, piperine exhibited higher binding affinities towards different inflammatory enzymes such as cyclooxygenase 1 (-7.9 kcal/mol), cyclooxygenase 2 (-8.4 kcal/mol), nitric oxide synthases (-8.9 kcal/mol), and L-type calcium channel (-8.8 kcal/mol), indicating better interaction of PP with these proteins. In conclusion, piperine showed a potent anti-diarrheal effect in castor oil-induced diarrheal chicks by suppressing the inflammation and calcium ion influx induced by castor oil.
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Affiliation(s)
- Meher Afroz
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | - Md Shimul Bhuia
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | - Md Anisur Rahman
- Department of Pharmacy, Islamic University, Kushtia, 7003, Bangladesh.
| | - Rubel Hasan
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | - Tawhida Islam
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | - Md Rakibul Islam
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | - Raihan Chowdhury
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | - Md Ali Khan
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | | | | | - Muhammad Torequl Islam
- Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
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Levine AC, Gainey M, Qu K, Nasrin S, Sharif MBE, Noor SS, Barry MA, Garbern SC, Schmid CH, Rosen RK, Nelson EJ, Alam NH. A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study. Lancet Glob Health 2023; 11:e1725-e1733. [PMID: 37776870 PMCID: PMC10593153 DOI: 10.1016/s2214-109x(23)00403-5] [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: 04/17/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Despite the importance of accurate and rapid assessment of hydration status in patients with acute diarrhoea, no validated tools exist to help clinicians assess dehydration severity in older children and adults. The aim of this study is to validate a clinical decision support tool (CDST) and a simplified score for dehydration severity in older children and adults with acute diarrhoea (both developed during the NIRUDAK study) and compare their accuracy and reliability with current WHO guidelines. METHODS A random sample of patients aged 5 years or older presenting with diarrhoea to the icddr,b Dhaka Hospital in Bangladesh between Jan 30 and Dec 13, 2022 were included in this prospective cohort study. Patients with fewer than three loose stools per day, more than 7 days of symptoms, previous enrolment in the study, or a diagnosis other than acute gastroenteritis were excluded. Patients were weighed on arrival and assessed separately by two nurses using both our novel clinical tools and WHO guidelines. Patients were weighed every 4 h to determine their percent weight change with rehydration, our criterion standard for dehydration. Accuracy for the diagnosis of dehydration category (none, some, or severe) was assessed using the ordinal c-index (ORC). Reliability was assessed by comparing the prediction of severe dehydration from each nurse's independent assessment using the intraclass correlation coefficient (ICC). FINDINGS 1580 patients were included in our primary analysis, of whom 921 (58·3%) were female and 659 (41·7%) male. The ORC was 0·74 (95% CI 0·71-0·77) for the CDST, 0·75 (0·71-0·78) for the simplified score, and 0·64 (0·61-0·67) for the WHO guidelines. The ICC was 0·98 (95% CI 0·97-0·98) for the CDST, 0·94 (0·93-0·95) for the simplified score, and 0·56 (0·52-0·60) for the WHO guidelines. INTERPRETATION Use of our CDST or simplified score by clinicians could reduce undertreatment and overtreatment of older children and adults with acute diarrhoea, potentially reducing morbidity and mortality for this common disease. FUNDING US National Institutes of Health. TRANSLATION For the Bangla translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Monique Gainey
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Kexin Qu
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | - Sabiha Nasrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohsena Bint-E Sharif
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Syada S Noor
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Meagan A Barry
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Stephanie C Garbern
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Christopher H Schmid
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | - Rochelle K Rosen
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Eric J Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Nur H Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Rosen RK, Gainey M, Nasrin S, Garbern SC, Lantini R, Elshabassi N, Sultana S, Hasnin T, Alam NH, Nelson EJ, Levine AC. Use of Framework Matrix and Thematic Coding Methods in Qualitative Analysis for mHealth: NIRUDAK Study Data. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2023; 22:10.1177/16094069231184123. [PMID: 38817641 PMCID: PMC11138313 DOI: 10.1177/16094069231184123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Objective Framework Matrix Analysis (FMA) and Applied Thematic Analysis (ATA) are qualitative methods that have not been as widely used/cited compared to content analysis or grounded theory. This paper compares methods of FMA with ATA for mobile health (mHealth) research. The same qualitative data were analyzed separately, using each methodology. The methods, utility, and results of each are compared, and recommendations made for their effective use. Methods Formative qualitative data were collected in eight focus group discussions with physicians and nurses from three hospitals in Bangladesh. Focus groups were conducted via video conference in the local language, Bangla, and audio recorded. Audio recordings were used to complete a FMA of participants' opinions about key features of a novel mHealth application (app) designed to support clinical management in patients with acute diarrhea. The resulting framework matrix was shared with the app design team and used to guide iterative development of the product for a validation study of the app. Subsequently, focus group audio recordings were transcribed in Bangla then translated into English for ATA; transcripts and codes were entered into NVivo qualitative analysis software. Code summaries and thematic memos explored the clinical utility of the mHealth app including clinicians' attitudes about using this decision support tool. Results Each of the two methods contributes differently to the research goal and have different implications for an mHealth research timeline. Recommendations for the effective use of each method in app development include: using FMA for data reduction where specific outcomes are needed to make programming and design decisions and using ATA to capture the more nuanced issues that guide use, product implementation, training, and workflow. Conclusions By describing how both analytical methods were used in this context, this paper provides guidance and an illustration for use of these two methods, specifically in mHealth design.
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Affiliation(s)
- Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Monique Gainey
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, United States
| | - Sabiha Nasrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephanie C Garbern
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Ryan Lantini
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Nour Elshabassi
- School of Public Health, Brown University, Providence, RI, United States
| | - Sufia Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmida Hasnin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nur H Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Eric J Nelson
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
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Levine AC, Barry MA, Gainey M, Nasrin S, Qu K, Schmid CH, Nelson EJ, Garbern SC, Monjory M, Rosen R, Alam NH. Correction: Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. PLoS Negl Trop Dis 2022; 16:e0011026. [PMID: 36584025 PMCID: PMC9803166 DOI: 10.1371/journal.pntd.0011026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pntd.0009266.].
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Genisca AE, Chu TC, Huang L, Gainey M, Adeniji M, Mbong EN, Kennedy SB, Laghari R, Nganga F, Muhayangabo RF, Vaishnav H, Perera SM, Colubri A, Levine AC, Michelow IC. Risk Prediction Score for Pediatric Patients with Suspected Ebola Virus Disease. Emerg Infect Dis 2022; 28:1189-1197. [PMID: 35608611 PMCID: PMC9155869 DOI: 10.3201/eid2806.212265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rapid diagnostic tools for children with Ebola virus disease (EVD) are needed to expedite isolation and treatment. To evaluate a predictive diagnostic tool, we examined retrospective data (2014-2015) from the International Medical Corps Ebola Treatment Centers in West Africa. We incorporated statistically derived candidate predictors into a 7-point Pediatric Ebola Risk Score. Evidence of bleeding or having known or no known Ebola contacts was positively associated with an EVD diagnosis, whereas abdominal pain was negatively associated. Model discrimination using area under the curve (AUC) was 0.87, which outperforms the World Health Organization criteria (AUC 0.56). External validation, performed by using data from International Medical Corps Ebola Treatment Centers in the Democratic Republic of the Congo during 2018-2019, showed an AUC of 0.70. External validation showed that discrimination achieved by using World Health Organization criteria was similar; however, the Pediatric Ebola Risk Score is simpler to use.
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Affiliation(s)
| | | | - Lawrence Huang
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Monique Gainey
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Moyinoluwa Adeniji
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Eta N. Mbong
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Stephen B. Kennedy
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Razia Laghari
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Fiston Nganga
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Rigo F. Muhayangabo
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Himanshu Vaishnav
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
| | - Shiromi M. Perera
- Brown Emergency Medicine, Providence, Rhode Island, USA (A.E. Genisca, H. Vaishnav, A.C. Levine)
- Alpert Medical School of Brown University, Providence (A.E. Genisca, A.C. Levine, I.C. Michelow)
- University of Georgia, Athens, Georgia, USA (T.C. Chu)
- Brown University, Providence (L. Huang, M. Adeniji)
- Rhode Island Hospital, Providence (M. Gainey)
- International Medical Corps, Goma, Democratic Republic of the Congo (E.N. Mbong, R. Laghari, F. Nganga, R.F. Muhayangabo)
- Ministry of Health, Monrovia, Liberia (S.B. Kennedy)
- International Medical Corps, Washington, DC, USA (S.M. Perera)
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (A. Colubri)
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Keddy KH, Saha S, Kariuki S, Kalule JB, Qamar FN, Haq Z, Okeke IN. Using big data and mobile health to manage diarrhoeal disease in children in low-income and middle-income countries: societal barriers and ethical implications. THE LANCET INFECTIOUS DISEASES 2022; 22:e130-e142. [DOI: 10.1016/s1473-3099(21)00585-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
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Nasrin S, Garbern SC, Gainey M, Kanekar S, Monjory M, Ahmed D, Qu K, Chu TC, Schmid CH, Nelson EJ, Ahmed T, Alam NH, Levine AC. Clinical, Sociodemographic and Environmental Risk Factors for Acute Bacterial Diarrhea among Adults and Children over Five Years in Bangladesh. Am J Trop Med Hyg 2022; 106:457-463. [PMID: 34724626 PMCID: PMC8832925 DOI: 10.4269/ajtmh.21-0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/12/2021] [Indexed: 02/03/2023] Open
Abstract
In 2016, diarrheal disease was the eighth leading cause of mortality globally accounting for over 1.6 million deaths with the majority of deaths in adults and children over 5 years. This study aims to investigate the clinical, sociodemographic, and environmental risk factors associated with common bacterial acute diarrhea among adults and children over 5. Data were collected from March 2019 to March 2020 in patients over 5 years presenting with acute gastroenteritis at icddr,b. Stool samples were collected from each patient for culture and polymerase chain reaction (PCR) testing. Bivariate associations between independent variables and stool-testing indicating bacterial etiology were calculated. This analysis included 2,133 diarrheal patients of whom a bacterial enteropathogen was identified in 1,537 (72%). Detection of bacteria was associated with: younger age (OR 0.92; 95% CI: 0.88-0.96), lower mean arterial pressure (OR 0.84; 95% CI: 0.79-0.89), heart rate (OR 1.06; 95% CI: 1.01-1.10), percentage dehydration (OR 1.33; 95% CI: 1.13-1.55), respiration rate (OR 1.23; 95% CI: 1.04-1.46), lower mid-upper arm circumference (OR 0.97; 95% CI: 0.94-0.99), confused/lethargic mental status (OR 1.85; 95% CI: 1.11-3.25), rice watery stool (OR 1.92; 95% CI: 1.54-2.41), and vomiting more than three times in the past 24 hours (OR 1.30; 95% CI: 1.06-1.58). Higher monthly income (OR 0.92; 95% CI: 0.86-0.98), > 8 years of education (OR 0.79; 95% CI: 0.63-1.00), and having more than five people living at home (OR 0.80; 95% CI: 0.66-0.98) were associated with lower odds of bacterial diarrhea. These findings may help guide the development of predictive tools to aid in identifying patients with bacterial diarrhea for timely and appropriate use of antibiotics.
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Affiliation(s)
- Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;,Address correspondence to Sabiha Nasrin, Nutrition and Clinical Services Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani. Mohakhali, Dhaka 1212, Bangladesh. E-mail:
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Monique Gainey
- Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island
| | | | - Mahmuda Monjory
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Tzu-Chun Chu
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Christopher H. Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Eric J. Nelson
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, Florida
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nur H. Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
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Gainey M, Qu K, Garbern SC, Barry MA, Lee JA, Nasrin S, Monjory M, Nelson EJ, Rosen R, Alam NH, Schmid CH, Levine AC. Assessing the performance of clinical diagnostic models for dehydration among patients with cholera and undernutrition in Bangladesh. Trop Med Int Health 2021; 26:1512-1525. [PMID: 34469615 PMCID: PMC9118139 DOI: 10.1111/tmi.13675] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Accurately assessing dehydration severity is a critical step in reducing mortality from diarrhoea, but is complicated by cholera and undernutrition. This study seeks to assess the accuracy of two clinical diagnostic models for dehydration among patients over five years with cholera and undernutrition and compare their respective performance to the World Health Organization (WHO) algorithm. METHODS In this secondary analysis of data collected from the NIRUDAK study, accuracy of the full and simplified NIRUDAK models for predicting severe and any dehydration was measured using the area under the Receiver Operator Characteristic curve (AUC) among patients over five with/without cholera and with/without wasting. Bootstrap with 1000 iterations was used to compare the m-index for each NIRUDAK model to that of the WHO algorithm. RESULTS A total of 2,139 and 2,108 patients were included in the nutrition and cholera subgroups respectively with an overall median age of 35 years (IQR = 42) and 49.6% female. All subgroups had acceptable discrimination in diagnosing severe or any dehydration (AUC > 0.60); though the full NIRUDAK model performed best among patients without cholera, with an AUC of 0.82 (95%CI:0.79, 0.85) and among patients without wasting, with an AUC of 0.79 (95%CI:0.76, 0.81). Compared with the WHO's algorithm, both the full and simplified NIRUDAK models performed significantly better in terms of their m-index (p < 0.001) for all comparisons, except for the simplified NIRUDAK model in the wasting group. CONCLUSIONS Both the full and simplified NIRUDAK models performed less well in patients over five years with cholera and/or wasting; however, both performed better than the WHO algorithm.
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Affiliation(s)
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Meagan A. Barry
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - John Austin Lee
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahmuda Monjory
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Eric J. Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Rochelle Rosen
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Nur H. Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Christopher H. Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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Rosen RK, Garbern SC, Gainey M, Lantini R, Nasrin S, Nelson EJ, Elshabassi N, Alam NH, Sultana S, Hasnin T, Qu K, Schmid CH, Levine AC. Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Research (Preprint). JMIR Hum Factors 2021; 9:e33325. [PMID: 35333190 PMCID: PMC8994146 DOI: 10.2196/33325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The availability of mobile clinical decision support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and apps. Although health care providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns have been raised, including perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective on the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle-income countries. Objective This study aims to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on the preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. Methods From November to December 2020, qualitative data were gathered through 8 web-based focus group discussions with physicians and nurses from 3 Bangladeshi hospitals. Each discussion was conducted in the local language—Bangla—and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo (version 12; QSR International), and applied thematic analysis was used to identify themes that explore the clinical utility of an mHealth app for assessing dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data; thematic memos were written and used for the final analysis. Results Of the 27 focus group participants, 14 (52%) were nurses and 13 (48%) were physicians; 15 (56%) worked at a diarrhea specialty hospital and 12 (44%) worked in government district or subdistrict hospitals. Participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 (SD 9.0) years. Key themes from the qualitative data analysis included current experience with CDS, overall perception of the app’s utility and its potential role in clinical care, barriers to and facilitators of app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. Participants felt that the tool would initially take time to use, but once learned, it could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. In addition, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. Conclusions Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to revise the mobile CDS tool. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.
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Affiliation(s)
- Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Stephanie C Garbern
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Monique Gainey
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, United States
| | - Ryan Lantini
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Sabiha Nasrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Eric J Nelson
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | | | - Nur H Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sufia Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmida Hasnin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kexin Qu
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, United States
| | - Christopher H Schmid
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, United States
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
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Lee JA, Qu K, Gainey M, Kanekar SS, Barry MA, Nasrin S, Alam NH, Schmid CH, Levine AC. Continuous diagnostic models for volume deficit in patients with acute diarrhea. Trop Med Health 2021; 49:70. [PMID: 34488910 PMCID: PMC8422628 DOI: 10.1186/s41182-021-00361-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Episodes of acute diarrhea lead to dehydration, and existing care algorithms base treatment around categorical estimates for fluid resuscitation. This study aims to develop models for the percentage dehydration (fluid deficit) in individuals with acute diarrhea, to better target treatment and avoid the potential sequelae of over or under resuscitation.
Methods This study utilizes data from two prospective cohort studies of patients with acute diarrhea in Dhaka, Bangladesh. Data were collected on patient arrival, including weight, clinical signs and symptoms, and demographic information. Consecutive weights were obtained to determine the true volume deficit of each patient. Data were entered into two distinct forward stepwise regression logistic models (DHAKA for under 5 years and NIRUDAK for 5 years and over). Results A total of 782 patients were included in the final analysis of the DHAKA data set, and 2139 were included in the final analysis of the NIRUDAK data set. The best model for the DHAKA data achieved an R2 of 0.27 and a root mean square error (RMSE) of 3.7 (compared to R2 of 0.06 and RMSE of 5.5 with the World Health Organization child care algorithm) and selected 6 predictors. The best performance model for the NIRUDAK data achieved an R2 of 0.28 and a RMSE of 2.6 (compared to R2 of 0.08 and RMSE of 4.3 with the World Health Organization adolescent/adult care algorithm) and selected 7 predictors with 2 interactions. Conclusions These are the first mathematical models for patients with acute diarrhea that allow for the calculation of a patient’s percentage dehydration (fluid deficit) and subsequent targeted treatment with fluid resuscitation. These findings are an improvement on existing World Health Organization care algorithms. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00361-9.
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Affiliation(s)
- J Austin Lee
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 55 Claverick Street, Providence, RI, 02903, USA.
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | | | | | - Meagan A Barry
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 55 Claverick Street, Providence, RI, 02903, USA
| | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nur H Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Christopher H Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 55 Claverick Street, Providence, RI, 02903, USA
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12
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Barry MA, Qu K, Gainey M, Schmid CH, Garbern SC, Nasrin S, Alam NH, Lee JA, Nelson EJ, Rosen R, Levine AC. Derivation and Internal Validation of a Score to Predict Dehydration Severity in Patients over 5 Years with Acute Diarrhea. Am J Trop Med Hyg 2021; 105:1368-1375. [PMID: 34398821 PMCID: PMC8592223 DOI: 10.4269/ajtmh.21-0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/06/2021] [Indexed: 11/07/2022] Open
Abstract
Diarrheal disease accounts for more than one million deaths annually in patients over 5 years of age. Although most patients can be managed with oral rehydration solution, patients with severe dehydration require resuscitation with intravenous fluids. Scoring systems to assess dehydration have been empirically derived and validated in children under 5 years, but none have been validated for patients over 5 years. In this study, a prospective cohort of 2,172 patients over 5 years presenting with acute diarrhea to International Centre for Diarrhoeal Disease Research, Dhaka Hospital, Bangladesh, were assessed for clinical signs of dehydration. The percent difference between presentation and posthydration stable weight determined severe (≥ 9%), some (3-9%), or no (< 3%) dehydration. An ordinal regression model was derived using clinical signs and demographics and was then converted to a 13-point score to predict none (score of 0-3), some (4-6), or severe (7-13) dehydration. The Novel, Innovative Research for Understanding Dehydration in Adults and Kids (NIRUDAK) Score developed by our team included age, sex, sunken eyes, radial pulse, respiration depth, skin turgor, and vomiting episodes in 24 hours. Accuracy of the NIRUDAK Score for predicting severe dehydration, as measured by the area under the receiver operating characteristic curve, was 0.76 (95% confidence interval = 0.73-0.78), with a sensitivity of 0.78 and a specificity of 0.61. Reliability was also robust, with an Inter-Class Correlation Coefficient of 0.88 (95% confidence interval = 0.84-0.91). This study represents the first empirically derived and internally validated scoring system for assessing dehydration in children ≥ 5 years and adults with acute diarrhea in a resource-limited setting.
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Affiliation(s)
- Meagan A. Barry
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | | | - Christopher H. Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nur H. Alam
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - J. Austin Lee
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eric J. Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Rochelle Rosen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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13
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Garbern SC, Chu TC, Gainey M, Kanekar SS, Nasrin S, Qu K, Barry MA, Nelson EJ, Leung DT, Schmid CH, Alam NH, Levine AC. Multidrug-resistant enteric pathogens in older children and adults with diarrhea in Bangladesh: epidemiology and risk factors. Trop Med Health 2021; 49:34. [PMID: 33966631 PMCID: PMC8108363 DOI: 10.1186/s41182-021-00327-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global public health threat and is increasingly prevalent among enteric pathogens in low- and middle-income countries (LMICs). However, the burden of multidrug-resistant organisms (MDROs) in older children, adults, and elderly patients with acute diarrhea in LMICs is poorly understood. This study's aim was to characterize the prevalence of MDR enteric pathogens isolated from patients with acute diarrhea in Dhaka, Bangladesh, and assess a wide range of risk factors associated with MDR. METHODS This study was a secondary analysis of data collected from children over 5 years, adults, and elderly patients with acute diarrhea at the International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Hospital between March 2019 and March 2020. Clinical, historical, socio-environmental information, and a stool sample for culture and antimicrobial susceptibility testing were collected from each patient. Univariate statistics and multiple logistic regression were used to assess the prevalence of MDR among enteric pathogens and the association between independent variables and presence of MRDOs among culture-positive patients. RESULTS A total of 1198 patients had pathogens isolated by stool culture with antimicrobial susceptibility results. Among culture-positive patients, the prevalence of MDR was 54.3%. The prevalence of MDR was highest in Aeromonas spp. (81.5%), followed by Campylobacter spp. (72.1%), Vibrio cholerae (28.1%), Shigella spp. (26.2%), and Salmonella spp. (5.2%). Factors associated with having MDRO in multiple logistic regression included longer transport time to hospital (>90 min), greater stool frequency, prior antibiotic use prior to hospital presentation, and non-flush toilet use. However, pseudo-R2 was low 0.086, indicating that other unmeasured variables need to be considered to build a more robust predictive model of MDR. CONCLUSIONS MDR enteric pathogens were common in this study population with clinical, historical, and socio-environmental risk factors associated with MDROs. These findings may help guide clinical decision-making regarding antibiotic use and selection in patients at greatest risk of complications due to MDROs. Further prospective research is urgently needed to determine what additional factors place patients at greatest risk of MDRO, and the best strategies to mitigate the spread of MDR in enteric pathogens.
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Affiliation(s)
- Stephanie C Garbern
- Department of Emergency Medicine, Alpert Medical School, Brown University, 55 Claverick, 2nd Floor, Providence, RI, 02903, USA.
| | - Tzu-Chun Chu
- Center for Statistical Sciences, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Monique Gainey
- Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903, USA
| | | | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Meagan A Barry
- Department of Emergency Medicine, Alpert Medical School, Brown University, 55 Claverick, 2nd Floor, Providence, RI, 02903, USA
| | - Eric J Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32610, USA
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of Medicine, 30 N 1900 E, Room 4B319, Salt Lake City, UT, 84132, USA
| | - Christopher H Schmid
- Department of Biostatistics, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Nur H Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Ave, Dhaka, 1212, Bangladesh
| | - Adam C Levine
- Department of Emergency Medicine, Alpert Medical School, Brown University, 55 Claverick, 2nd Floor, Providence, RI, 02903, USA
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