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Huda M, Rabbani F, Shipton L, Aftab W, Khan KS, Marini MG. Listening to Caregivers: Narratives of Health Seeking for Children Under Five with Pneumonia and Diarrhea: Insights from the NIGRAAN Trial in Pakistan. J Multidiscip Healthc 2023; 16:3629-3640. [PMID: 38034877 PMCID: PMC10683648 DOI: 10.2147/jmdh.s417102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Background Understanding health-seeking behaviors of caregivers is important to reduce child mortality. Several factors influence decision-making related to childhood illnesses. Objective The objective of this study was to gather caretaker narratives to develop a comprehensive understanding of the context and process of caregiving at household level during all stages of an episode of diarrhea and pneumonia in children <5. Methods Using a narrative interview approach, stories from caregivers of children <5 were collected from a rural district in Sindh Pakistan. Eleven households with children <5 were randomly selected and purposive sampling was done to interview 20 caregivers. All data collection was conducted privately in participants' homes and informed consent taken. Manual content analysis was carried out by three independent researchers and emerging themes drawn. Results The role of joint family system is integral in making decisions and the child's paternal grandmother, is an important and trusted source of information regarding child sickness in the household. They often promote home remedies with considerable authority prior to formal consultation with the health care system. Caregivers were generally dissatisfied with doctors in the public sector who were perceived to be providing free consultation with a poor quality of care and long waiting time as compared to private doctors. Financial considerations and child support were favorably addressed in households with a joint family system. Conclusion The joint family system provides a strong support system, but also tends to reduce parental autonomy in decision-making and delay first contact with formal health providers. Prevalent home remedies, and authority of elders in the family influence management practices. Interventions for reducing improving child mortality should be cognizant of the context of decision-making and social influences at the household level.
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Affiliation(s)
- Maryam Huda
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - Leah Shipton
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kausar S Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Maria Giulia Marini
- Research and Health Care Director, Fondazione ISTUD per la Cultura d’Impresa e di Gestione, Milan, Italy
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Tian J, Wang XL, Wang LC, Chen F, Tian Y, Ma L, Pan CY, Wang YP. Qiangli Wuhu mixture alleviates LPS-induced pneumonia by inhibiting the TLR4/NF-κB/NLRP3 pathway: a study based on network pharmacology. PHARMACEUTICAL BIOLOGY 2022; 60:1331-1340. [PMID: 35819372 PMCID: PMC9291688 DOI: 10.1080/13880209.2022.2093384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT Qiangli Wuhu (QLWH) mixture is a concoction approved and registered by Ningxia Medical Products Administration. It has therapeutic effects on various types of pneumonia. OBJECTIVE To clarify the mechanisms of QLWH in treating pneumonia. MATERIALS AND METHODS The potential targets of QLWH in the treatment of pneumonia were predicted by network pharmacology. Male, Institute of Cancer Research (ICR) mice were randomly divided into five groups of 12 mice, control, vehicle, QLWH (10 and 20 mg/kg) and dexamethasone (DXM), and orally treated twice daily with normal saline, QLWH or DXM. The pneumonia model was established by tracheal instillation of lipopolysaccharide (LPS). After treatment five days, ELISA, H&E staining and Western blot were used to investigate protective effects of QLWH. RESULTS Nine hundred and ninety-four active ingredients were found through network pharmacology, corresponding to 135 targets for the treatment of pneumonia; compared to the vehicle group, QLWH (10 and 20 mg/kg) significantly decreased the levels of TNF-α (14.3% and 28.8%), IL-1β (23.9% and 42.8%) and IL-6 (13.2% and 16.1%), increased the levels of IL-10 (134.3% and 172.9%); in terms of mechanism, QLWH down-regulated TLR4/NF-κB/NLRP3 axis related proteins in lung tissue of pneumonia model mice (p < 0.05). DISCUSSION AND CONCLUSIONS This study combined network pharmacology and animal experiments, providing effective evidence for the clinical promotion of QLWH. Meanwhile, it is of significance for further development.
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Affiliation(s)
- Jie Tian
- Ningxia Chinese Medicine Research Center, Yinchuan, China
| | - Xiao-Long Wang
- Ningxia Chinese Medicine Research Center, Yinchuan, China
- School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | | | - Fei Chen
- Ningxia Chinese Medicine Research Center, Yinchuan, China
- School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Yun Tian
- Ningxia Chinese Medicine Research Center, Yinchuan, China
- School of Education, Monash University, Melbourne, Australia
| | - Li Ma
- Ningxia Chinese Medicine Research Center, Yinchuan, China
| | - Chao-Yun Pan
- Ningxia Chinese Medicine Research Center, Yinchuan, China
| | - Yan-Ping Wang
- Ningxia Chinese Medicine Research Center, Yinchuan, China
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Mekonnen TC, Tadesse SE, Dawed YA, Cherie N, Abebe H, Shumye G, Mohammed F, Hussien A. The role of nutrition‐sensitive agriculture combined with behavioral interventions in childhood growth in Ethiopia: An adequacy evaluation study. Health Sci Rep 2022; 5:e524. [PMID: 35284644 PMCID: PMC8893299 DOI: 10.1002/hsr2.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The study aimed to investigate the role of nutrition‐sensitive and specific interventions along with nutrition education on child stunting during the first 1000 days in Ethiopia. Methods An adequacy evaluation study was used to see changes between the baseline and end‐line data after following for 1 year. A sample of 170 mother‐child pairs who had a 1‐year followed up was used to detect differences. We performed structural equation modeling to elucidate changes in feeding behaviors, socioeconomic status, water, sanitation and hygiene on child linear growth. Furthermore, the independent effect of covariates on child linear growth was handled using a general linear model. Results A total of 170 and 270 mother‐child dyads were interviewed at baseline and end‐line surveys, respectively. After about 1 year of intervention, the annual rate of stunting prevalence declined from 29.3% (95% confidence interval [CI] = 18.6, 42.7) to 16.4% (95% CI = 10.7, 24.2). There was a significant change in the mean of length‐for‐age Z‐score which changed from −1.18 to −0.45 (P < .034). Adjusting for the different constructs of the health belief model, child sex, age, feeding behaviors, and dietary diversity, one egg consumption per day was responsible for the most significant variability explained (36%) for stunting reduction. Conclusions Sustainable access to egg consumption for children below 2 years experienced a substantial reduction in childhood stunting. A combination of nutrition‐sensitive agricultural and direct nutrition interventions along with behavioral‐based education is a sustainable strategy in reducing and preventing child growth from faltering in the early life stages.
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Affiliation(s)
- Tefera Chane Mekonnen
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Sisay Eshete Tadesse
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Yeshimebet Ali Dawed
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Nigus Cherie
- Reproductive and Family Health Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Hunegnaw Abebe
- Departments of Animal Science College of Agriculture, Wollo University Dessie Ethiopia
| | - Getachew Shumye
- Department of Plant Science College of Agriculture, Wollo University Dessie Ethiopia
| | - Foziya Mohammed
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Ahmed Hussien
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
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Sun C, Yan S, Jiang K, Wang C, Dong X. A preliminary nomogram constructed for early diagnosis of bronchitis obliterans in children with severe pneumonia. Transl Pediatr 2021; 10:485-493. [PMID: 33850807 PMCID: PMC8039784 DOI: 10.21037/tp-20-272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To establish and internally validate a nomogram for early diagnosis of bronchitis obliterans in children with severe pneumonia. METHODS The diagnostic model was established using a dataset of 147 pediatric patients with severe pneumonia. The clinical characteristics of bronchitis obliterans were determined using the least absolute shrinkage and selection operator method. According to the results of the multivariate logistic regression analysis, an individual nomogram was established, the C-index, calibration plot, and decision curve analysis were used to evaluate the performance of the nomogram. RESULTS Adenovirus infection, length of symptoms, percentage of macrophages in bronchial alveolar lavage fluid, and mucosal abnormalities were all important clinical characteristics included in the nomogram. According to internal validation, the C-index of nomogram was 0.91 (C-index, 0.878 to 0.942), suggesting that the nomogram has excellent discrimination. The nomogram showed good calibration with the Hosmer-Lemeshow test demonstrating no statistical significance. The net reclassification index was 0.2022 (95% CI, 0.008 to 0.3968; P=0.042), and the integrated discrimination improvement was 0.0975 (95% CI, 0.026 to 0.169; P=0.008). Decision curve analysis showed that the nomogram is clinically useful. CONCLUSIONS This nomogram can help clinicians make early diagnoses of bronchitis obliterans in children for whom membranous tissue has not yet formed.
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Affiliation(s)
- Chao Sun
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Silei Yan
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kun Jiang
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chao Wang
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Dong
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Atypical Enteropathogenic Escherichia coli: from Kittens to Humans and Beyond! Infect Immun 2021; 89:IAI.00752-20. [PMID: 33361199 DOI: 10.1128/iai.00752-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atypical enteropathogenic Escherichia coli (aEPEC) are associated with diarrhea worldwide, yet genome-wide investigations to probe their virulome are lacking. In this issue of Infection and Immunity, V. E. Watson, T. H. Hazen, D. A. Rasko, M. E. Jacob, et al. (IAI 89:e00619-20, 2020, https://doi.org/10.1128/IAI.00619-20) sequenced aEPEC isolates from diarrheic and asymptomatic kittens. Using phylogenomics, they demonstrated that these isolates were genetically indistinguishable from human isolates, suggesting that kittens may serve as a reservoir and, perhaps, a much-needed model to interrogate aEPEC virulence. The diarrheic isolates were hypermotile, suggesting that this phenotype may distinguish virulent strains from their innocuous counterparts.
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Jacob Arriola KR, Ellis A, Webb-Girard A, Ogutu EA, McClintic E, Caruso B, Freeman MC. Designing integrated interventions to improve nutrition and WASH behaviors in Kenya. Pilot Feasibility Stud 2020; 6:10. [PMID: 32042436 PMCID: PMC6998333 DOI: 10.1186/s40814-020-0555-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/23/2020] [Indexed: 01/05/2023] Open
Abstract
Background Child stunting, an indicator of chronic malnutrition, is a global public health problem. Malnutrition during pregnancy and the first 2 years of life undermines the survival, growth, and development of children. Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. The aim of this study was to describe a systematic, theoretically informed approach (that drew from the Starr and Fornoff approach to the Theory of Change development and the Behavior Change Wheel approach) to design a multi-component and integrated social and behavior change intervention to improve WASH and nutrition-related behaviors in western Kenya. Methods This intervention was developed to be integrated into an existing project that utilized the care group model and aimed to create a culture of care and support for HIV/AIDS-affected children under two and their caregivers and was executed by local partners. We tested the newly created intervention packages in user-testing trials using an adapted Trials of Improved Practices approach to pilot acceptability and feasibility. Results Using authentic stakeholder engagement and relevant theories, we conducted an 8-step process: (1) conduct mixed methods formative research, (2) prioritize target behaviors, (3) use causal analysis to create problem trees, (4) develop solution trees and articulate assumptions and rationales for change, (5) link solution trees to intervention functions, (6) develop the intervention plan, (7) create the intervention packages, and (8) test and refine the intervention packages. Conclusions This study highlights the need to take a multi-sectorial, integrated approach that integrates contextually relevant behavior change theories with the experiential knowledge gleaned from stakeholders into the design of interventions that seek to reduce child stunting. This process resulted in the creation of intervention packages that grouped behaviors thematically to be most relevant and responsive to the population context. This work has the potential to make important contributions towards achievement of the United Nations’ sustainable development goals.
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Affiliation(s)
- Kimberly R Jacob Arriola
- 1Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Anna Ellis
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Amy Webb-Girard
- 3Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emily Awino Ogutu
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emilie McClintic
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Bethany Caruso
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Matthew C Freeman
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
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Zhong Q, Cheng F, Liang J, Wang X, Chen Y, Fang X, Hu L, Hang Y. Profiles of volatile indole emitted by Escherichia coli based on CDI-MS. Sci Rep 2019; 9:13139. [PMID: 31511564 PMCID: PMC6739388 DOI: 10.1038/s41598-019-49436-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/24/2019] [Indexed: 12/25/2022] Open
Abstract
Escherichia coli is an important pathogen of nosocomial infection in clinical research, Thus, exploring new methods for the rapid detection of this pathogen is urgent. We reported the early release of molecular volatile indole vapour of E. coli cultures and blood cultures analyzed by direct atmospheric corona discharge ionization mass spectrometry (CDI-MS). The concentration of indole in E. coli cultures remarkably increases during the early log and lag phases of bacterial growth, thereby enabling early detection. Technical replicates were cultivated for 3 days for reference diagnosis using current conventional bacteraemia detection. A reference MS screen of common microbes from other genera confirmed that the peaks at m/z 116 signal corresponded to indole were specifically present in E. coli. Our results indicated that volatile indole based on CDI-MS without the need for any sample pretreatment is highly suitable for the reliable and cost-efficient differentiation of E. coli, especially for bacteraemia in humans.
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Affiliation(s)
- Qiaoshi Zhong
- Department of clinical laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China
| | - Feng Cheng
- Department of clinical laboratory, Jiangxi Chest (third people) Hospital, Nanchang, 330006, P.R. China
| | - Juchao Liang
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation, East China Institute of Technology, Nanchang, 330013, P.R. China
| | - Xiaozhong Wang
- Department of clinical laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China
| | - Yanhui Chen
- Department of clinical laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China
| | - Xueyao Fang
- Department of clinical laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China
| | - Longhua Hu
- Department of clinical laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China.
| | - Yaping Hang
- Department of clinical laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P.R. China.
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Von Saint André-Von Arnim AO, Okeyo B, Cook N, Steere M, Roberts J, Howard CRA, Stanberry LI, John-Stewart GC, Shirk A. Feasibility of high-flow nasal cannula implementation for children with acute lower respiratory tract disease in rural Kenya. Paediatr Int Child Health 2019; 39:177-183. [PMID: 30451100 DOI: 10.1080/20469047.2018.1536874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: High-flow nasal cannula (HFNC) is a well-established respiratory support device in high-income countries, but to our knowledge, its use in sub-Saharan Africa has not been reported. This feasability study describes the implementation process of HFNC in rural Kenya. Methods: HFNC was implemented in intensive care and high dependency units at Kijabe Hospital, Kenya for children with acute lower respiratory disease. Rate of intubation was compared with historical controls and challenges of implementation described. Results: Fifteen patients received HFNC between January and November 2016, and compared to 25 historical control patients. Both groups had many comorbidities, and control patients were significantly younger. There were no significant differences in clinical outcome between the groups: 5 (33%) HFNC vs 12 (48%) controls required intubation; 10 (67%) HFNC vs 22 (88%) controls survived to discharge; and the HFNC required 3 vs the controls' 4 days on respiratory support. The greatest technical issues encountered were large pressure differences between air from a wall outlet (wall air) and oxygen and an inability to automatically refill humidifier water chambers. Conclusion: HFNC in limited-resource settings is feasible but there were technical challenges and concern about the increased workload. The small sample size, heterogeneous population, availability of oxygen and blending of wall air at the study site limit inferences for other sites in low- and middle-income countries. Abbreviations: ALRI, acute lower respiratory infection; CPAP, continuous positive airway pressure; ETAT, emergency triage, assessment and treatment; HDU, high dependency unit; HFNC, high-flow nasal cannula; HIC, high-income country; HR, heart rate; ICU, intensive care unit; LMIC, low- and middle-income countries; PSI, pounds per square inch; RR, respiratory rate; mRISC, modified Respiratory Index of Severity in Children.
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Affiliation(s)
| | - Bob Okeyo
- b African Inland Church , Kijabe Hospital , Kijabe , Kenya
| | - Nathan Cook
- b African Inland Church , Kijabe Hospital , Kijabe , Kenya
| | - Mardi Steere
- b African Inland Church , Kijabe Hospital , Kijabe , Kenya
| | - Joan Roberts
- c Seattle Children's Research Institute , Seattle , WA , USA
| | | | - Larissa I Stanberry
- d Departments of Global Health, Epidemiology, Medicine and Pediatrics , University of Washington , Seattle , WA , USA
| | - Grace C John-Stewart
- e Department of Pediatrics , University of Washington and Seattle Children's , Seattle , WA , USA
| | - Arianna Shirk
- b African Inland Church , Kijabe Hospital , Kijabe , Kenya
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Yang X, Sheng G. YKL-40 levels are associated with disease severity and prognosis of viral pneumonia, but not available in bacterial pneumonia in children. BMC Pediatr 2018; 18:381. [PMID: 30514252 PMCID: PMC6280336 DOI: 10.1186/s12887-018-1345-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022] Open
Abstract
Background Viral pneumonia is the main type of community-acquired pneumonia (CAP) in children. YKL-40, a chitinase-like protein, is regarded as a biomarker of the degree of inflammation. Methods Children who were diagnosed with CAP, including viral pneumonia, bacterial pneumonia, and dual infection, were included in the cohort study. The pathogenic diagnosis depended on PCR and immunoassay test. YKL-40 levels were examined twice by enzyme-linked immunoassay (ELISA). Results Serum YKL-40 levels were higher in patients with pneumonia than in healthy controls. The admission levels of YKL-40 in serum and Bronchoalveolar lavage (BALFs) indicated a positive correlation with the serum levels of C-reactive protein and other inflammatory cytokines (IL-6 and TNF-α). The disease severity have no correlation with the admission serum levels of YKL-40. Meanwhile, reductions in YKL-40 levels from initial admission levels to day 5 post-admission were correlated with disease severity. The multiple logistic analysis indicated the decreased extent of serum YKL-40 level as an independent prognostic predictor of severe cases in patients with viral pneumonia. Conclusions Reductions in serum YKL-40 levels on day 5 after receiving therapy is a possible prognostic biomarker for children with viral pneumonia.
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Affiliation(s)
- Xingge Yang
- Pediatrics, the First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Guangyao Sheng
- Pediatrics, the First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, Henan, China.
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Qadori M, Flem E, Bekkevold T, Døllner H, Gilje AM, Rojahn A, Størdal K. Hypoglycaemia was common in acute gastroenteritis in a prospective hospital-based study, but electrolyte imbalances were not. Acta Paediatr 2018. [PMID: 29532511 DOI: 10.1111/apa.14318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Using routine blood sampling in a gastroenteritis diagnostic workup is debatable. This study examined the relationship between the severity of acute gastroenteritis and blood test abnormalities. METHODS We prospectively enrolled children under five years of age referred for outpatient or inpatient management for gastroenteritis from February 2014 to April 2016. The four study hospitals cared for 30% of Norwegian children. The severity of gastroenteritis was assessed using Vesikari scores. Blood samples were analysed at each hospital. RESULTS The 659 children had a median age of 19 months. The rotavirus was found in 314/514 children with stool samples (61%). Severe gastroenteritis, indicated by a Vesikari score of ≥11, was found in 392/549 (71%) with completed scores, but only 40 of 649 (6%) assessed for dehydration were more than 5% dehydrated. None had sodium <130 mmol/L. Glucose of 3.0-3.3 mmol/L was detected in 52/578 (9%) and <3.0 mmol/L in 33/578 (6%). Hypoglycaemia, elevated urea, low bicarbonate and negative base excess were associated with disease severity. The duration of vomiting and the rotavirus infection were associated with hypoglycaemia. Elevated urea, low bicarbonate and negative base excess had high specificities, but low sensitivities. CONCLUSION Hypoglycaemia was common in acute gastroenteritis, but major electrolyte disturbances were infrequent.
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Affiliation(s)
- Mohammed Qadori
- Department of Paediatrics; Ostfold Hospital Trust; Grålum Norway
| | - Elmira Flem
- Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - Terese Bekkevold
- Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - Henrik Døllner
- Institute of Laboratory Medicine; Children's and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
- Department of Paediatrics; St Olavs University Hospital; Trondheim Norway
| | - Ann Marit Gilje
- Department of Paediatrics; Stavanger University Hospital; Stavanger Norway
| | - Astrid Rojahn
- Department of Paediatrics; Oslo University Hospital; Ullevaal Norway
| | - Ketil Størdal
- Department of Paediatrics; Ostfold Hospital Trust; Grålum Norway
- Child Health; Norwegian Institute of Public Health; Oslo Norway
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Nuzhat S, Ahmed T, Kawser CA, Khan AI, Islam SMR, Shahrin L, Shahunja KM, Shahid ASMSB, Al Imran A, Chisti MJ. Age specific fast breathing in under-five diarrheal children in an urban hospital: Acidosis or pneumonia? PLoS One 2017; 12:e0185414. [PMID: 28953928 PMCID: PMC5617187 DOI: 10.1371/journal.pone.0185414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 09/12/2017] [Indexed: 11/08/2022] Open
Abstract
Background Children with diarrhea often present with fast breathing due to metabolic acidosis from dehydration. On the other hand, age specific fast breathing is the cornerstone for the diagnosis of pneumonia following classification of pneumonia recommended by the World Health Organization (WHO). Correction of metabolic acidosis by rehydrating the diarrheal children requires time, which delays early initiation of appropriate antimicrobials for pneumonia and thereby increases the risk of deaths. We need to further investigate the simple clinical features other than fast breathing which might help us in earliest diagnosis of pneumonia in children with diarrhea Thus, the objective of our study was to identify other contributing clinical features that may independently help for early diagnosis of pneumonia in diarrheal children who present with age specific fast breathing. Methods This was an unmatched case-control study. Diarrheal children aged 0–59 months, admitted to Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) during January 2014 to December 2014 having age specific fast breathing (<2 month ≥60 breath/min, 2–11 months ≥50 breaths/min, >11–59 months ≥40 breaths/min) were studied. The study children with clinical and radiological pneumonia constituted the cases (n = 276) and those without pneumonia constituted the controls (n = 446). Comparison of clinical features and outcomes between the cases and the controls was made. Results The distribution of acidosis among the cases and the controls was comparable (35% vs. 41%, p = 0.12). The cases had proportionately higher deaths compared to the controls, however, the difference was not statistically significant (3% vs. 1%; p = 0.23). In logistic regression analysis after adjusting for potential confounders, the cases were independently associated with cough (OR = 62.19, 95% CI = 27.79–139.19; p<0.01) and chest wall indrawing (OR = 31.05, 95%CI = 13.43–71.82; p<0.01) and less often had severe acute malnutrition (OR = 0.33, 95%CI = 0.13–0.79; p<0.01). The sensitivity and specificity of cough were 83% (78–87%) and 93% (91–96%). The sensitivity and specificity for lower chest wall indrawing were 65% (59–71%) and 95% (93–97%). However, the sensitivity and specificity of cough and lower chest wall indrawing combined were 94% (89–97%) and 99% (97–100%). Conclusion and significance Thus, diarrheal children having fast breathing who present with cough and/or lower chest wall indrawing, irrespective of presence or absence of metabolic acidosis, are more likely to have radiological pneumonia. The results underscore the importance of early identification of these simple clinical features that may help to minimize potential delay due to rehydration in initiating prompt treatment of pneumonia in order to reduce fatal consequences in such children.
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Affiliation(s)
- Sharika Nuzhat
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Chowdhury Ali Kawser
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Azharul Islam Khan
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S. M. Rafiqul Islam
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S. M. S. B. Shahid
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdullah Al Imran
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
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12
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Sreeramareddy CT, Low YP, Forsberg BC. Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985-2012. BMC Pediatr 2017; 17:83. [PMID: 28320354 PMCID: PMC5360044 DOI: 10.1186/s12887-017-0836-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 03/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries. METHODS We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys. RESULTS Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%. CONCLUSIONS Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.
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Affiliation(s)
| | - Yue-Peng Low
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Birger Carl Forsberg
- Health Systems and Policy Research (HSP), Department of Public Health Sciences, Karolinska Institutet, S-17177 Stockholm, Sweden
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Chowdhury R, Taneja S, Bhandari N, Sinha B, Upadhyay RP, Bhan MK, Strand TA. Vitamin-D deficiency predicts infections in young north Indian children: A secondary data analysis. PLoS One 2017; 12:e0170509. [PMID: 28273084 PMCID: PMC5342185 DOI: 10.1371/journal.pone.0170509] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/05/2017] [Indexed: 02/05/2023] Open
Abstract
Background Recent studies have demonstrated a relationship between poor vitamin D status and respiratory infections and diarrhea among young children. Acute lower respiratory infections (ALRI) and diarrhea are among the two most important causes of death in under-5 children. In this paper, we examined the extent to which vitamin-D deficiency (<10 ng/ml) predicts ALRI, clinical pneumonia and diarrhea among 6 to 30 months old children. Methods We used data from a randomized controlled trial (RCT) of daily folic acid and/or vitamin B12 supplementation for six months in 6 to 30 months old children conducted in Delhi, India. Generalized estimating equations (GEE) were used to examine the associations between vitamin-D deficiency and episodes of ALRI, clinical pneumonia and diarrhea. Results Of the 960 subjects who had vitamin-D concentrations measured, 331(34.5%) were vitamin-D deficient. We found, after controlling for relevant potential confounders (age, sex, breastfeeding status, wasting, stunting, underweight, anemia status and season), that the risk of ALRI was significantly higher among vitamin-D deficient (OR 1.26; 95% CI: 1.03 to 1.55) compared to vitamin-D-replete children in the six months follow-up period. Vitamin-D status was not associated with episodes of diarrhea or clinical pneumonia. Conclusion Vitamin-D deficiency is common in young children in New Delhi and is associated with a higher risk of ALRI. The role of vitamin D in Indian children needs to be elucidated in further studies.
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Affiliation(s)
- Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
- * E-mail:
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bireshwar Sinha
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Maharaj Kishan Bhan
- Indian Institute of Technology - Delhi, New Delhi, India
- Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
| | - Tor A. Strand
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
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Yin G, Zeng Q, Zhao H, Wu P, Cai S, Deng L, Jiang W. Effect and mechanism of calpains on pediatric lobar pneumonia. Bioengineered 2016; 8:374-382. [PMID: 27786573 PMCID: PMC5553339 DOI: 10.1080/21655979.2016.1234544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Lobar pneumonia, one of the community-acquired pneumonia (CAP), is a common pediatric low respiratory tract infection. Calpains are Ca2+-activated cysteine proteases whose activation mechanism is elusive. The present study was undertaken to detect the role and mechanism of calpains in pediatric lobar pneumonia. The human acute lung infection model (ALIM) was constructed and infected by Streptococcus. Enzyme-linked immunosorbent assay (ELISA) was used to measure interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α. We observed the lactate dehydrogenase (LDH) release, calpains activity and calpain inhibitor effects in ALIM. The expression of proliferating cell nuclear antigen (PCNA) protein was quantified by western blotting. Then the effects of calpain 1 and 2 knockdown on expressions of inflammation factors and PCNA protein, LDH release and apoptosis were evaluated in lung MRC-5 cells. In constructed ALIM, expressions of IL-6 (P < 0.01), IL-8 (P < 0.01), TNF-α (P < 0.05) and PCNA protein (P < 0.05) were significantly reduced by the calpain inhibitor. Expressions of IL-6, IL-8, TNF-α, PCNA protein and relative LDH release were statistically reduced by the small interfering (si) RNA-calpain 1 and 2 in MRC-5 cells (P < 0.05). Calpains silence increased apoptotic cells from 5% (negative control) to more than 20% in MRC-5 cells. The present study suggests that calpains possess a significant effect on inflammations, cell proliferation and apoptosis. Suppression of calpains may provide a potential therapeutic target of lobar pneumonia.
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Affiliation(s)
- Genquan Yin
- a Chronic Airways Disease Laboratory, Department of Respiratory and Critical Care Medicine , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong Province , China.,b Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Qiang Zeng
- b Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Haijin Zhao
- a Chronic Airways Disease Laboratory, Department of Respiratory and Critical Care Medicine , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong Province , China
| | - Peiqiong Wu
- b Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Shaoxi Cai
- a Chronic Airways Disease Laboratory, Department of Respiratory and Critical Care Medicine , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong Province , China
| | - Li Deng
- b Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Wenhui Jiang
- b Guangzhou Women and Children's Medical Center , Guangzhou Medical University , Guangzhou , Guangdong Province , China
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15
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Salam RA, Qureshi RN, Sheikh S, Khowaja AR, Sawchuck D, Vidler M, von Dadelszen P, Zaidi S, Bhutta Z. Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan. Reprod Health 2016; 13:107. [PMID: 27719680 PMCID: PMC5056493 DOI: 10.1186/s12978-016-0214-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan. Methods A qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10. Results Findings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers. Conclusion There is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision. Trial registration ClinicalTrial.gov, NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0214-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rehana A Salam
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rahat Najam Qureshi
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. .,Department of Obstetrics and Gynaecology, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Sana Sheikh
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Asif Raza Khowaja
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R1J8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's, University of London, London, SW17 0RE, UK
| | - Shujaat Zaidi
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Bhutta
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, M5G 2L3, Canada
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Aluisio AR, Maroof Z, Chandramohan D, Bruce J, Masher MI, Manaseki-Holland S, Ensink JHJ. Risk factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan: a prospective cohort study. PLoS One 2015; 10:e0116342. [PMID: 25679979 PMCID: PMC4332656 DOI: 10.1371/journal.pone.0116342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/08/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Childhood diarrheal illnesses are a major public health problem. In low-income settings data on disease burden and factors associated with diarrheal illnesses are poorly defined, precluding effective prevention programs. This study explores factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan. METHODS A cohort of 1-11 month old infants was followed for 18 months from 2007-2009. Data on diarrheal episodes were gathered through active and passive surveillance. Information on child health, socioeconomics, water and sanitation, and hygiene behaviors was collected. Factors associated with recurrent diarrheal illnesses were analyzed using random effects recurrent events regression models. RESULTS 3,045 children were enrolled and 2,511 (82%) completed 18-month follow-up. There were 14,998 episodes of diarrheal disease over 4,200 child-years (3.51 episodes/child-year, 95%CI 3.40-3.62). Risk of diarrheal illness during the winter season was 63% lower than the summer season (HR = 0.37, 95%CI 0.35-0.39, P<0.001). Soap for hand washing was available in 72% of households and 11.9% had toilets with septic/canalization. Half of all mothers reported using soap for hand washing. In multivariate analysis diarrheal illness was lower among children born to mothers with post-primary education (aHR = 0.79, 95%CI 0.69-0.91, p = 0.001), from households where maternal hand washing with soap was reported (aHR = 0.83, 95%CI 0.74-0.92, p<0.001) and with improved sanitation facilities (aHR = 0.76, 95%CI 0.63-0.93, p = 0.006). Malnourished children from impoverished households had significantly increased risks for recurrent disease [(aHR = 1.15, 95%CI 1.03-1.29, p = 0.016) and (aHR = 1.20, 95%CI 1.05-1.37, p = 0.006) respectively]. CONCLUSIONS Maternal hand washing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and utilization suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population and these findings support multi-sector interventions to combat illness. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00548379 https://www.clinicaltrials.gov/ct2/show/NCT00548379.
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Affiliation(s)
- Adam R. Aluisio
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Zabihullah Maroof
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Bruce
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mohammad I. Masher
- Department of Paediatrics, Kabul Medical University, Kabul, Afghanistan Department of Pediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Semira Manaseki-Holland
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jeroen H. J. Ensink
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hu J, Torres AG. Enteropathogenic Escherichia coli: foe or innocent bystander? Clin Microbiol Infect 2015; 21:729-34. [PMID: 25726041 DOI: 10.1016/j.cmi.2015.01.015] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 01/27/2023]
Abstract
Enteropathogenic Escherichia coli (EPEC) remain one the most important pathogens infecting children and they are one of the main causes of persistent diarrhoea worldwide. Historically, typical EPEC (tEPEC), defined as those isolates with the attaching and effacement (A/E) genotype (eae(+)), which possess bfpA(+) and lack the stx(-) genes are found strongly associated with diarrhoeal cases. However, occurrence of atypical EPEC (aEPEC; eae(+)bfpA(-)stx(-)) in diarrhoeal and asymptomatic hosts has made investigators question the role of these pathogens in human disease. Current epidemiological data are helping to answer the question of whether EPEC is mainly a foe or an innocent bystander during infection.
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Affiliation(s)
- J Hu
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - A G Torres
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA; Department of Pathology and Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX, USA.
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18
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Rabbani F, Mukhi AAA, Perveen S, Gul X, Iqbal SP, Qazi SA, Syed IA, Shaikh KH, Aftab W. Improving community case management of diarrhoea and pneumonia in district Badin, Pakistan through a cluster randomised study--the NIGRAAN trial protocol. Implement Sci 2014; 9:186. [PMID: 25490971 PMCID: PMC4297376 DOI: 10.1186/s13012-014-0186-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan’s Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community case management (CCM) of childhood pneumonia and diarrhoea will improve. Methods/Design NIGRAAN is a cluster-randomised trial in District Badin, Pakistan. There are approximately 1100 LHWs supervised by 36 LHSs in Badin. For this study, each LHS serves as a cluster. All LHSs working permanently in Badin who regularly conduct and report field visits are eligible. Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique. Five LHWs from each LHSs are also randomly picked. All 34 LHSs and 170 LHWs will be actively monitored. The intervention consists of training to build LHS knowledge and skills, clinical mentorship and written feedback to LHWs. Pre- and post-intervention assessments of LHSs, LHWs and community caregivers will be conducted via focus group discussions, in-depth interviews, knowledge assessment questionnaires, skill assessment scorecards and household surveys. Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level. Discussion NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia. No significant harm to participants is anticipated. The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally. Trial registration NIGRAAN is registered with the ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Aftab Akbar Ali Mukhi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Shagufta Perveen
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Xaher Gul
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Saleem Perwaiz Iqbal
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Shamim Ahmed Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
| | - Iqbal Azam Syed
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Khalid Hussain Shaikh
- Department of Health, Government of Sindh, 6th floor, New Sindh Secretariat, Karachi, Pakistan.
| | - Wafa Aftab
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
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Lassi ZS, Das JK, Salam RA, Bhutta ZA. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings. Reprod Health 2014; 11 Suppl 2:S2. [PMID: 25209692 PMCID: PMC4160921 DOI: 10.1186/1742-4755-11-s2-s2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media campaigns and community education as standalone interventions. Future efforts should be concerted on increasing the availability and training of the community based skilled health workers especially in resource limited settings where the highest burden exists with limited resources to mobilize.
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Affiliation(s)
- Zohra S Lassi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- Program for Global Pediatric Research, Hospital For Sick Children, Toronto
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Jiang NM, Tofail F, Moonah SN, Scharf RJ, Taniuchi M, Ma JZ, Hamadani JD, Gurley ES, Houpt ER, Azziz-Baumgartner E, Haque R, Petri WA. Febrile illness and pro-inflammatory cytokines are associated with lower neurodevelopmental scores in Bangladeshi infants living in poverty. BMC Pediatr 2014; 14:50. [PMID: 24548288 PMCID: PMC3936797 DOI: 10.1186/1471-2431-14-50] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/11/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND An estimated one-third of children younger than 5 years in low- and middle-income countries fail to meet their full developmental potential. The first year of life is a period of critical brain development and is also when most of the morbidity from infection is suffered. We aimed to determine if clinical and biological markers of inflammation in the first year of life predict cognitive, language, and motor outcomes in children living in an urban slum in Bangladesh. METHODS Children living in Dhaka, Bangladesh were observed from birth until 24 months of age. Febrile illness was used as a clinical marker of inflammation and elevated concentrations of inflammation-related cytokines (IL-1β, IL-6, TNF-α, IL-4, IL-10) in sera collected from a subset of the cohort (N = 127) at 6 months of age were used as biomarkers of inflammation. Psychologists assessed cognitive, language, and motor development using a culturally adapted version of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 12 (N = 398) and 24 months of age (N = 210). We tested for the ability of febrile illness and elevated cytokine levels to predict developmental outcomes, independent of known predictors of stunting, family income, and maternal education. RESULTS Every additional 10 days of fever was associated with a 1.9 decrease in language composite score and a 2.1 decrease in motor composite score (p = 0.005 and 0.0002, respectively). Elevated levels of the pro-inflammatory cytokines IL-1β (> 7.06 pg/mL) and IL-6 (> 10.52 pg/mL) were significantly associated with a 4.9 and 4.3 decrease in motor score, respectively. Conversely, an elevated level of the Th-2 cytokine IL-4 (> 0.70 pg/mL) was associated with a 3.6 increase in cognitive score (all p < 0.05). CONCLUSIONS Clinical and biological markers of inflammation in the first year of life were significantly associated with poor neurodevelopmental outcomes. Conversely, a Th2-like response was associated with a better outcome. These findings suggest that markers of inflammation could serve as prognostic indicators and potentially lead to immune-based therapies to prevent developmental delays in at-risk children.
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Affiliation(s)
- Nona M Jiang
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, PO Box 801340, Charlottesville, VA 22908, USA
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shannon N Moonah
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, PO Box 801340, Charlottesville, VA 22908, USA
| | - Rebecca J Scharf
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, PO Box 801340, Charlottesville, VA 22908, USA
- Division of Developmental Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mami Taniuchi
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, PO Box 801340, Charlottesville, VA 22908, USA
| | - Jennie Z Ma
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jena D Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, PO Box 801340, Charlottesville, VA 22908, USA
| | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, PO Box 801340, Charlottesville, VA 22908, USA
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Aluisio AR, Maroof Z, Chandramohan D, Bruce J, Mughal MZ, Bhutta Z, Walraven G, Masher MI, Ensink JHJ, Manaseki-Holland S. Vitamin D₃supplementation and childhood diarrhea: a randomized controlled trial. Pediatrics 2013; 132:e832-40. [PMID: 24019420 PMCID: PMC3866796 DOI: 10.1542/peds.2012-3986] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the effect of vitamin D3 supplementation on the incidence and risk for first and recurrent diarrheal illnesses among children in Kabul, Afghanistan. METHODS This double-blind placebo-controlled trial randomized 3046 high-risk 1- to 11-month-old infants to receive 6 quarterly doses of oral vitamin D3 (cholecalciferol 100000 IU) or placebo in inner city Kabul. Data on diarrheal episodes (≥ 3 loose/liquid stools in 24 hours) was gathered through active and passive surveillance over 18 months of follow-up. Time to first diarrheal illness was analyzed by using Kaplan-Meier plots. Incidence rates and hazard ratios (HRs) were calculated by using recurrent event Poisson regression models. RESULTS No significant difference existed in survival time to first diarrheal illness (log rank P = .55). The incidences of diarrheal episodes were 3.43 (95% confidence interval [CI], 3.28-3.59) and 3.59 per child-year (95% CI, 3.44-3.76) in the placebo and intervention arms, respectively. Vitamin D3 supplementation was found to have no effect on the risk for recurrent diarrheal disease in either intention-to-treat (HR, 1.05; 95% CI, 0.98-1.17; P = .15) or per protocol (HR, 1.05; 95% CI, 0.98-1.12; P = .14) analyses. The lack of preventive benefit remained when the randomized population was stratified by age groups, nutritional status, and seasons. CONCLUSIONS Quarterly supplementation with vitamin D3 conferred no reduction on time to first illness or on the risk for recurrent diarrheal disease in this study. Similar supplementation to comparable populations is not recommended. Additional research in alternative settings may be helpful in elucidating the role of vitamin D3 supplementation for prevention of diarrheal diseases.
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Affiliation(s)
- Adam R Aluisio
- MSc, SUNY Downstate Medical Center, Department of Emergency Medicine, 450 Clarkson Ave, Brooklyn, NY 11203.
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