Association between child-care and acute diarrhea: a study in Portuguese children

Rotavirus A infection in children under five years old with a double health problem: undernutrition and diarrhoea - a cross-sectional study in four provinces of Mozambique

BACKGROUND

Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique.

METHODS

The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR).

RESULTS

Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed.

CONCLUSIONS

The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.

Improving hand hygiene compliance in child daycare centres: a randomized controlled trial

Gastrointestinal and respiratory infections in children attending daycare centres (DCCs) are common and compliance with hand hygiene (HH) guidelines to prevent infections is generally low. An intervention was developed to increase HH compliance and reduce infections in DCCs. The objective of this paper was to evaluate the effectiveness of this intervention on HH compliance. The intervention was evaluated in a two-arm cluster randomized controlled trial in 71 DCCs in The Netherlands. Thirty-six DCCs received the intervention including: (1) HH products; (2) training about HH guidelines; (3) two team training sessions aimed at goal setting and formulating HH improvement activities; and (4) reminders and cues for action (posters/stickers). Intervention DCCs were compared to 35 control DCCs that continued usual practice. HH compliance of caregivers and children was observed at baseline and at 1, 3 and 6 months follow-up. Using multilevel logistic regression, odds ratios (ORs) with 95% confidence intervals (CIs) were obtained for the intervention effect. Of 795 caregivers, 5042 HH opportunities for caregivers and 5606 opportunities for supervising children's HH were observed. At 1 month follow-up caregivers' compliance in intervention DCCs was 66% vs. 43% in control DCCs (OR 6·33, 95% CI 3·71-10·80), and at 6 months 59% vs. 44% (OR 4·13, 95% CI 2·33-7·32). No effect of the intervention was found on supervising children's HH (36% vs. 32%; OR 0·64, 95% CI 0·18-2·33). In conclusion, HH compliance of caregivers increased due to the intervention, therefore dissemination of the intervention can be considered.

Childhood diarrhoea in Danish day care centres could be associated with infant colic, low birthweight and antibiotics

AIM

Diarrhoea is very common in children attending day care centres. The aim of this study was to examine certain predisposing risk factors for an association with diarrhoea, including foreign travel, treatment with antibiotics, having household pets, infant colic, bottle feeding, using a pacifier and low birthweight.

METHODS

A dynamic one-year follow-up cohort study comprising 179 children from 36 day care centres was conducted from September 2009 to July 2013 in Copenhagen, Denmark. Questionnaires were sent to the children's parents or legal guardians every two months for a year, requesting information on gastrointestinal symptoms and exposure. A logistic regression was performed to identify the odds ratios of different risk factors for diarrhoea.

RESULTS

The odds ratios for diarrhoea were 1.97 (0.93-4.20) for children with a history of infant colic, 1.91 (0.90-4.04) for low birthweight children and 1.45 (0.74-2.82) for children who had used antibiotics. Having a pet in the household had a possible protective effect towards diarrhoeal events, with an odds ratio of 0.47 (0.20-1.09).

CONCLUSION

A history of infant colic, low birthweight, and to a lesser extent antibiotic use, possibly increased the risk of diarrhoea in Danish children in day care centres.

A hierarchical model for studying risk factors for childhood diarrhoea: a case-control study in a middle-income country

OBJECTIVE

To identify factors associated with diarrhoea occurrence in children in a city in a middle-income country, with high access to water and sanitation.

METHODS

A case-control study in the city of Salvador, north-eastern Brazil was conducted from November 2002 to August 2004. The study population consisted of children presenting at a health facility. A total of 1688 cases of diarrhoea and 1676 controls were selected. Data collection was by a questionnaire and structured observation during home visits. The explanatory variables were grouped according to a conceptual model defined previously. Analysis was done using a hierarchical approach, to provide a more dynamic view of the transmission characteristics of childhood diarrhoea. Non-conditional logistic regression was used, and odds ratio and population-attributable fractions were estimated.

RESULTS

Socioeconomic factors contributed most to determining diarrhoea occurrence, followed by interpersonal contact, while factors related to food preparation, the environment and water and sanitation made a smaller contribution.

CONCLUSION

The findings indicate that the transmission of diarrhoea is influenced by factors from all hierarchical levels, with interpersonal transmission playing a relatively higher role than previously thought. This is compatible with a predominance of viruses and other agents spread by interpersonal routes including Shigella, Giardia and Cryptosporidium. Diarrhoea control strategies in similar settings (middle-income countries in which a large proportion of the population has access to water and sanitation) must give greater emphasis to policies geared towards reducing person-to-person transmission for the prevention of diarrhoea.

The knowledge of staff in day nurseries about some basic measures which promote child health

Purpose

This paper aims to determine the knowledge that staff in day nurseries in Brazil had of basic measures to promote child health which are connected with high child mortality. These measures included breastfeeding, oral rehydration therapy, child growth follow‐up, immunization and the identification of signs that indicate that the child must be referred to a health facility.

Design/methodology/approach

A cross‐sectional study was performed in day nurseries in the state of Bahia, Brazil, involving 194 care staff from 77 different establishments. Questionnaires, the observation of practical exercises and documentary evidence were used to assess knowledge.

Findings

Seventeen percent of professionals were able to use growth charts correctly, 37.1 percent were able to prepare an oral rehydration solution adequately, 77.8 percent were able to provide appropriate breastfeeding counseling, 65.0 percent were able to identify children who showed respiratory danger signs and refer them to a health facility, and 58.5 percent were able to check the immunization status. This suggests a serious lack of basic knowledge in key areas.

Research limitations/implications

The losses observed in the beginning of the study and the possibility of the existence of memory bias related to the verbal information obtained might have influenced the results.

Practical implications

These findings suggest that there is an urgent need to address the lack of knowledge about basic child health measures shown by these key workers through appropriate educational programs.

Originality/value

This is one of the first studies of levels of knowledge about basic child health measures in professionals who work outside the medical profession, and in particular in day nurseries. It also provides valuable information about health knowledge in a developing country.