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Legesse BT, Wondie WT, Gedefaw GD, Workineh YT, Seifu BL. Coutilisation of oral rehydration solution and zinc for treating diarrhoea and its associated factors among under-five children in East Africa: a multilevel robust Poisson regression. BMJ Open 2024; 14:e079618. [PMID: 38453192 PMCID: PMC10921486 DOI: 10.1136/bmjopen-2023-079618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE This study aimed to assess the coutilisation of oral rehydration solution (ORS) and zinc for treating diarrhoea and its associated factors among under-5 children in East Africa. DESIGN Cross-sectional study design. Multilevel Poisson regression analysis with robust variance was fitted to identify predictors of zinc and ORS coutilisation. An adjusted prevalence ratio (aPR) with a 95% CI was reported to declare the statistical significance. SETTING Twelve East African countries. PARTICIPANTS 16 850 under-5 children who had diarrhoea were included in the study. RESULT In East African nations, the coutilisation of ORS and zinc for the treatment of diarrhoea in children under 5 was 53.27% with a 95% CI (52.54% to 54.01%). Children of mothers with primary education (aPR 1.15, 95% CI 1.09 to 1.20), secondary education (aPR 1.08, 95% CI 1.02 to 1.14), higer education (aPR 1.19, 95% CI 1.10 to 1.29), those from maternal age category of 20-24 (aPR 1.14, 95% CI 1.07 to 1.21), age category of 25-29 (aPR 1.13, 95% CI 1.06 to 1.21), age category of 30-34 (aPR 1.09, 95% CI 1.02 to 1.16), those from wealthy households (aPR 1.04, 95% CI 1.01 to 1.09) and those who have a media exposure (aPR 1.04, 95% CI 1.01 to 1.08) were more likely to receive combination. CONCLUSION Only half of the under-5 children with diarrhoea in East Africa were treated with a combination of ORS and zinc. To increase the use of the suggested combination therapy of ORS with zinc, it is important to empower women through education and prevent teen pregnancy.
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Affiliation(s)
- Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, Wollega University, Nekemte, Ethiopia
| | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, Ambo University College of Medicine and Public Health, Ambo, Ethiopia
| | - Gezahagn Demsu Gedefaw
- Department of Neonatal Health Nursing, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Yakob Tadese Workineh
- Department of Pediatrics and Child Health Nursing, Wolaita Sodo University, Sodo, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Effectiveness of Bubble Continuous Positive Airway Pressure (BCPAP) for Treatment of Children Aged 1–59 Months with Severe Pneumonia and Hypoxemia in Ethiopia: A Pragmatic Cluster Randomized Controlled Clinical Trial. J Clin Med 2022; 11:jcm11174934. [PMID: 36078864 PMCID: PMC9456562 DOI: 10.3390/jcm11174934] [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: 06/29/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Despite the beneficial effect of bubble continuous positive airway pressure (BCPAP) oxygen therapy for children with severe pneumonia under the supervision of physicians that has been shown in different studies, effectiveness trials in developing country settings where low-flow oxygen therapy is the standard of care are still needed. Thus, the aim of this study is to assess the effectiveness of bubble CPAP oxygen therapy compared to the WHO standard low-flow oxygen therapy among children hospitalized with severe pneumonia and hypoxemia in Ethiopia. This is a cluster randomized controlled trial where six district hospitals are randomized to BCPAP and six to standard WHO low-flow oxygen therapy. The total sample size is 620 per arm. Currently, recruitment of the patients is still ongoing where the management and follow-up of the enrolled patients are performed by general physicians and nurses under the supervision of pediatricians. The primary outcome is treatment failure and main secondary outcome is death. We anticipate to complete enrollment by September 2022 and data analysis followed by manuscript writing by December 2022. Findings will also be disseminated in December 2022. Our study will provide data on the effectiveness of BCPAP in treating childhood severe pneumonia and hypoxemia in a real-world setting.
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Adepoju AA, Adelaja AO, Amoo A, Orimadegun AE, Akinyinka OO. Edwardsiella ictaluri, an unusual cause of bacteraemia in a Nigerian child with acute bloody diarrhoea. INTERNATIONAL JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 9:3175-3178. [PMID: 34660819 PMCID: PMC8516347 DOI: 10.18203/2320-6012.ijrms20213951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Enteric septicaemia of catfish was first detected in 1976 as an economically significant disease associated with commercial catfish production. Initially, Edwardsiella ictaluri was a host specific pathogen of catfish species but has also been reported from other hosts other than the catfish such as the zebrafish. E. ictaluri has not been isolated in humans hence it is not a zoonotic infection. There has been no previous report of isolation of this organism in humans. This was a case report of a 5 year old boy who presented with fever, vomiting, passage of bloody stool of 6 days and abdominal pain of a day duration. In the case of this 5 year old boy who presented with features of dysentery, blood culture using BACTEC™ grew E. ictaluri. E. ictaluri may be a pathogen which can infect humans just like another closely related species, Edwardsiella tarda. Although, E. ictaluri has not been reported in humans, could this be the first case? Non availability of diagnostic technique appropriate for its diagnosis may explain the rare incidence of the organism in humans, hence many cases would have been treated without isolating the organism.
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Affiliation(s)
- Akinlolu A Adepoju
- Department of Paediatrics, University College Hospital/College of Medicine, University of Ibadan, Nigeria
| | - Adesola O Adelaja
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Abimbola Amoo
- Department of Medical Microbiology, University College Hospital, Ibadan, Nigeria
| | | | - Olusegun O Akinyinka
- Department of Paediatrics, University College Hospital/College of Medicine, University of Ibadan, Nigeria
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Belina D, Hailu Y, Gobena T, Hald T, Njage PMK. Prevalence and epidemiological distribution of selected foodborne pathogens in human and different environmental samples in Ethiopia: a systematic review and meta-analysis. ONE HEALTH OUTLOOK 2021; 3:19. [PMID: 34474688 PMCID: PMC8414678 DOI: 10.1186/s42522-021-00048-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/09/2021] [Indexed: 05/15/2023]
Abstract
Bacterial Foodborne Pathogens (FBP) are the commonest cause of foodborne illness or foodborne diseases (FBD) worldwide. They contaminate food at any stages in the entire food chain, from farm to dining-table. Among these, the Diarrheagenic Escherichia coli (DEC), Non typhoidal Salmonella (NTS), Shigella spp. and Campylobacter spp. are responsible for a large proportion of illnesses, deaths; and, particularly, as causes of acute diarrheal diseases. Though existing studies indicate the problem may be severe in developing countries like Ethiopia, the evidence is commonly based on fragmented data from individual studies. A review of published and unpublished manuscripts was conducted to obtain information on major FBP and identify the gaps in tracking their source attributions at the human, animal and environmental interface. A total of 1753 articles were initially retrieved after restricting the study period to between January 2000 and July 2020. After the second screening, only 51 articles on the humans and 43 on the environmental sample based studies were included in this review. In the absence of subgroups, overall as well as human stool and environmental sample based pooled prevalence estimate of FBP were analyzed. Since, substantial heterogeneity is expected, we also performed a subgroup analyses for principal study variables to estimate pooled prevalence of FBP at different epidemiological settings in both sample sources. The overall random pooled prevalence estimate of FBP (Salmonella, pathogenic Escherichia coli (E. coli), Shigella and Campylobacter spp.) was 8%; 95% CI: 6.5-8.7, with statistically higher (P < 0.01) estimates in environmental samples (11%) than in human stool (6%). The subgroup analysis depicted that Salmonella and pathogenic E. coli contributed to 5.7% (95% CI: 4.7-6.8) and 11.6% (95% CI: 8.8-15.1) respectively, of the overall pooled prevalence estimates of FBD in Ethiopia. The result of meta-regression showed, administrative regional state, geographic area of the study, source of sample and categorized sample size all significantly contributed to the heterogeneity of Salmonella and pathogenic E. coli estimates. Besides, the multivariate meta- regression indicated the actual study year between 2011 and 2015 was significantly associated with the environmental sample-based prevalence estimates of these FBP. This systematic review and meta-analysis depicted FBP are important in Ethiopia though majority of the studies were conducted separately either in human, animal or environmental samples employing routine culture based diagnostic method. Thus, further FBD study at the human, animal and environmental interface employing advanced diagnostic methods is needed to investigate source attributions of FBD in one health approach.
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Affiliation(s)
- Dinaol Belina
- College of Veterinary Medicine, Haramaya University, P.O. Box 138, Dire Dawa, Ethiopia
| | - Yonas Hailu
- College of Agriculture and Environmental Sciences, Haramaya University, Dire Dawa, Ethiopia
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Tesfaye Gobena
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Tine Hald
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
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Infectious diseases in India: assessing the role of household amenities and socio-demographic determinants. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Fagbamigbe AF, Ologunwa OP, Afolabi EK, Fagbamigbe OS, Uthman AO. Decomposition analysis of the compositional and contextual factors associated with poor-non-poor inequality in diarrhoea among under-five children in low- and middle-income countries. Public Health 2021; 193:83-93. [PMID: 33744594 DOI: 10.1016/j.puhe.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to assess the magnitude of wealth inequalities in the development of diarrhoea among under-five children in low- and middle-income countries (LMICs) and to identify and quantify contextual and compositional factors' contribution to the inequalities. DESIGN This is a cross-sectional study. METHODS We used cross-sectional data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in LMICs. Descriptive statistics were used to understand the gap in having diarrhoea between the children from poor and non-poor households and across the selected covariates using Fairlie decomposition techniques with multivariable binary logistic regressions at P = 0.05. RESULTS Of the 57 countries, we found a statistically significant pro-poor odds ratio in only 29 countries, 7 countries showed pro-non-poor inequality and others showed no statistically significant inequality. Among the countries with statistically significant pro-poor inequality, the risk difference was largest in Cameroon (94.61/1000), whereas the largest pro-non-poor risk difference in diarrhoea was widest in Timor-Leste (-41.80/1000). Important factors responsible for pro-poor inequality varied across countries. The largest contributors to the pro-poor inequalities in having diarrhoea are maternal education, access to media, neighbourhood socio-economic status, place of residence, birth order and maternal age. CONCLUSION Diarrhoea remains a major challenge in most LMICs, with a wide range of pro-poor inequalities. These disparities were explained by both compositional and contextual factors, which varied widely across the countries. Thus, multifaceted geographically specific economic alleviation intervention may prove to be a potent approach for addressing the poor and non-poor differentials in the risk of diarrhoea with policies tailored to country-specific risk factors. There is a need for further investigation of factors that drive pro-non-poor inequalities found in 9 of the LMICs.
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Affiliation(s)
- A F Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Division of Health Sciences, Populations, Evidence and Technologies Group, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
| | - O P Ologunwa
- Department of Economics, School of Management Technology, Federal University of Technology, Akure, Nigeria
| | - E K Afolabi
- Department of Nursing Science, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | - O S Fagbamigbe
- Portsmouth Business School, Faculty of Business and Law, University of Portsmouth, Portsmouth, United Kingdom
| | - A O Uthman
- Division of Health Sciences, Populations, Evidence and Technologies Group, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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RUKAMBILE ELPIDIUS, MUSCATELLO GARY, SINTCHENKO VITALI, THOMSON PETERC, MAULAGA WENDE, MMASSY RICHARD, DE BRUYN JULIA, KOCK RICHARD, DARNTON-HILL IAN, ALDERS ROBYN. Determinants of diarrhoeal diseases and height-for-age z-scores in children under five years of age in rural central Tanzania. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E409-E423. [PMID: 33150230 PMCID: PMC7595080 DOI: 10.15167/2421-4248/jpmh2020.61.3.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/10/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Childhood diarrhoeal diseases and stunting are major health problems in low- and middle-income countries (LMICs). Poor water supply, sanitation services and hygiene, frequently encountered in resource-poor settings, contribute to childhood diarrhoea and stunting. METHODS Data on demographic characteristics, hygiene practices, sanitation and human-animal interactions (predictors) and child height-for-age z-scores (HAZ) (outcome) were collected once, while diarrhoea incidences were collected fortnightly for 24 months (outcome). RESULTS Drinking water from public taps (OR = 0.51, 95% CI. 0.44-0.61; p < 0.001) and open wells (OR = 0.46, 95% CI. 0.39-0.54; p < 0.001) and older age of children (OR = 0.43, 95% CI. 0.27-0.67; p < 0.001) were protective against diarrhoea. Inappropriate disposal of children's faeces (OR = 1.15, 95% CI. 1.02-1.31; p = 0.025), sharing water sources with animals in the dry season (OR = 1.48, 95% CI. 1.29-1.70; p < 0.001), overnight sharing of houses with cats (OR = 1.35, 95% CI. 1.16-1.57; p < 0.001) and keeping chickens inside the house overnight regardless of room (OR = 1.39, 95% CI. 1.20-1.60; p < 0.001) increased the risk of diarrhoea. The Sukuma language group (p = 0.005), washing hands in running water (p = 0.007), access of chickens to unwashed kitchen utensils (p = 0.030) and overnight sharing of the house with sheep (p = 0.020) were associated with higher HAZ in children. CONCLUSIONS Until a more precise understanding of the key risk factors is available, these findings suggest efforts towards control of diarrhoea and improved linear growth in these areas should be directed to increased access to clean and safe water, hand-washing, sanitation, and improved animal husbandry practices.
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Affiliation(s)
- ELPIDIUS RUKAMBILE
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Australia
- Tanzania Veterinary Laboratory Agency, Dar es Salaam, Tanzania
| | - GARY MUSCATELLO
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Australia
| | - VITALI SINTCHENKO
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Australia
- Centre for Infectious Diseases and Microbiology - Public Health, Westmead Hospital and New South Wales Health Pathology, Sydney, Australia
| | - PETER C. THOMSON
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Australia
| | - WENDE MAULAGA
- Tanzania Veterinary Laboratory Agency, Dar es Salaam, Tanzania
| | | | - JULIA DE BRUYN
- Natural Resources Institute, University of Greenwich, United Kingdom
| | - RICHARD KOCK
- The Royal Veterinary College, University of London, United Kingdom
| | - IAN DARNTON-HILL
- The University of Sydney, Faculty of Medicine and Health, Brisbane, Australia
| | - ROBYN ALDERS
- Kyeema Foundation, Brisbane, Australia
- Centre for Global Health Security, Chatham House, London, United Kingdom
- Development Policy Centre, Australian National University, Canberra, Australia
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, United States
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Ahmed J, Wong LP, Chua YP, Channa N, Mahar RB, Yasmin A, VanDerslice JA, Garn JV. Quantitative Microbial Risk Assessment of Drinking Water Quality to Predict the Risk of Waterborne Diseases in Primary-School Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082774. [PMID: 32316585 PMCID: PMC7215448 DOI: 10.3390/ijerph17082774] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 01/13/2023]
Abstract
Primary-school children in low- and middle-income countries are often deprived of microbiologically safe water and sanitation, often resulting in a high prevalence of gastrointestinal diseases and poor school performance. We used Quantitative Microbial Risk Assessment (QMRA) to predict the probability of infection in schoolchildren due to consumption of unsafe school water. A multistage random-sampling technique was used to randomly select 425 primary schools from ten districts of Sindh, Pakistan, to produce a representative sample of the province. We characterized water supplies in selected schools. Microbiological testing of water resulted in inputs for the QMRA model, to estimate the risks of infections to schoolchildren. Groundwater (62%) and surface water (38%) were identified as two major sources of drinking water in the selected schools, presenting varying degrees of health risks. Around half of the drinking-water samples were contaminated with Escherichia coli (49%), Shigella spp. (63%), Salmonella spp. (53%), and Vibrio cholerae (49%). Southern Sindh was found to have the highest risk of infection and illness from Campylobacter and Rotavirus. Central and Northern Sindh had a comparatively lower risk of waterborne diseases. Schoolchildren of Karachi were estimated to have the highest probability of illness per year, due to Campylobacter (70%) and Rotavirus (22.6%). Pearson correlation was run to assess the relationship between selected pathogens. V. cholerae was correlated with Salmonella spp., Campylobacter, Rotavirus, and Salmonella spp. Overall, the risk of illness due to the bacterial infection (E. coli, Salmonella spp., V. cholerae, Shigella, and Campylobacter) was high. There is a dire need for management plans in the schools of Sindh, to halt the progression of waterborne diseases in school-going children.
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Affiliation(s)
- Jamil Ahmed
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- US- Pakistan Center for Advanced Studies in Water, Mehran University of Engineering & Technology, Jamhsoro 76062, Pakistan; (N.C.); (R.B.M.)
- Correspondence: (J.A.); (L.P.W.)
| | - Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence: (J.A.); (L.P.W.)
| | - Yan Piaw Chua
- Institute of Educational Leadership, Level 11, Wisma R & D, UM, University of Malaya, Jalan Pantai Baru, Kuala Lumpur 59000, Malaysia;
| | - Najeebullah Channa
- US- Pakistan Center for Advanced Studies in Water, Mehran University of Engineering & Technology, Jamhsoro 76062, Pakistan; (N.C.); (R.B.M.)
| | - Rasool Bux Mahar
- US- Pakistan Center for Advanced Studies in Water, Mehran University of Engineering & Technology, Jamhsoro 76062, Pakistan; (N.C.); (R.B.M.)
| | - Aneela Yasmin
- Department of Biotechnology, Sindh Agriculture University, Tandojam 70060, Sindh, Pakistan;
| | - James A. VanDerslice
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Joshua V. Garn
- School of Community Health Sciences, University of Nevada, Reno, NV 89557, USA;
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Glucagon-like Peptide 2 Concentrations Vary in Zambian Children During Diarrhoea, in Malnutrition and Seasonally. J Pediatr Gastroenterol Nutr 2020; 70:513-520. [PMID: 32044830 PMCID: PMC7340486 DOI: 10.1097/mpg.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Glucagon-like peptide 2 (GLP-2) is a 33 amino acid peptide hormone released from enteroendocrine L-cells following nutrient ingestion. It has been shown to exert trophic effects on the gut. We set out to measure GLP-2 concentrations in blood in children with diarrhoea and malnutrition. METHODS GLP-2 levels were measured in blood samples collected from 5 different groups of children (n = 324) at different time points: those with acute diarrhoea, during illness and 3 weeks after recovery; persistent diarrhoea and severe acute malnutrition; controls contemporaneous for diarrhoea; stunted children from the community; and controls contemporaneous for the stunted children. Stool biomarkers and pathogen analysis were carried out on the children with stunting. RESULTS GLP-2 concentrations were higher during acute diarrhoea (median 3.1 ng/mL, interquartile range 2.1, 4.4) than on recovery (median 1.8, interquartile range 1.4, 3.1; P = 0.001), but were not elevated in children with persistent diarrhoea and severe acute malnutrition. In stunted children, there was a progressive decline in GLP-2 levels from 3.2 ng/mL (1.9, 4.9) to 1.0 (0.0, 2.0; P < 0.001) as the children became more stunted. Measures of seasonality (rainfall, temperature,Food Price Index, and Shiga toxin-producing Escherichia coli) were found to be significantly associated with GLP-2 concentrations in multivariable analysis. We also found a correlation between stool inflammatory biomarkers and GLP-2. CONCLUSIONS In diarrhoea, GLP-2 levels increased in acute but not persistent diarrhoea. Malnutrition was associated with reduced concentrations. GLP-2 displayed seasonal variation consistent with variations in nutrient availability.
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Sarmin M, Hossain MI, Islam SB, Alam NH, Sarker SA, Islam MM, Chisti MJ, Islam SMR, Mahfuz M, Ahmed T. Efficacy of a Green Banana-Mixed Diet in the Management of Persistent Diarrhea: Protocol for an Open-Labeled, Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15759. [PMID: 32224490 PMCID: PMC7154927 DOI: 10.2196/15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 12/15/2019] [Indexed: 12/17/2022] Open
Abstract
Background Diarrhea is the second-leading cause of death in children under 5 years of age. In low- and middle-income countries, 3%-20% of acute diarrheal episodes become persistent diarrhea (PD) (ie, duration ≥14 days), which results in 36%-56% of all diarrheal deaths. In Bangladesh, PD causes >25% of diarrhea-related deaths. Commensal gut microbiota dysbiosis is increasingly recognized in the pathogenesis of PD. Hospital-based management of PD requires a hospital stay, which increases the risk of infection and hospital costs. The higher cost of treatment and high case-fatality rates reiterate PD as an important public health problem. At the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), for the last two decades, a consensus-based guideline has been followed for PD. Observation has revealed that green banana helps in the resolution of diarrhea. However, no larger prospective study has been conducted to evaluate the efficacy of green banana in the management of PD among children older than 6 months of age. Objective Our objective is to assess the efficacy of full-strength rice suji (semolina) with and without green banana compared to three-quarter-strength rice suji in the management of PD in children aged 6-36 months at the Dhaka Hospital of the icddr,b. Methods This open-labeled, randomized controlled study aims to enroll a total of 145 children with PD who have not been improving on a diet of milk suji. Children will be randomized into three different diet-specific groups: full-strength rice suji containing green banana, full-strength rice suji alone, and three-quarter-strength rice suji. The primary outcome is the percentage of children who recovered from diarrhea by day 5. Results Recruitment and data collection began in December 2017 and were completed in November 2019. Results are expected by April 2020. Conclusions This study is expected to provide insights into the incorporation of green banana into the dietary management of PD. This would be the first study to investigate the role of microbiota and metabolomics in the pathogenesis of PD. Trial Registration ClinicalTrials.gov NCT03366740; https://clinicaltrials.gov/ct2/show/NCT03366740 International Registered Report Identifier (IRRID) DERR1-10.2196/15759
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Affiliation(s)
- Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - Shoeb Bin Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - Nur Haque Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - Shafiqul Alam Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - S M Rafiqul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital, Dhaka, Bangladesh
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Price J, Lee J, Willcox M, Harnden A. Place of death, care-seeking and care pathway progression in the final illnesses of children under five years of age in sub-Saharan Africa: a systematic review. J Glob Health 2020; 9:020422. [PMID: 31673338 PMCID: PMC6815655 DOI: 10.7189/jogh.09.020422] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Half of all under-5 deaths occur in sub-Saharan Africa. Reducing child mortality requires understanding of the modifiable factors that contribute to death. Social autopsies collect information about place of death, care-seeking and care-provision, but this has not been pooled to learn wider lessons. We therefore undertook a systematic review to collect, evaluate, map, and pool all the available evidence for sub-Saharan Africa. Methods We searched PubMed, Embase, Global Health, the Cochrane Library and grey literature for studies relating to under-5 deaths in sub-Saharan Africa with information on place of death and/or care-seeking during a child’s final illness. We assessed study quality with a modified Axis tool. We pooled proportions using random effects meta-analysis for place of death and for each stage of the Pathways to Survival framework. Pre-specified subgroup analysis included age group, national income and user-fee policy. We explored heterogeneity with meta-regression. Our protocol was published prospectively (CRD42018111484). Results We included 34 studies from 17 countries. Approximately half of the children died at home, irrespective of age. More children died at home in settings with user-fees (69.1%, 95% confidence interval (CI) = 56.2-80.6, I2 = 98.4%) compared to settings without user-fees (43.8%, 95% CI = 34.3-53.5, I2 = 96.7%). Signs of illness were present in over 95% of children but care-seeking differed by age. 40.1% of neonates (95% CI = 20.7-61.3, I2 = 98.0%) died without receiving any care, compared to 6.4% of older children (95% CI = 4.2%-9.0%, I2 = 90.6%). Care-seeking outside the home was less common in neonatal deaths (50.5%, 95% CI = 35.6-65.3, I2 = 98.3%) compared to infants and young children (82.4%, 95% CI = 79.4%-85.2%, I2 = 87.5%). In both age groups, most children were taken for formal care. Healthcare facilities discharged 69.6% of infants and young children who arrived alive (95% CI = 59.6-78.7, I2 = 95.5%), of whom only 34.9% were referred for further care (95% CI = 15.1-57.9, I2 = 98.7%). Conclusions Despite similar distributions in place of death for neonates and infants and young children, care-seeking behaviour differed by age groups. Poor illness recognition is implicated in neonatal deaths, but death despite care-seeking implies inadequate quality care and referral for older children. Understanding such care-seeking patterns enables targeted interventions to reduce under-5 mortality across the region.
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Affiliation(s)
- Jessica Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Merlin Willcox
- Department of Primary Care and Population Medicine, University of Southampton, Southampton, UK
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Freedman SB, Soofi SB, Willan AR, Williamson-Urquhart S, Siddiqui E, Xie J, Dawoud F, Bhutta ZA. Oral Ondansetron Administration to Dehydrated Children in Pakistan: A Randomized Clinical Trial. Pediatrics 2019; 144:peds.2019-2161. [PMID: 31694979 DOI: 10.1542/peds.2019-2161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Ondansetron is an effective antiemetic employed to prevent vomiting in children with gastroenteritis in high-income countries; data from low- and middle-income countries are sparse. METHODS We conducted a randomized, double-blind, placebo-controlled superiority trial in 2 pediatric emergency departments in Pakistan. Dehydrated children aged 6 to 60 months with ≥1 diarrheal (ie, loose or liquid) stool and ≥1 vomiting episode within the preceding 4 hours were eligible to participate. Participants received a single weight-based dose of oral ondansetron (8-15 kg: 2 mg; >15 kg: 4 mg) or identical placebo. The primary outcome was intravenous administration of ≥20 mL/kg over 4 hours of an isotonic fluid within 72 hours of random assignment. RESULTS All 918 (100%) randomly assigned children completed follow-up. Intravenous rehydration was administered to 14.7% (68 of 462) and 19.5% (89 of 456) of those administered ondansetron and placebo, respectively (difference: -4.8%; 95% confidence interval [CI], -9.7% to 0.0%). In multivariable logistic regression analysis adjusted for other antiemetic agents, antibiotics, zinc, and the number of vomiting episodes in the preceding 24 hours, children administered ondansetron had lower odds of the primary outcome (odds ratio: 0.70; 95% CI, 0.49 to 1.00). Fewer children in the ondansetron, relative to the placebo group vomited during the observation period (difference: -12.9%; 95% CI, -18.0% to -7.8%). The median number of vomiting episodes (P < .001) was lower in the ondansetron group. CONCLUSIONS Among children with gastroenteritis-associated vomiting and dehydration, oral ondansetron administration reduced vomiting and intravenous rehydration use. Ondansetron use may be considered to promote oral rehydration therapy success among dehydrated children in low- and middle-income countries.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Alberta Children's Hospital Research Institute and
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Andrew R Willan
- Ontario Child Health Support Unit, SickKids Research Institute, Toronto, Ontario, Canada; and
| | - Sarah Williamson-Urquhart
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emaduddin Siddiqui
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fady Dawoud
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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Billah SM, Raihana S, Ali NB, Iqbal A, Rahman MM, Khan ANS, Karim F, Karim MA, Hassan A, Jackson B, Walker N, Hossain MA, Sarker S, Black RE, El Arifeen S. Bangladesh: a success case in combating childhood diarrhoea. J Glob Health 2019; 9:020803. [PMID: 31673347 PMCID: PMC6816141 DOI: 10.7189/jogh.09.020803] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Bangladesh had a large reduction in childhood deaths due to diarrhoeal disease in recent decades. This paper explores the preventive, promotive, curative and contextual drivers that helped Bangladesh achieve this exemplary success. METHODS Primary and secondary data collection approaches were used to document trends in reduction of Diarrhoea Specific Mortality Rate (DSMR) between 1980 and 2015, understand what policies and programmes played key roles, and estimate the contribution of specific interventions that were implemented during the period. Data acquisition involved relevant document reviews and in-depth interviews with key stake-holders. A systematic search of literature was undertaken to explore socio-economic, aetiological, behavioural, and nutritional drivers of diarrhoeal disease reduction in Bangladesh. Finally, we used LiST (Lives Saved Tool) to model the contributions of the relevant interventions during three time periods (1980-2015, 1980-2000 and 2000-2015), and to project the number of lives saved in 2030 (compared to 2015) if these interventions were implemented at near universal coverage (90%). RESULTS The factors which likely had the most impact on DSMR were the coordinated efforts of the Government of Bangladesh (GoB) with non-government organizations (NGOs) and the private sector that enabled swift implementation, at scale, of interventions like oral rehydration solution (ORS) and zinc, promotion of breastfeeding, handwashing and sanitary latrines (WASH), as well as improvements in female education and nutrition. Compared to 1980, we found ORS and reduction in stunting prevalence had the greatest impact on DSMR, saving roughly 70 000 lives combined in 2015. Until 2000, ORS had a higher contribution to DSMR reduction than reduction in stunting prevalence. This proportionate contribution was reversed during 2000-2015. At near universal coverage (90%) of combined direct diarrhoeal disease, nutrition and WASH interventions, we project that an additional 5356 deaths due to diarrhoea could be averted in 2030. CONCLUSION Bangladesh's achievement in reduction of DSMR highlights the important role of an enabling policy environment that fostered coordinated efforts of the public and private sectors and NGOs for maximal impact. To maintain this momentum, evidence-based interventions should be scaled up at universal coverage.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahreen Raihana
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nazia Binte Ali
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afrin Iqbal
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Masudur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohd Anisul Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aniqa Hassan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Bianca Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - M Altaf Hossain
- Directorate General for Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | | | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Zangenberg M, Johansen ØH, Abdissa A, Eshetu B, Kurtzhals JAL, Friis H, Sommerfelt H, Langeland N, Hanevik K. Prolonged and persistent diarrhoea is not restricted to children with acute malnutrition: an observational study in Ethiopia. Trop Med Int Health 2019; 24:1088-1097. [PMID: 31325406 DOI: 10.1111/tmi.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess the prevalence of prolonged and persistent diarrhoea, to estimate their co-occurrence with acute malnutrition and association with demographic and clinical factors. METHODS Case-control study where cases were children under 5 years of age with diarrhoea and controls were children without diarrhoea, frequency-matched weekly by age and district of residency. Controls for cases 0-11 months were recruited from vaccination rooms, and controls for cases 12-59 months were recruited by house visits using random locations in the catchment area of the study sites. Data were analysed by mixed model logistic regression. RESULTS We enrolled 1134 cases and 946 controls. Among the cases, 967 (85%) had acute diarrhoea (AD), 129 (11%) had ProD and 36 (3.2%) had PD. More cases had acute malnutrition at enrolment (17% vs. 4%, P < 0.0001) and more were born prematurely (5.7% vs. 1.8%, P < 0.0001) than controls. About 75% of ProPD cases did not have acute malnutrition. Cases with AD and ProPD had different symptomatology, even beyond illness duration. CONCLUSIONS ProPD is common among children presenting with diarrhoea and is not confined to children with acute malnutrition. There is an urgent need for studies assessing causes of ProPD with and without acute malnutrition to develop treatment guidelines for these conditions.
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Affiliation(s)
- Mike Zangenberg
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Øystein H Johansen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Alemseged Abdissa
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Beza Eshetu
- Department of Paediatrics, Jimma University, Jimma, Ethiopia
| | - Jørgen A L Kurtzhals
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Halvor Sommerfelt
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kurt Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
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15
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van der Westhuizen FP, Slogrove AL, Kunneke HM, Kruger M. Factors Associated with Severe Dehydrating Diarrhoea in the Rural Western Cape, South Africa. J Trop Pediatr 2019; 65:1-8. [PMID: 29415224 DOI: 10.1093/tropej/fmy002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Acute diarrhoea (AD) remains a leading cause of childhood death. We evaluated whether delayed healthcare seeking was associated with severe dehydration in rural South Africa. METHODS In a prospective cohort study of children with AD admitted to a secondary-level hospital, data were collected through structured caregiver interviews and hospital record review. The primary outcome was severe dehydration/death, and the primary determinant was delay >12 h between AD symptom onset and healthcare facility presentation. RESULTS Total 68% (71 of 104) of children experienced a delay, and 51% (54 of 104) had severe dehydration with no in-hospital deaths. There was no difference in children with (35 of 71) or without (19 of 33) delay for severe dehydration. Mothers of children with severe dehydration tended to be younger [median (interquartile range) 24 (21-28) vs. 27 (23-30) years, p = 0.07] and used less oral rehydration solution (63 vs. 80%, p = 0.08). CONCLUSION Delay of >12 h in seeking healthcare for AD was not associated with severe dehydration.
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Affiliation(s)
| | - Amy L Slogrove
- Department of Paediatrics and Child Health, Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa
| | - H Marlize Kunneke
- Department of Paediatrics, Worcester Provincial Hospital, Worcester, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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16
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Demilew YM, Alem AT. Food security is not the only solution to prevent under-nutrition among 6-59 months old children in Western Amhara region, Ethiopia. BMC Pediatr 2019; 19:7. [PMID: 30616560 PMCID: PMC6323821 DOI: 10.1186/s12887-018-1386-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/27/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In spite of surplus food production, in Amhara region, a significant number of children had under-nutrition. Investigating factors associated with under-nutrition in food secured households is crucial to design preventive measures. Therefore, the objective of this study was to assess under-nutrition and associated factors among 6-59 months old children in food secured households in Western Amhara Region, Ethiopia. METHODS A community-based cross-sectional study was performed using interviewer-administered questionnaire on 6-59 months old children from Jun 01-30/ 2017. A multi-stage sampling strategy was used to select study participants. Prevalence of stunting, underweight, wasting and overweight/obesity were computed. Predictors were assessed using logistic regression analysis. RESULT The prevalence of stunting, underweight, wasting and overweight/obesity were 40%, 19.8%, 11.6%, and 2.7%, respectively. Having mother who have no formal education (AOR] =2.21, 95% CI: [1.5, 3.2]), taking less diversified food (AOR =1.7, 95% CI: [1.1, 2.5]), having mother who did not wash her hands before food preparation (AOR =1.46, 95% CI: [1.1, 2.0]) and living in the households where solid wastes managed by scattering in the field (AOR =1.6, 95% CI: [1.1, 2.1]) were predictors of stunting. Whereas, wasting was associated with having illness in the prior two weeks of data collection day (AOR =2.7, 95% CI: [1.6, 4.7]), lack of getting antenatal care (AOR =2.0, 95% CI: [1.1, 3.4]) and taking food less than four times per day (AOR =2.00, 95% CI: [1.2, 3.2]). CONCLUSION The prevalence of under-nutrition was very high. Therefore, health professionals and health extension workers should give nutrition counseling about the frequency and diversity of meal, environmental and personal hygiene by giving emphasis to mothers who have no formal education.
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Affiliation(s)
- Yeshalem Mulugeta Demilew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Abiot Tefera Alem
- School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
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17
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Bawankule R, Shetye S, Singh A, Singh A, Kumar K. Epidemiological investigation and management of bloody diarrhea among children in India. PLoS One 2019; 14:e0222208. [PMID: 31518363 PMCID: PMC6743764 DOI: 10.1371/journal.pone.0222208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines-the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context. METHODS We used data from the National Family Health Survey (NFHS)-4 conducted in 2015-16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years. FINDINGS The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children's socioeconomic and demographic characteristics. CONCLUSION The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children's stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.
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Affiliation(s)
- Rahul Bawankule
- International Institute for Population Sciences, Mumbai, India
- * E-mail:
| | - Sadanand Shetye
- B. K. L. Walawalkar Hospital and Rural Medical College, Kasarwadi-Sawarde, India
| | - Ashish Singh
- SJM School of Management, Indian Institute of Technology Bombay, Powai, Mumbai, India
| | - Abhishek Singh
- International Institute for Population Sciences, Mumbai, India
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Bitew BD, Gete YK, Biks GA, Adafrie TT. The effect of SODIS water treatment intervention at the household level in reducing diarrheal incidence among children under 5 years of age: a cluster randomized controlled trial in Dabat district, northwest Ethiopia. Trials 2018; 19:412. [PMID: 30064489 PMCID: PMC6069566 DOI: 10.1186/s13063-018-2797-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Solar Disinfection (SODIS) of water is an economical, user-friendly, and environmentally safe household water treatment method that has been advocated as a means of decreasing the burden of diarrhea among children under 5 years of age. Laboratory studies have consistently shown the efficacy of the SODIS method to destroy waterborne pathogens. However, the evidence-based health effect of a SODIS intervention at the household level is limited. The main aim of the study was to examine the effectiveness of a SODIS intervention in reducing the incidence of diarrhea among under-five children. METHODS A community-based, cluster randomized controlled trial was conducted, over 6 months from 10 January to 7 July 2016, in 28 rural villages of northwest Ethiopia. In the intervention group, 384 children in 279 households received polyethylene terephthalate (PET) bottles, and in the control group 394 children in 289 households who continued to use their usual drinking-water sources were included in the trial. The study compared diarrheal incidence among the intervention group children who were exposed to SODIS household water treatment and the control group children who were not exposed to such water treatment. A generalized estimating equation (GEE) model was used to compute the adjusted incidence rate ratio and the corresponding 95% confidence interval. RESULTS In this trial, the overall SODIS compliance was 90.6%. The incidence of diarrhea was 8.3 episodes/100 person-week observations in the intervention group compared to 15.3 episodes/100 person-week observations in the control group. A statistically significant reduction was observed in the incidence of diarrhea in the intervention group compared to the control (adjusted IRR 0.60 (95% CI 0.52, 0.70) with a corresponding prevention of 40% (95% CI: 34, 48). CONCLUSION The SODIS intervention substantially reduced the incidence of diarrhea among under-five children in a rural community of northwest Ethiopia. This indicates that a SODIS intervention is an invaluable strategy that needs to be integrated with the National Health Extension Program to be addressed to rural communities. TRIAL REGISTRATION Clinical Trial Registry India, ID: CTRI/2017/09/009640 . Registered retrospectively on 5 September 2017.
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Affiliation(s)
- Bikes Destaw Bitew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health Service Management and Health Economics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Takele Tadesse Adafrie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine Referral Hospital, Wolaita Sodo University, Wolaita, Ethiopia
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Akech S, Ayieko P, Gathara D, Agweyu A, Irimu G, Stepniewska K, English M. Risk factors for mortality and effect of correct fluid prescription in children with diarrhoea and dehydration without severe acute malnutrition admitted to Kenyan hospitals: an observational, association study. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:516-524. [PMID: 29971245 PMCID: PMC6004535 DOI: 10.1016/s2352-4642(18)30130-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diarrhoea causes many deaths in children younger than 5 years and identification of risk factors for death is considered a global priority. The effectiveness of currently recommended fluid management for dehydration in routine settings has also not been examined. METHODS For this observational, association study, we analysed prospective clinical data on admission, immediate treatment, and discharge of children age 1-59 months with diarrhoea and dehydration, which were routinely collected from 13 Kenyan hospitals. We analysed participants with full datasets using multivariable mixed-effects logistic regression to assess risk factors for in-hospital death and effect of correct rehydration on early mortality (within 2 days). FINDINGS Between Oct 1, 2013, and Dec 1, 2016, 8562 children with diarrhoea and dehydration were admitted to hospital and eligible for inclusion in this analysis. Overall mortality was 9% (759 of 8562 participants) and case fatality was directly correlated with severity. Most children (7184 [84%] of 8562) with diarrhoea and dehydration had at least one additional diagnosis (comorbidity). Age of 12 months or younger (adjusted odds ratio [AOR] 1·71, 95% CI 1·42-2·06), female sex (1·41, 1·19-1·66), diarrhoea duration of more than 14 days (2·10, 1·42-3·12), abnormal respiratory signs (3·62, 2·95-4·44), abnormal circulatory signs (2·29, 1·89-2·77), pallor (2·15, 1·76-2·62), use of intravenous fluid (proxy for severity; 1·68, 1·41-2·00), and abnormal neurological signs (3·07, 2·54-3·70) were independently associated with in-hospital mortality across hospitals. Signs of dehydration alone were not associated with in-hospital deaths (AOR 1·08, 0·87-1·35). Correct fluid prescription significantly reduced the risk of early mortality (within 2 days) in all subgroups: abnormal respiratory signs (AOR 1·23, 0·68-2·24), abnormal circulatory signs (0·95, 0·53-1·73), pallor (1·70, 0·95-3·02), dehydration signs only (1·50, 0·79-2·88), and abnormal neurological signs (0·86, 0·51-1·48). INTERPRETATION Children at risk of in-hospital death are those with complex presentations rather than uncomplicated dehydration, and the prescription of recommended rehydration guidelines reduces risk of death. Strategies to optimise the delivery of recommended guidance should be accompanied by studies on the management of dehydration in children with comorbidities, the vulnerability of young girls, and the delivery of immediate care. FUNDING The Wellcome Trust.
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Affiliation(s)
- Samuel Akech
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Philip Ayieko
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Gathara
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ambrose Agweyu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi Kenya
| | - Kasia Stepniewska
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Worldwide Antimalarial Resistance Network, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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20
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da Silva RE, Amato AA, Sousa TDR, de Carvalho MR, Novaes MRCG. The patient’s safety and access to experimental drugs after the termination of clinical trials: regulations and trends. Eur J Clin Pharmacol 2018; 74:1001-1010. [DOI: 10.1007/s00228-018-2474-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/02/2018] [Indexed: 11/25/2022]
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Pavlinac PB, Brander RL, Atlas HE, John-Stewart GC, Denno DM, Walson JL. Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review. BMC Public Health 2018; 18:208. [PMID: 29391004 PMCID: PMC5796301 DOI: 10.1186/s12889-018-5092-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although acute diarrhea often leads to acute dehydration and electrolyte imbalance, children with diarrhea also suffer long term morbidity, including recurrent or prolonged diarrhea, loss of weight, and linear growth faltering. They are also at increased risk of post-acute mortality. The objective of this systematic review was to identify interventions that address these longer term consequences of diarrhea. METHODS We searched Medline for randomized controlled trials (RCTs) of interventions conducted in low- and middle-income countries, published between 1980 and 2016 that included children under 15 years of age with diarrhea and follow-up of at least 7 days. Effect measures were summarized by intervention. PRISMA guidelines were followed. RESULTS Among 314 otherwise eligible RCTs, 65% were excluded because follow-up did not extend beyond 7 days. Forty-six trials were included, the majority of which (59%) were conducted in Southeast Asia (41% in Bangladesh alone). Most studies were small, 76% included less than 200 participants. Interventions included: therapeutic zinc alone (28.3%) or in combination with vitamin A (4.3%), high protein diets (19.6%), probiotics (10.9%), lactose free diets (10.9%), oral rehydration solution (ORS) formulations (8.7%), dietary supplements (6.5%), other dietary interventions (6.5%), and antimicrobials (4.3%). Prolonged or recurrent diarrhea was the most commonly reported outcome, and was assessed in ORS, probiotic, vitamin A, and zinc trials with no consistent benefit observed. Seven trials evaluated mortality, with follow-up times ranging from 8 days to 2 years. Only a single trial found a mortality benefit (therapeutic zinc). There were mixed results for dietary interventions affecting growth and diarrhea outcomes in the post-acute period. CONCLUSION Despite the significant post-acute mortality and morbidity associated with diarrheal episodes, there is sparse evidence evaluating the effects of interventions to decrease these sequelae. Adequately powered trials with extended follow-up are needed to identify effective interventions to prevent post-acute diarrhea outcomes.
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Affiliation(s)
| | | | - Hannah E. Atlas
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Department of Medicine (Infectious Disease), University of Washington, Seattle, WA USA
| | - Donna M. Denno
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Department of Medicine (Infectious Disease), University of Washington, Seattle, WA USA
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Bitew BD, Woldu W, Gizaw Z. Childhood diarrheal morbidity and sanitation predictors in a nomadic community. Ital J Pediatr 2017; 43:91. [PMID: 28985750 PMCID: PMC5639577 DOI: 10.1186/s13052-017-0412-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diarrhea remains a leading killer of young children on the globe despite the availability of simple and effective solutions to prevent and control it. The disease is more prevalent among under - five children (U5C) in the developing world due to lack of sanitation. A child dies every 15 s from diarrheal disease caused largely by poor sanitation. Nearly 90% of diarrheal disease is attributed to inadequate sanitation. Even though, the health burden of diarrheal disease is widely recognized at global level, its prevalence and sanitation predictors among a nomadic population of Ethiopia are not researched. This study was therefore designed to assess the prevalence of childhood diarrheal disease and sanitation predictors among a nomadic people in Hadaleala district, Afar region, Northeast Ethiopia. METHODS A community based cross-sectional study design was carried out to investigate diarrheal disease among U5C. A total of 704 households who had U5C were included in this study and the study subjects were recruited by a multistage cluster sampling technique. Data were collected using a structured questionnaire and an observational checklist. All the mothers of U5C found in the selected clusters were interviewed. Furthermore, the living environment was observed. Univariable binary logistic regression analysis was used to choose variables for the multivariable binary logistic regression analysis on the basis of p- value less than 0.2. Finally, multivariable binary logistic regression analysis was used to identify variables associated with childhood diarrhea disease on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05. RESULTS The two weeks period prevalence of diarrheal disease among U5C in Hadaleala district was 26.1% (95% CI: 22.9 - 29.3%). Childhood diarrheal disease was statistically associated with unprotected drinking water sources [AOR = 2.449, 95% CI = (1.264, 4.744)], inadequate drinking water service level [AOR = 1.535, 95% CI = (1.004, 2.346)], drinking water sources not protected from animal contact [AOR = 4.403, 95% CI = (2.424, 7.999)], un-availability of any type of latrine [AOR = 2.278, 95% CI = (1.045, 4.965)], presence of human excreta in the compound [AOR = 11.391, 95% CI = (2.100, 61.787)], not washing hand after visiting toilet [AOR = 16.511, 95% CI = (3.304, 82.509)], and live in one living room [AOR = 5.827, 95% CI = (3.208, 10.581)]. CONCLUSION Childhood diarrheal disease was the common public health problem in Hadaleala district. Compared with the national and regional prevalence of childhood diarrhea, higher prevalence of diarrhea among U5C was reported. Types of drinking water sources, households whose water sources are shared with livestock, volume of daily water collected, availability of latrine, presence of faeces in the compound, hand washing after visiting the toilet and number of rooms were the sanitation predictors associated with childhood diarrhea. Therefore, enabling the community with safe and continuous supply of water and proper disposal of wastes including excreta is necessary with particular emphasis to the rural nomadic communities.
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Affiliation(s)
- Bikes Destaw Bitew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondwoson Woldu
- Hadaleala District Health Office, Hadaleala District, Hadaleala town, Afar Regional State Ethiopia
| | - Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abstract
Purpose of review This review focuses on recent data highlighting the interactions between intestinal pathogens, enteropathy and malnutrition in developing countries, which drive morbidity and mortality and hinder the long-term developmental potential of children. Recent findings Diarrhoea remains the second commonest cause of death in children below 5 years, and malnutrition underlies 45% of all child deaths. Even in the absence of diarrhoea, subclinical pathogen carriage and enteropathy are almost universal in developing countries. Here, we review recent studies addressing the causes and consequences of diarrhoea; emerging data on environmental influences that govern postnatal development of the gut and microbiota; current concepts of environmental enteric dysfunction; and recent intervention trials in the field. We highlight the interactions between these processes, whereby intestinal pathogens drive a cycle of gut damage, malabsorption, chronic inflammation and failed mucosal regeneration, leading to malnutrition and susceptibility to further enteric infections. Summary Efforts to improve child survival and long-term developmental potential need to address the overlapping and interacting effects of diarrhoea, enteropathy and malnutrition. Recent insights from human and animal studies suggest potential targets for intervention.
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Clark A, Black R, Tate J, Roose A, Kotloff K, Lam D, Blackwelder W, Parashar U, Lanata C, Kang G, Troeger C, Platts-Mills J, Mokdad A, Sanderson C, Lamberti L, Levine M, Santosham M, Steele D. Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements. PLoS One 2017; 12:e0183392. [PMID: 28892480 PMCID: PMC5593200 DOI: 10.1371/journal.pone.0183392] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/03/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. METHODS AND FINDINGS We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83-90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57-74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95-98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31-36%). This increased by a factor of 1.08 (95% CI 1.02-1.14) when the GEMS results were reanalysed using a more sensitive molecular test. CONCLUSIONS We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.
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Affiliation(s)
- Andrew Clark
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jacqueline Tate
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Roose
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Karen Kotloff
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Diana Lam
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William Blackwelder
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claudio Lanata
- Instituto de Investigacion Nutricional, Lima, Peru
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - James Platts-Mills
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Ali Mokdad
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | | | - Colin Sanderson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Lamberti
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Myron Levine
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Mathuram Santosham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Duncan Steele
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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25
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Schilling KA, Omore R, Derado G, Ayers T, Ochieng JB, Farag TH, Nasrin D, Panchalingam S, Nataro JP, Kotloff KL, Levine MM, Oundo J, Parsons MB, Bopp C, Laserson K, Stauber CE, Rothenberg R, Breiman RF, O'Reilly CE, Mintz ED. Factors Associated with the Duration of Moderate-to-Severe Diarrhea among Children in Rural Western Kenya Enrolled in the Global Enteric Multicenter Study, 2008-2012. Am J Trop Med Hyg 2017; 97:248-258. [PMID: 28719331 DOI: 10.4269/ajtmh.16-0898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diarrheal disease is a leading cause of death among young children worldwide. As rates of acute diarrhea (AD; 1-6 days duration) have decreased, persistent diarrhea (PD; > 14 days duration) accounts for a greater proportion of the diarrheal disease burden. We describe factors associated with the duration of moderate-to-severe diarrhea in Kenyan children < 5 years old enrolled in the Global Enteric Multicenter Study. We found 587 (58%) children experienced AD, 360 (35%) had prolonged acute diarrhea (ProAD; 7-13 days duration), and 73 (7%) had PD. We constructed a Cox proportional hazards model to identify factors associated with diarrheal duration. Risk factors independently associated with longer diarrheal duration included infection with Cryptosporidium (hazard ratio [HR]: 0.868, P = 0.035), using an unimproved drinking water source (HR: 0.87, P = 0.035), and being stunted at enrollment (HR: 0.026, P < 0.0001). Diarrheal illness of extended duration appears to be multifactorial; given its association with adverse health and development outcomes, effective strategies should be implemented to reduce the duration and severity of diarrheal illness. Effective treatments for Cryptosporidium should be identified, interventions to improve drinking water are imperative, and nutrition should be improved through exclusive breastfeeding in infants ≤ 6 months and appropriate continued feeding practices for ill children.
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Affiliation(s)
- Katharine A Schilling
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Omore
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Gordana Derado
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John B Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Tamer H Farag
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Dilruba Nasrin
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Sandra Panchalingam
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.,Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Karen L Kotloff
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Myron M Levine
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Joseph Oundo
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Michelle B Parsons
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryl Bopp
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kayla Laserson
- Centers for Disease Control and Prevention, Delhi, India.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia.,Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ciara E O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Mahfuz M, Alam MA, Islam SB, Naila NN, Chisti MJ, Alam NH, Sarker SA, Ahmed T. Treatment outcome of children with persistent Diarrhoea admitted to an Urban Hospital, Dhaka during 2012-2013. BMC Pediatr 2017; 17:142. [PMID: 28606066 PMCID: PMC5469056 DOI: 10.1186/s12887-017-0896-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/01/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite availability of treatment guidelines, persistent diarrhoea (PD) has been a major contributor of diarrhoeal deaths in low and middle income countries. We evaluated the outcome of children under the age of 5 years who were treated for PD using management algorithm with locally available foods in a diarrhoeal disease hospital in Dhaka. METHODS We extracted retrospective data from electronic database for all the under-five children admitted for PD in the Longer Stay Ward and Intensive Care Unit of the Dhaka hospital at icddr,b between 2012 and 2013. Descriptive analysis was done to explore available baseline socio-demographic, nutritional, and co-morbid statuses, pathogens from stool isolates, duration of treatment, use of antibiotics, duration of hospital stay and treatment success rates. We sought to investigate above mentioned descriptive features in addition to associated factors with time to recover from PD using survival analysis with Cox proportional hazard model. RESULTS A total number of 426 children with a median age of 7.46 (inter-quartile range IQR; 5.39, 9.43) months were admitted for PD during the study period. Of these, 95% of children were recovered from PD and discharged from the hospital. The median duration of treatment response was 6 (IQR 4, 9) days. The case fatality rate was 1.17%. Multivariate analysis among the children of 6 months or less showed that the rate of recovery from PD was 57% lower in children with severe stunting compared to those without severe stunting (HR 0.43, 95% CI 0.22, 0.88, p < 0.05), 42% lower in children with severe wasting (HR 0.58, 95% CI 0.36, 0.95, p < 0.05), and 81% reduced in children who developed hospital acquired infection (HAI) compared to those without HAI (HR 0.19, 95% CI 0.06, 0.62, p < 0.05). Among the children who were more than 6 months old, age in months (HR 1.05, 95% CI 1.02, 1.09) and female gender (HR 1.41, 95% CI 1.09, 1.84) had better rates of recovery from PD (p < 0.05). Moreover, among children more than 6 months of age, HAI (HR 0.44, 95% CI 0.26, 0.75), and antibiotic use (HR 0.40, 95% CI 0.28, 0.56) were associated with impeded recovery rates from PD (p < 0.05). CONCLUSION The treatment guideline for persistent diarrhoea patients followed at icddr,b Dhaka hospital was found to be successful and can be used in other treatment facilities of Bangladesh and other developing countries where any treatment algorithm for PD is unavailable. More emphasis is required to be given for the prevention of hospital acquired infection that may help to limit the use of antibiotic in order to enhance the recovery rate from PD.
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Affiliation(s)
- Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Mohammed Ashraful Alam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Shoeb Bin Islam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Nur Haque Alam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Shafiqul Alam Sarker
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
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Gizaw Z, Woldu W, Bitew BD. Child feeding practices and diarrheal disease among children less than two years of age of the nomadic people in Hadaleala District, Afar Region, Northeast Ethiopia. Int Breastfeed J 2017; 12:24. [PMID: 28592985 PMCID: PMC5460459 DOI: 10.1186/s13006-017-0115-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhea is a serious public health problem in Ethiopia. It is responsible for 24-30% of all infant deaths and there is a lack of evidence on the health burdens among the nomadic people. This study was therefore designed to assess the prevalence of diarrhea among children less thanvtwo year's of age and its association with feeding practices among the nomadic people in Hadaleala district, northeast Ethiopia. METHODS A cross-sectional study was conducted in Hadaleala district. A total of 367 children less than two years of age were included using the multistage cluster sampling technique. Data were collected by a structured questionnaire. Multivariable binary logistic regression analysis was used to identify variables associated with diarrheal disease. RESULTS The prevalence of diarrhea among children less than two year's of age during the two week period was 31.3% (95% CI, 25.9, 36.1%). Diarrhea occurrence was associated with; children aged between 6-11 months (AOR 6.28, 95% CI, 3.00, 13.12), aged between 12-24 months (AOR 6.21, 95% CI, 3.13, 12.30), illiterate mothers (AOR 6.61, 95% CI, 2.27, 19.21), delay to initiate early breastfeeding for children aged less than six months (AOR 9.13, 95% CI, 1.78, 46.72), children less than six months of age not currently exclusively breastfed (AOR 13.33, 95% CI, 1.59, 112.12), delay to initiate early breastfeeding for children aged 6-24 months (AOR 2.87, 95% CI, 1.49, 5.51), no breastfeeding at the time of the survey (AOR 3.51, 95% CI, 1.57, 7.82), children aged 6-24 months who didn't exclusively breastfeed in the first six months (AOR 19.24, 95% CI, 8.26, 44.82), consuming uncooked foods (AOR 6.99, 95% CI, 2.89, 16.92), not eating cooked foods immediately after cooking (AOR 3.74, 95% CI, 1.48, 9.45), hand washing with only water (AOR 24.94, 95% CI, 6.68, 93.12), and rotavirus vaccination (AOR 0.09, 95% CI, 0.03, 0.29). CONCLUSIONS The prevalence of diarrhea among children less than two year's of age in Hadaleala district was high. To prevent diarrhea, the mothers should start breastfeeding early and practice exclusive breastfeeding. Moreover, mothers should improve the hygiene of supplementary foods.
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Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondwoson Woldu
- Hadaleala District Health Office, Hadaleala District, Afar Regional State Ethiopia
| | - Bikes Destaw Bitew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Thiago JDSB, Andréa FF, Ana CDPRI, Norma A. Cytotoxic, antibacterial and antibiofilm activities of aqueous extracts of leaves and flavonoids occurring in Kalanchoe pinnata (Lam.) Pers. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jmpr2016.6260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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29
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Purwar S, Roy S, Metgud S. Non-O157:H7 Shiga Toxin Producing Diarrhoeagenic Escherichia coli (STEC) in Southern India: A Tinderbox for Starting Epidemic. J Clin Diagn Res 2016; 10:DC11-DC15. [PMID: 27891338 DOI: 10.7860/jcdr/2016/21462.8714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Outbreaks due to non-O157:H7 Shiga toxin producing Escherichia coli (STEC) resulting in Haemolytic Uraemic Syndrome (HUS) have garnered much attention because of associated mortality transcending across continents and also because diarrhoea due to E.coli itself is rare in developed countries. The actual incidence of non-O157:H7 STEC in sporadic acute diarrhoea is not fully elucidated, both in developing as well as in developed countries. Due to larger extent of faecal-oral transmission in developing countries it is prudent to look for non-O157: H7 STEC in such epidemiological settings because of very high potential to spread across larger geographical regions and cause life threatening illness. AIM To determine the extent of acute diarrhoea caused by Shiga toxin producing E. coli and measure their genotypic diversity. MATERIALS AND METHODS The study was designed as a cross-sectional study and conducted between 2009-2011 in department of Microbiology at JN Medical College Belgaum (Karnataka) and Regional Medical Research Center, Belgaum (RMRC-ICMR). Stool samples from 300 sporadic cases of acute diarrhoea were processed by microscopy, culture, for the identification of diarrhoeagenic pathogens viz. Vibrio cholera, Shigella spp., Salmonella spp. and protozoan parasites. PCR was performed for the detection of eae and stx genes in E. coli isolates. Their relatedness was determined by Random Amplification of Polymorphic DNA (RAPD). RESULTS PCR detected stx along with eae in 23.2% culture isolates of E.coli isolated from diarrhoea samples. Only three isolates were identified as STEC by serology as O59, O60 and O69 serotypes. Eleven clones were detected by RAPD fingerprinting in the 46 STEC isolates. CONCLUSION Non-O157:H7 STEC are prevalent in this region and laboratories shall look beyond O157:H7 serotype of E.coli. These isolates have potential of causing outbreaks transcending borders. Hence they shall be reported and efforts be made to identify their sources and prevent spread.
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Affiliation(s)
- Shashank Purwar
- Associate Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS) , Bhopal, (M.P.), India
| | - Subrana Roy
- Scientist E, Regional Medical Research Centre (ICMR) , Belgaum, Karnataka, India
| | - Sharada Metgud
- Professor, Department of Microbiology, Jawaharlal Nehru Medical College Belgaum, Karnataka, India
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Healy-Profitós J, Lee S, Mouhaman A, Garabed R, Moritz M, Piperata B, Lee J. Neighborhood diversity of potentially pathogenic bacteria in drinking water from the city of Maroua, Cameroon. JOURNAL OF WATER AND HEALTH 2016; 14:559-70. [PMID: 27280618 PMCID: PMC6563931 DOI: 10.2166/wh.2016.204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study examined the spatial variation of potential gastrointestinal pathogens within drinking water sources and home storage containers in four neighborhoods in Maroua, Cameroon. Samples were collected from source (n = 28) and home containers (n = 60) in each study neighborhood. Pathogen contamination was assessed using quantitative polymerase chain reaction, targeting Campylobacter spp., Shiga toxin producing Escherichia coli (virulence genes, stx1 and stx2), and Salmonella spp. Microbial source tracking (MST) targeted three different host-specific markers: HF183 (human), Rum2Bac (ruminant) and GFD (poultry) to identify contamination sources. Staphylococcus aureus and the tetracycline-resistance gene (tetQ) were assessed to measure human hand contact and presence of antibiotic-resistant bacteria. Pathogen/MST levels were compared statistically and spatially, and neighborhood variation was compared with previously collected demographic information. All the test fecal markers and pathogens (except Arcobacter) were detected in home and source samples. Two neighborhoods tested positive for most pathogens/MST while the others only tested positive for one or two. Spatial variation of pathogens/MST existed between sources, storage containers, and neighborhoods. Differing population density and ethno-economic characteristics could potentially explain variation. Future research should explore the influence of demographic and ethno-economic factors on water quality during microbial risk assessments in urban Africa.
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Affiliation(s)
- Jessica Healy-Profitós
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, Ohio, USA E-mail: ; Present address: Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Seungjun Lee
- Environmental Science Graduate Program, The Ohio State University, Columbus, Ohio, USA
| | - Arabi Mouhaman
- University of Maroua, Maroua, Far North Region, Cameroon
| | - Rebecca Garabed
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark Moritz
- Environmental Science Graduate Program, The Ohio State University, Columbus, Ohio, USA; Department of Anthropology, The Ohio State University, Columbus, Ohio, USA; Netherlands Institute for Advanced Study (NIAS), Wassenaar, The Netherlands
| | - Barbara Piperata
- Department of Anthropology, The Ohio State University, Columbus, Ohio, USA
| | - Jiyoung Lee
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, Ohio, USA E-mail: ; Environmental Science Graduate Program, The Ohio State University, Columbus, Ohio, USA; Department of Food Science and Technology, The Ohio State University, Columbus, Ohio, USA
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Bado AR, Susuman AS, Nebie EI. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990-2013): assessing the neighborhood inequalities. Glob Health Action 2016; 9:30166. [PMID: 27174860 PMCID: PMC4865764 DOI: 10.3402/gha.v9.30166] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diarrheal diseases are a major cause of child mortality and one of the main causes of medical consultation for children in sub-Saharan countries. This paper attempts to determine the risk factors and neighborhood inequalities of diarrheal morbidity among under-5 children in selected countries in sub-Saharan Africa over the period 1990-2013. DESIGN Data used come from the Demographic and Health Survey (DHS) waves conducted in Burkina Faso (1992-93, 1998-99, 2003, and 2010), Mali (1995, 2001, 2016, and 2012), Nigeria (1990, 1999, 2003, 2008, and 2013), and Niger (1992, 1998, 2006, and 2012). Bivariate analysis was performed to assess the association between the dependent variable and each of the independent variables. Multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with diarrheal morbidity. RESULTS The findings showed that the proportion of diarrheal morbidity among under-5 children varied considerably across the cohorts of birth from 10 to 35%. There were large variations in the proportion of diarrheal morbidity across countries. The proportions of diarrheal morbidity were higher in Niger compared with Burkina Faso, Mali, and Nigeria. The risk factors of diarrheal morbidity varied from one country to another, but the main factors included the child's age, size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. The analysis shows an increasing trend of diarrheal inequalities according to DHS rounds. In Burkina Faso, the value of the intraclass correlation coefficient (ICC) was 0.04 for 1993 DHS and 0.09 in 2010 DHS; in Mali, the ICC increased from 0.04 in 1995 to 0.16 in 2012; in Nigeria, the ICC increased from 0.13 in 1990 to 0.19 in 2013; and in Niger, the ICC increased from 0.07 in 1992 to 0.11 in 2012. CONCLUSIONS This suggests the need to fight against diarrheal diseases on both the local and community levels across villages.
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Affiliation(s)
- Aristide R Bado
- Department of Statistics and Population Studies, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - A Sathiya Susuman
- Department of Statistics and Population Studies, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa;
| | - Eric I Nebie
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
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Zhu T, Qiu J, Wan J, Wang F, Tang X, Guo H. Expression of serotonin receptors in the colonic tissue of chronic diarrhea rats. Saudi J Gastroenterol 2016; 22:234-9. [PMID: 27184643 PMCID: PMC4898094 DOI: 10.4103/1319-3767.182460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to investigate the difference among the expression of serotonin receptors (5-HT3, 5-HT4, and 5-HT7receptors) in colonic tissue of chronic diarrhea rats. MATERIALS AND METHODS A rat model of chronic diarrhea was established by lactose diet. The expression of 5-HT3, 5-HT4, and 5-HT7receptors in the colonic tissue was detected using immunohistochemistry, real-time PCR and Western blotting techniques. RESULTS There is no significant difference on the protein expression of 5-HT3receptor between the normal group and the chronic diarrhea model group. The mRNA expression of 5-HT3receptor in the chronic diarrhea model group was significantly lower than that in the normal group (n = 10; P< 0.01). The protein and mRNA expression of 5-HT4receptor in the chronic diarrhea model group were significantly higher than those in the normal group (n = 10; P< 0.05, P< 0.01). On the contrary, the protein and mRNA expressions of 5-HT7receptor in the chronic diarrhea model group were significantly decreased compared with the normal group (n = 10; P< 0.01, P< 0.01). CONCLUSIONS The results suggested the receptors of 5-HT4and 5-HT7may be involved in inducing diarrhea by lactose diet.
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Affiliation(s)
- Tong Zhu
- Central Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Juanjuan Qiu
- Central Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Jiajia Wan
- Central Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Fengyun Wang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China
| | - Xudong Tang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China,Address for correspondence: Prof. Huishu Guo, Central Laboratory, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian, Liaoning 116011, P.R. China. E-mail: Prof. Xudong Tang, Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China. E-mail:
| | - Huishu Guo
- Central Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China,Address for correspondence: Prof. Huishu Guo, Central Laboratory, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian, Liaoning 116011, P.R. China. E-mail: Prof. Xudong Tang, Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R. China. E-mail:
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Mohamed H, Clasen T, Njee RM, Malebo HM, Mbuligwe S, Brown J. Microbiological effectiveness of household water treatment technologies under field use conditions in rural Tanzania. Trop Med Int Health 2015; 21:33-40. [PMID: 26505903 DOI: 10.1111/tmi.12628] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the microbiological effectiveness of several household water treatment and safe storage (HWTS) options in situ in Tanzania, before consideration for national scale-up of HWTS. METHODS Participating households received supplies and instructions for practicing six HWTS methods on a rotating 5-week basis. We analysed 1202 paired samples (source and treated) of drinking water from 390 households, across all technologies. Samples were analysed for thermotolerant (TTC) coliforms, an indicator of faecal contamination, to measure effectiveness of treatment in situ. RESULTS All HWTS methods improved microbial water quality, with reductions in TTC of 99.3% for boiling, 99.4% for Waterguard™ brand sodium hypochlorite solution, 99.5% for a ceramic pot filter, 99.5% for Aquatab® sodium dichloroisocyanurate (NaDCC) tablets, 99.6% for P&G Purifier of Water™ flocculent/disinfectant sachets, and 99.7% for a ceramic siphon filter. Microbiological performance was relatively high compared with other field studies and differences in microbial reductions between technologies were not statistically significant. CONCLUSIONS Given that microbiological performance across technologies was comparable, decisions regarding scale-up should be based on other factors, including uptake in the target population and correct, consistent, and sustained use over time.
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Affiliation(s)
- Hussein Mohamed
- School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,School of Environmental Science and Technology, Ardhi University, Dar es Salaam, Tanzania
| | - Thomas Clasen
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | | | - Hamisi M Malebo
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephen Mbuligwe
- School of Environmental Science and Technology, Ardhi University, Dar es Salaam, Tanzania
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Sepanlou SG, Malekzadeh F, Delavari F, Naghavi M, Forouzanfar MH, Moradi-Lakeh M, Malekzadeh R, Poustchi H, Pourshams A. Burden of Gastrointestinal and Liver Diseases in Middle East and North Africa: Results of Global Burden of Diseases Study from 1990 to 2010. Middle East J Dig Dis 2015; 7:201-15. [PMID: 26609348 PMCID: PMC4655840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gastrointestinal and liver diseases (GILDs) are major causes of death and disability in Middle East and North Africa (MENA). However, they have different patterns in countries with various geographical, cultural, and socio-economic status. We aimed to compare the burden of GILDs in Iran with its neighboring countries using the results of the Global Burden of Disease (GBD) Study in 2010. METHODS Classic metrics of GBD have been used including: age-standardized rates (ASRs) of death, years of life lost due to premature death (YLL), years of life lost due to disability (YLD), and disability adjusted life years (DALY). All countries neighboring Iran have been selected. In addition, all other countries classified in the MENA region were included. Five major groups of gastrointestinal and hepatic diseases were studied including: infections of gastrointestinal tract, gastrointestinal and pancreatobilliary cancers, acute hepatitis, cirrhosis, and other digestive diseases. RESULTS The overall burden of GILDs is highest in Afghanistan, Pakistan, and Egypt. Diarrheal diseases have been replaced by gastrointestinal cancers and cirrhosis in most countries in the region. However, in a number of countries including Afghanistan, Pakistan, Turkmenistan, Egypt, and Yemen, communicable GILDs are still among top causes of mortality and morbidity in addition to non-communicable GILDs and cancers. These countries are experiencing the double burden. In Iran, burden caused by cancers of stomach and esophagus are considerably higher than other countries. Diseases that are mainly diagnosed in outpatient settings have not been captured by GBD. CONCLUSION Improving the infrastructure of health care system including cancer registries and electronic recording of outpatient care is a necessity for better surveillance of GILDs in MENA. In contrast to expensive treatment, prevention of most GILDs is feasible and inexpensive. The health care systems in the region can be strengthened for prevention and control.
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Affiliation(s)
- Sadaf Ghajarieh Sepanlou
- 1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2 Liver and Pancreatobilliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
, These two authors contributed equally to this paper
| | - Fatemeh Malekzadeh
- 1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,3 Non-Communicable Disease Research Center, Endocrine and Metabolism Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
, These two authors contributed equally to this paper
| | - Farnaz Delavari
- 1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Naghavi
- 4 Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Maziar Moradi-Lakeh
- 4 Institute for Health Metrics and Evaluation, Seattle, WA, USA
,5 Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- 1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2 Liver and Pancreatobilliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
,6 Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hossein Poustchi
- 1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2 Liver and Pancreatobilliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
,6 Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Akram Pourshams
- 1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2 Liver and Pancreatobilliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
,6 Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
,Corresponding Author: Akram Pourshams, MD Digestive Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, N. Kargar St. Tehran, Iran Tel: + 98 21 82415104 Fax: + 98 21 82415400
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Efunshile MA, Ngwu BAF, Kurtzhals JAL, Sahar S, König B, Stensvold CR. Molecular Detection of the Carriage Rate of Four Intestinal Protozoa with Real-Time Polymerase Chain Reaction: Possible Overdiagnosis of Entamoeba histolytica in Nigeria. Am J Trop Med Hyg 2015; 93:257-62. [PMID: 26101274 PMCID: PMC4530744 DOI: 10.4269/ajtmh.14-0781] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/11/2015] [Indexed: 12/17/2022] Open
Abstract
Diarrhea remains the second largest killer of children worldwide, and Nigeria ranks number two on the list of global deaths attributable to diarrhea. Meanwhile, prevalence studies on potentially diarrheagenic protozoa in asymptomatic carriers using molecular detection methods remain scarce in sub-Saharan countries. To overcome sensitivity issues related to microscopic detection and identification of cysts in stool concentrates, real-time polymerase chain reaction (PCR) was used to analyze genomic DNAs extracted from stool samples from 199 healthy school children for Entamoeba histolytica, E. dispar, Giardia intestinalis, and Cryptosporidium. Questionnaires were administered for epidemiological data collection. E. histolytica was not detected in any of the samples, whereas Giardia (37.2%), E. dispar (18.6%), and Cryptosporidium (1%) were found. Most of the children sourced their drinking water from community wells (91%), while the majority disposed of feces in the bush (81.9%). Our study is the first to use real-time PCR to evaluate the epidemiology of E. histolytica, Giardia, and Cryptosporidium in Nigeria where previous studies using traditional diagnostic techniques have suggested higher and lower carriage rates of E. histolytica and Giardia, respectively. It is also the first study to accurately identify the prevalence of common potentially diarrheagenic protozoa in asymptomatic carriers in sub-Saharan Africa.
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Affiliation(s)
- Michael A Efunshile
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Bethrand A F Ngwu
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Jørgen A L Kurtzhals
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Sumrin Sahar
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Brigitte König
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Christen R Stensvold
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Liu X, Meng L, Li J, Liu X, Bai Y, Yu D, Ren X, Liu H, Shen X, Wang P, Hu X, Wei K, Pei H, Kang Q. Etiological epidemiology of viral diarrhea on the basis of sentinel surveillance in children younger than 5 years in Gansu, northwest China, 2009-2013. J Med Virol 2015; 87:2048-53. [DOI: 10.1002/jmv.24283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Xiaoning Liu
- Institution of Health Statistics and Epidemiology, School of Public Health; Lanzhou University; Gansu Provinse P. R. China
| | - Lei Meng
- Centers’ for Disease Control and Prevention; Gansu Province P. R. China
| | - Juansheng Li
- Institution of Health Statistics and Epidemiology, School of Public Health; Lanzhou University; Gansu Provinse P. R. China
| | - Xinfeng Liu
- Centers’ for Disease Control and Prevention; Gansu Province P. R. China
| | - Yana Bai
- Institution of Health Statistics and Epidemiology, School of Public Health; Lanzhou University; Gansu Provinse P. R. China
| | - Deshan Yu
- Centers’ for Disease Control and Prevention; Gansu Province P. R. China
| | - Xiaowei Ren
- Institution of Health Statistics and Epidemiology, School of Public Health; Lanzhou University; Gansu Provinse P. R. China
| | - Haixia Liu
- Centers’ for Disease Control and Prevention; Gansu Province P. R. China
| | - Xiping Shen
- Institution of Health Statistics and Epidemiology, School of Public Health; Lanzhou University; Gansu Provinse P. R. China
| | - Peng Wang
- Centers’ for Disease Control and Prevention; Gansu Province P. R. China
| | - Xiaobin Hu
- Institution of Health Statistics and Epidemiology, School of Public Health; Lanzhou University; Gansu Provinse P. R. China
| | - Kongfu Wei
- Centers’ for Disease Control and Prevention; Gansu Province P. R. China
| | - Hongbo Pei
- Institution of Health Statistics and Epidemiology, School of Public Health; Lanzhou University; Gansu Provinse P. R. China
| | - Qian Kang
- Centers’ for Disease Control and Prevention; Gansu Province P. R. China
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Bhutta ZA, Baker SK. Premature abandonment of global vitamin A supplementation programmes is not prudent! Int J Epidemiol 2015; 44:297-9. [PMID: 25638819 DOI: 10.1093/ije/dyu274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada, Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan and Bill & Melinda Gates Foundation, Seattle, WA, USA Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada, Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan and Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Shawn K Baker
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada, Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan and Bill & Melinda Gates Foundation, Seattle, WA, USA
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