Diarrheal morbidity and mortality in children in the Central African Republic

A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries

We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38-.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50-6.76; P < .001), positively linking Giardia with that syndrome. The well-powered Global Enteric Multicenter Study (GEMS) is prospectively addressing the association between G. lamblia infection and diarrhea in children in developing countries.

Estimating child mortality due to diarrhoea in developing countries

OBJECTIVE

The major objective of this study is to provide estimates of diarrhoea mortality at country, regional and global level by employing the Child Health Epidemiology Reference Group (CHERG) standard.

METHODS

A systematic and comprehensive literature review was undertaken of all studies published since 1980 reporting under-5 diarrhoea mortality. Information was collected on characteristics of each study and its population. A regression model was used to relate these characteristics to proportional mortality from diarrhoea and to predict its distribution in national populations.

FINDINGS

Global deaths from diarrhoea of children aged less than 5 years were estimated at 1.87 million (95% confidence interval, CI: 1.56-2.19), approximately 19% of total child deaths. WHO African and South-East Asia Regions combined contain 78% (1.46 million) of all diarrhoea deaths occurring among children in the developing world; 73% of these deaths are concentrated in just 15 developing countries.

CONCLUSION

Planning and evaluation of interventions to control diarrhoea deaths and to reduce under-5 mortality is obstructed by the lack of a system that regularly generates cause-of-death information. The methods used here provide country-level estimates that constitute alternative information for planning in settings without adequate data.

Association between household conditions and diarrheal diseases among children in Turkey: a cohort study

BACKGROUND

This aim of the present study was to estimate the frequency of diarrheal diseases among children as well as investigating the relationship between diarrheal diseases and household conditions and other factors.

METHODS

The study was performed over 12 month period in Binevler Health Center, Gaziantep, Turkey. Five health stations were selected by using a sampling technique with probability proportional to size, and all households with children under the age of 5 years were visited. A questionnaire on diarrhea, household conditions, socioeconomic status of the family and individual characteristics of the children was applied to the mothers by doctors. Three composite indices, including household conditions, socioeconomic status of the family and individual status of the children, were prepared and a classification was made as good, mild or poor in order to better evaluate the results of the study. Daily recordings of diarrheal disease symptoms were made by the parents and these records were collected every month for 1 year.

RESULTS

The annual mean incidence of diarrheal diseases was found to be 1.09 per child per year (median = 1). The mean was higher in children with poor household conditions (1.48 +/- 0.12) and with poor individual status (1.48 +/- 0.14), compared with good household conditions (0.76 +/- 0.07) and good individual status (0.71 +/- 0.08). The mean was also higher in children aged between 6 and 11 months (1.51 +/- 0.18), whose father graduated from primary school or lower (1.34 +/- 0.09) and with parents having no habit of washing their hands before taking care of the child (2.00 +/- 0.33). Person-month and case-month incidence rates of diarrhea were calculated to be 8.56 and 9.12%, respectively.

CONCLUSIONS

Household conditions, individual status, age, education level of fathers and parents' habit of washing hands before taking care of the child were major factors affecting the incidence of diarrhea.

Managed care and public health departments: who is responsible for the health of the population?

This review examines changes over the past decade in the delivery of health care in the United States, specifically the move toward managed care and capitation. Over 77 million Americans are now enrolled in health maintenance organizations, and the health care delivery system is reorganizing into large group practices and integrated health systems. Examined here are the implications of this shift on the interaction between managed care and public health agencies. How will a population-based system of health care be achieved in light of managed care organizations' responsibility only for their enrolled population, in contrast to the responsibility of the public health service for the entire population? Where does the responsibility of MCOs end and that of public health begin? Should certain public health functions be absorbed by managed care organizations? What are the prospects for partnership between these two systems?

Characterization by enzyme-linked immunosorbent assay using subgroup- and serotype-specific monoclonal antibodies of human rotavirus obtained from diarrheic patients in Bangladesh

By enzyme-linked immunosorbent assay with group A-, subgroup-, and serotype-specific monoclonal antibodies (MAbs), we tested 414 stool specimens collected from pediatric and adult patients hospitalized with acute gastroenteritis between January and June 1988. Of 414 specimens tested, 124 (30%) were positive for group A rotavirus. The subgroup was determined in 110 specimens (88.7%); 16.1% were subgroup I, and 72.6% were subgroup II. Two specimens reacted with both subgroup I- and subgroup II-specific MAbs. Serotype determinations showed that serotype 1 (38.4%) was predominant over serotypes 2 (28.2%), 3 (2.5%), and 4 (23%). Three specimens reacted with more than one serotype-specific MAb. While the frequency of serotype 1 was highest in the two hospitals in Mymensingh, serotype 2 was most prevalent in one hospital in Dhaka. All human rotavirus strains with subgroup I and serotype 2 specificities showed a short electropherotype, and all but one strain with subgroup II and serotype 1, 3, or 4 specificities exhibited a long electropherotype.

Prospective longitudinal study of rotavirus infections in children from birth to two years of age in Central Africa

A cohort of 111 children born in Bangui (Central African Republic) was followed from birth to two years of age for rotavirus infections by biweekly stool investigations until six months of age, as well as at each diarrhoeic episode. Thirty-eight children (34.2%) exhibited at least one rotavirus infection by the age of 6 months. Thirty children (27%) presented with rotavirus-associated diarrhoea before 2 years of age. Until the children reached the age of 12 months, rotavirus was identified significantly more frequently in diarrhoeic stools than in non-diarrhoeic stools (p less than 0.001). A low diversity of characterized rotavirus strains was found; only two electrophoretypes were identified, and 91% of the strains belonged to subgroup II, serotype 1, with no special strain identified in newborns. A total of 38 children had a rotavirus infection before the age of six months, while 73 did not: only 2.6% of the first group had diarrhoea associated with rotavirus between 6 and 24 months, versus 20.5% in the second group (p less than 0.05). In two-thirds of the cases of infection, the presence of rotavirus in stools was detected only once; repetitive isolations were more frequent in diarrhoeic than in asymptomatic infections. The isolation rate of rotavirus in the general populations was found to be very low (0.2%).