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Halli SS, Biradar RA, Prasad JB. Oral rehydration therapy and Zinc treatment among diarrhoeal children in India: Exploration from latest cross-sectional National Family Health Survey. PLoS One 2024; 19:e0307657. [PMID: 39361593 PMCID: PMC11449306 DOI: 10.1371/journal.pone.0307657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/09/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND AND AIMS Diarrhoea is one of the deadliest diseases and causing death among children in India, but no systematic attempt is made to understand it especially its control using oral rehydration salts (ORS). It is well known that use of ORS and Zinc have been effective in containing diarrhoea among children. An attempt is made using large scale national data set in India to understand use of ORS and Zinc to control diarrhoea and their associated factors among diarrhoeal children under five in India. METHODS Publicly available most recent cross-sectional National Family Health Survey data in India was used for the study. The multi-stage cluster sampling design was used with 2011 Census of India as a sampling frame. Households were selected using a Systematic Random Sampling design from selected primary sampling units in rural and urban clusters. From the selected households, the eligible children were those who suffered from diarrhoea in the two weeks preceding the survey and were less than 5 years old. Using this criterion, out of 232,920 children in the survey of less than five years, 16,213 sample diarrheal children found to be available for the study. Both descriptive and inferential statistical techniques were used to analyse the data. RESULTS Across India, 61% and 31% of the children were given ORS and Zinc respectively. However, combined ORS + Zinc treatment was only around 24%. The treatment of ORS, Zinc, and combined ORS + Zinc supplementations were significantly higher among younger children, children of 24-35 age group mothers, children from rich wealth index groups, belong to Hindu religion and general caste compared to their counterparts. The logistic regression results showed that consumption of ORS among diarrhoeal children under five years of age depends upon size of a child at birth. For instance, diarrheal children who were very small size at birth compared to very large at birth, had 39% lower odds of consuming ORS (AOR = 0.61; CI 0.48, 0.78; p<0.001). Another important variable is place of first treatment sought for diarrheal children. That is children who first sought treatment in private hospital compared to government hospital had 52% lower odds of ORS consumption. The logistic regression adjusted AORs are similar with Zinc and ORS + Zinc supplementations. CONCLUSIONS To improve the coverage and management of childhood diarrhoea in India, planning activities should focus not only on distribution, and increasing knowledge of ORS preparation especially for urban slum residents and rural disadvantaged groups through demonstration. There should be also proper focus on providing ongoing pathways to ensure proper supply chains.
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Affiliation(s)
- Shiva S. Halli
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rajeshwari A. Biradar
- Shri Murughendr Shivayogi Vishvast Vidyapeeth M G C G Memorial College, Athani, Belgaum, India
| | - Jang B. Prasad
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Osborne A, Bangura C. Trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone. Trop Med Health 2024; 52:66. [PMID: 39358813 PMCID: PMC11445861 DOI: 10.1186/s41182-024-00633-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/14/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Sierra Leone has improved child health outcomes in recent decades. However, diarrhoeal diseases remain a public health concern, particularly among children under five. This study investigates the trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone in 2008, 2013 and 2019. METHODS The analysis utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The software utilised for the calculation of various measures of inequality, including simple difference, ratio, population-attributable risk, and population-attributable fraction, was the World Health Organization Health Equity Assessment Toolkit. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region. RESULTS Our findings reveal that children under five with diarrhoea receiving oral rehydration therapy and continued feeding increased from 56.5% in 2008 to 59.7% in 2019 in Sierra Leone. Children of mothers aged 20-49 had more coverage over time than those with mothers aged 15-19. Children of mothers who are wealthy, more educated, and living in urban areas show a decrease in coverage with time compared to the poor, the lowly educated, and those residing in rural areas. Male children had higher coverage than female children. Regional inequality decreased slightly from 21.5 percentage points in 2008 to 21.2 percentage points in 2019. CONCLUSION The findings revealed a mixed picture of progress in oral rehydration therapy and continued feeding for children under five in Sierra Leone. While national coverage has increased, inequalities persist. Children of older mothers and those from disadvantaged backgrounds have experienced improvements, while children of younger, wealthier, and more educated mothers in urban areas have seen a decline in coverage. The gender and regional inequalities remain. Expanding community-based health programs, providing subsidised or free supplies, and strengthening health systems in underserved areas are key strategies to ensure equitable and effective healthcare for all children in Sierra Leone.
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Affiliation(s)
- Augustus Osborne
- Department of Biological Sciences, School of Basic Sciences, PMB, Njala University, Freetown, Sierra Leone.
| | - Camilla Bangura
- Department of Biological Sciences, School of Basic Sciences, PMB, Njala University, Freetown, Sierra Leone
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Garrido G, Garrido-Suárez BB, Martínez-Tapia N, Valdés-González M, Ortega-Mardones A. Antidiarrheal effect of Psidium guajava L. extract in acute diarrhea: a systematic review. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024; 104:7731-7753. [PMID: 38578668 DOI: 10.1002/jsfa.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/21/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024]
Abstract
Acute diarrheal diseases are a leading cause of childhood mortality and morbidity worldwide. Psidium guajava has been globally used for its antidiarrheal potential. We conducted a systematic review of scientific articles published up to the year 2021, which included in vivo pre-clinical tests and clinical trials involving patients with acute infectious diarrhea to verify the antidiarrheal, antibacterial and antispasmodic effects of galenic preparations or phytopharmaceuticals from P. guajava. PRISMA and Rayyan were used as tools for the selection of studies collected in four databases (Pubmed, Scopus, Web of Science and Science Direct). The keywords used to carry out the search were: 'Psidium guajava', 'guava', 'antidiarrhe*' and 'diarrhe*', joined by Boolean operators 'OR' or 'AND'. The characteristics of studies in animal models of acute diarrhea induction, as well as in vivo and in vitro motility and microbiological tests linked with its main pathophysiological mechanisms, were collected. Twenty-three articles were included. Twenty (87%) of these reported heterogenic preclinical studies, predominating pharmacological studies of efficacy against conventional antidiarrheal agents, which utilized relevant outcomes and models of infectious diarrhea from the top pathogens in the clinic along with classical castor oil-induced diarrhea associated with motility tests. Only three articles (13%) corresponded to clinical trials investigating the efficacy, dose and safety of these preparations. Most studies reported positive results and significant mechanistic evidence from antibacterial, anti-motility, anti-secretory and protective/anti-inflammatory perspectives. However, further studies are needed to define the clinical significance and safety treatment with P. guajava extracts. © 2024 Society of Chemical Industry.
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Affiliation(s)
- Gabino Garrido
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del Norte, Antofagasta, Chile
| | | | - Nicolás Martínez-Tapia
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del Norte, Antofagasta, Chile
| | - Marisela Valdés-González
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del Norte, Antofagasta, Chile
| | - Andrea Ortega-Mardones
- Departamento Procesos de Diagnóstico y Evaluación, Facultad Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
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Haque F, Lampe FC, Hajat S, Stavrianaki K, Hasan SMT, Faruque ASG, Ahmed T, Jubayer S, Kelman I. Is heat wave a predictor of diarrhoea in Dhaka, Bangladesh? A time-series analysis in a South Asian tropical monsoon climate. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003629. [PMID: 39226251 PMCID: PMC11371214 DOI: 10.1371/journal.pgph.0003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/29/2024] [Indexed: 09/05/2024]
Abstract
While numerous studies have assessed the association between temperature and diarrhoea in various locations, evidence of relationship between heat wave and diarrhoea is scarce. We defined elevated daily mean and maximum temperature over the 95th and 99th percentiles lasting for at least one day between March to October 1981-2010 as TAV95 and TAV99 and D95 and D99 heat wave, respectively. We investigated the association between heat wave and daily counts of hospitalisations for all-cause diarrhoea in Dhaka, Bangladesh using time series regression analysis employing constrained distributed lag-linear models. Effects were assessed for all ages and children aged under 5 years of age. Diarrhoea hospitalisation increased by 6.7% (95% CI: 4.6%- 8.9%), 8.3% (3.7-13.1), 7.0 (4.8-9.3) and 7.4 (3.1-11.9) in all ages on a TAV95, TAV99, D95 and D99 heat wave day, respectively. These effects were more pronounced for under-5 children with an increase of 13.9% (95% CI: 8.3-19.9), 24.2% (11.3-38.7), 17.0 (11.0-23.5) and 19.5 (7.7-32.6) in diarrhoea hospitalisations on a TAV95, TAV99, D95 and D99 heat wave day, respectively. At lags of 3 days, we noticed a negative association indicating a 'harvesting' effect. Our findings suggest that heat wave was a significant risk factor for diarrhoea hospitalisation in Dhaka. Further research is needed to elucidate the causal pathways and identify the preventive measures necessary to mitigate the impacts of heat waves on diarrhoea. Given that no heat wave definitions exist for Dhaka, these results may help to define heat waves for Dhaka and trigger public health interventions including heat alerts to prevent heat-related morbidity in Dhaka, Bangladesh.
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Affiliation(s)
- Farhana Haque
- Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
- UK Public Health Rapid Support Team (UK-PHRST), Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Fiona C. Lampe
- Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Katerina Stavrianaki
- Department of Statistical Science, Department of Risk and Disaster Reduction, University College London (UCL), London, United Kingdom
| | | | - A. S. G. Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Shamim Jubayer
- National Heart Foundation Hospital and Research Institute (NHF&RI), Dhaka, Bangladesh
| | - Ilan Kelman
- Department of Risk and Disaster Reduction, Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
- University of Agder, Kristiansand, Norway
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Haque F, Lampe FC, Hajat S, Stavrianaki K, Hasan SMT, Faruque ASG, Ahmed T, Jubayer S, Kelman I. Impacts of climate change on diarrhoeal disease hospitalisations: How does the global warming targets of 1.5-2°C affect Dhaka, Bangladesh? PLoS Negl Trop Dis 2024; 18:e0012139. [PMID: 39325697 PMCID: PMC11426472 DOI: 10.1371/journal.pntd.0012139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/20/2024] [Indexed: 09/28/2024] Open
Abstract
Dhaka is one of the world's densely populated cities and faces significant public health challenges including high burden of diarrhoeal diseases. Climate change is intensifying existing environmental problems including urban heat island effect and poor water quality. While numerous epidemiological studies have linked meteorological factors to diarrhoeal diseases in Bangladesh, assessment of the impacts of future climate change on diarrhoeal diseases is scarce. We provide the assessment of climate change impacts on diarrhoeal disease in Dhaka and project future health risks under climate change scenarios. About 3 million acute diarrhoea cases presenting to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) during 1981-2010 were linked to daily temperature, rainfall and humidity and association investigated using time series adapted negative binomial regression models employing constrained distributed lag linear models. The findings were applied to climate projections to estimate future risks of diarrhoea under various global warming scenarios. There was a significantly raised risk of diarrhoea hospitalisation in all ages with daily mean temperature (RR: 3.4, 95% CI: 3.0-3.7) after controlling for the confounding effects of heavy rainfall, humidity, autocorrelations, day of the week effect, long-term time, and seasonal trends. Using the incidence rate ratio (IRR) of 1.034, temperature increases based on the global warming targets of 1.5-2°C could result in an increase of diarrhoea hospitalisations by 4.5-7.4% in all age groups by the 2100s. These effects were more pronounced among <5 children where the predicted temperature increases could raise diarrhoea hospitalisation by 5.7% - 9.4%. Diarrhoea hospitalisation will increase significantly in Dhaka even if the global warming targets adopted by the Paris Agreement is reached. This underscores the importance of preparing the city for management and prevention of diarrhoeal diseases.
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Affiliation(s)
- Farhana Haque
- Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
- UK Public Health Rapid Support Team (UK-PHRST), Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Fiona C Lampe
- Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Katerina Stavrianaki
- Department of Statistical Science, Department of Risk and Disaster Reduction, University College London (UCL), London, United Kingdom
| | - S M Tafsir Hasan
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Shamim Jubayer
- National Heart Foundation Hospital and Research Institute (NHF&RI), Dhaka, Bangladesh
| | - Ilan Kelman
- Institute for Global Health (IGH) and Department of Risk and Disaster Reduction, University College London (UCL), London, United Kingdom
- University of Agder, Kristiansand, Norway
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Lamshöft MM, Liheluka E, Ginski G, Lusingu JPA, Minja D, Gesase S, Mbwana J, Gesase G, Rautman L, Loag W, May J, Dekker D, Krumkamp R. Understanding pre-hospital disease management of fever and diarrhoea in children-Care pathways in rural Tanzania. Trop Med Int Health 2024; 29:706-714. [PMID: 38888511 DOI: 10.1111/tmi.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Many children in sub-Saharan Africa die from infectious diseases like malaria, pneumonia, and diarrhoea that can be prevented by early diagnosis, effective and targeted treatment. This study aimed to gain insights into case management practices by parents before they present their children to hospital. METHODS We conducted a cross-sectional study among 332 parents attending a district hospital with their under-fives symptomatic with fever and/or diarrhoea between November 2019 and July 2020 in rural Tanzania. Timely and targeted treatment was defined as seeking health care within 24 h of fever onset, and continued fluid intake in case of diarrhoea. RESULTS The main admission diagnoses were acute respiratory infections (61.8%), malaria (25.3%), diarrhoea (18.4%) and suspected sepsis (8.1%). The majority of children (91%) received treatment prior to admission, mostly antipyretics (75.6%), local herbal medicines (26.8%), and antibiotics (17.8%)-half of them without prescription from a clinician. For diarrhoea, the use of oral rehydration solution was rare (9.0%), although perceived as easily accessible and affordable. 49.4% of the parents presented their children directly to the hospital, 23.2% went to a pharmacy/drug shop and 19.3% to a primary health facility first. Malaria symptoms began mostly 3 days before the hospital visit; only 25.4% of febrile children visited any health facility within 24 h of disease onset. Prior use of local herbal medicine (AOR = 3.2; 95% CI 1.4-7.3), visiting the pharmacy (adjusted Odds Ratio [AOR] = 3.1; 95% confidence interval [CI]: 1.0-9.8), the dispensary being the nearest health facility (AOR = 3.0; 95% CI: 1.5-6.2), and financial difficulties (AOR = 2.2; 95% CI 1.1-4.5) were associated with delayed treatment. CONCLUSION This study suggests that antipyretics and antibiotics dispensed at pharmacies/drug shops, as well as use of local herbal medicines, delay early diagnosis and treatment, which can be life-threatening. Pharmacies/drug shops could be integrated as key focal points for sensitising community members on how to respond to paediatric illnesses and encourage the use of oral rehydration solutions.
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Affiliation(s)
- Maike Maria Lamshöft
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, DZIF, Hamburg-Borstel-Riems, Germany
- University Clinic Hamburg-Eppendorf, UKE, Hamburg, Germany
| | - Edwin Liheluka
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Greta Ginski
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - John P A Lusingu
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Daniel Minja
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Samwel Gesase
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Joyce Mbwana
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - George Gesase
- National Institute for Medical Research, NIMR, Tanga Centre, Tanga, Tanzania
| | - Lydia Rautman
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Clinic Hamburg-Eppendorf, UKE, Hamburg, Germany
| | - Wibke Loag
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jürgen May
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, DZIF, Hamburg-Borstel-Riems, Germany
- University Clinic Hamburg-Eppendorf, UKE, Hamburg, Germany
| | - Denise Dekker
- Department for Implementation Research, Bernhard Nocht Institute for Tropical Medicine, One Health Bacteriology, Hamburg, Germany
| | - Ralf Krumkamp
- Department for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, DZIF, Hamburg-Borstel-Riems, Germany
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Chua PLC, Tobias A, Madaniyazi L, Ng CFS, Phung VLH, Fu SH, Rodriguez PS, Brown P, Coelho MDSZS, Saldiva PHN, Scovronick N, Deshpande A, Salazar MAS, Dorotan MMC, Tantrakarnapa K, Kliengchuay W, Abrutzky R, Carrasco-Escobar G, Roye D, Hales S, Hashizume M. Association between precipitation and mortality due to diarrheal diseases by climate zone: A multi-country modeling study. Environ Epidemiol 2024; 8:e320. [PMID: 39027089 PMCID: PMC11257672 DOI: 10.1097/ee9.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Background Precipitation could affect the transmission of diarrheal diseases. The diverse precipitation patterns across different climates might influence the degree of diarrheal risk from precipitation. This study determined the associations between precipitation and diarrheal mortality in tropical, temperate, and arid climate regions. Methods Daily counts of diarrheal mortality and 28-day cumulative precipitation from 1997 to 2019 were analyzed across 29 locations in eight middle-income countries (Argentina, Brazil, Costa Rica, India, Peru, the Philippines, South Africa, and Thailand). A two-stage approach was employed: the first stage is conditional Poisson regression models for each location, and the second stage is meta-analysis for pooling location-specific coefficients by climate zone. Results In tropical climates, higher precipitation increases the risk of diarrheal mortality. Under extremely wet conditions (95th percentile of 28-day cumulative precipitation), diarrheal mortality increased by 17.8% (95% confidence interval [CI] = 10.4%, 25.7%) compared with minimum-risk precipitation. For temperate and arid climates, diarrheal mortality increases in both dry and wet conditions. In extremely dry conditions (fifth percentile of 28-day cumulative precipitation), diarrheal mortality risk increases by 3.8% (95% CI = 1.2%, 6.5%) for temperate and 5.5% (95% CI = 1.0%, 10.2%) for arid climates. Similarly, under extremely wet conditions, diarrheal mortality risk increases by 2.5% (95% CI = -0.1%, 5.1%) for temperate and 4.1% (95% CI = 1.1%, 7.3%) for arid climates. Conclusions Associations between precipitation and diarrheal mortality exhibit variations across different climate zones. It is crucial to consider climate-specific variations when generating global projections of future precipitation-related diarrheal mortality.
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Affiliation(s)
- Paul L. C. Chua
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Lina Madaniyazi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Vera Ling Hui Phung
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sze Hang Fu
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Peter S. Rodriguez
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Patrick Brown
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Noah Scovronick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aniruddha Deshpande
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Wissanupong Kliengchuay
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Rosana Abrutzky
- Instituto de Investigaciones Gino Germani, Facultad de Ciencias Sociales, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Carrasco-Escobar
- Scripps Institution of Oceanography, University of California, San Diego, California
- Health Innovation Laboratory, Institute of Tropical Medicine “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Simon Hales
- Department of Public Health, University of Otago, Newtown, Wellington, New Zealand
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Rathi N, Kansal S, Worsley A. Indian fathers' perceptions of young childcare and feeding - A qualitative study. Appetite 2024; 199:107404. [PMID: 38723669 DOI: 10.1016/j.appet.2024.107404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
The role of parents in fostering children's healthy habits is a robust area of research. However, most of the existing literature predominantly focuses on mothers' parenting practices. Given the emergence of nuclear, dual earning families and the recent surge in maternal employment in urban India, fathers' engagement in child rearing and feeding warrants attention. The purpose of this research was to document the views of Indian fathers about paternal parenting practices, with an emphasis on children's diet among other health behaviors. Thirty-three fathers of children aged 6-59 months from Kolkata, India took part in semi-structured interviews conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. The interviews were audio recorded, transcribed verbatim, and translated to English. The transcribed data were subjected to thematic analysis informed by the Template Analysis technique. Themes were detected using the NVivo software program. Overall, these Indian fathers played an important role in early childhood care and feeding as reflected in the following seven themes: (i) Involvement of fathers in various childcare activities; (ii) Implementation of responsive and non-responsive feeding practices; (iii) Concerns regarding fussy and slow eating; (iv) Concerns regarding excessive screen time; (v) Paternal vs maternal parenting; (vi) Barriers to routine engagement of fathers in childcare; (vii) Desire for more nutrition and health knowledge. This enhanced understanding of paternal parenting behavior supports the inclusion of fathers in future family-focused lifestyle interventions aimed at improving children's health outcomes, including their dietary habits.
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Affiliation(s)
- Neha Rathi
- Department of Home Science, Mahila Maha Vidyalaya, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India.
| | - Sangeeta Kansal
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India.
| | - Anthony Worsley
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
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Yitageasu G, Feleke H, Andualem Z, Demoze L, Asrat K, Gizaw Z. Detection of spatial, temporal and spatiotemporal distribution of diarrhea incidence among under-five children in Central Gondar zone, Northwest Ethiopia: a time-series study (2019-2022). BMC Pediatr 2024; 24:433. [PMID: 38969969 PMCID: PMC11225151 DOI: 10.1186/s12887-024-04900-1] [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: 03/16/2024] [Accepted: 06/20/2024] [Indexed: 07/07/2024] Open
Abstract
Under-five children's diarrhea is a significant public health threat and the World Health Organization (WHO) reported it as the second leading cause of children's death worldwide. In this study area, little is known about the spatiotemporal distribution of under-5 diarrhea incidence. This study was therefore, conducted among all districts in the Central Gondar zone to assess the spatial, temporal, and spatiotemporal variation in diarrhea incidence among under-five children in the Central Gondar zone. The data for children under 5 years of age with diarrhea was obtained from Central Gondar Zone Health Department diarrhea reports from January 2019 to December 2022. All districts were included and geo-coded. The spatial data were created in ArcGIS 10.8.1. Global and local spatial autocorrelation were used to detect hot spots and cold spots. The Poisson model was generated by applying the Kulldorff method in SaTScan™9.6 to analyse the the purely temporal, spatial, and space-time clusters. The study revealed spatial variation of under-5 diarrhea where Gondar City, Gondar Zuria, East Dembia, and Lay Armacho districts were the high-rate spatial clusters during the study period. A year search window for temporal scan statistic identified 01 January 2020-30 December 2021 as risk periods across all districts. Spatiotemporal scan statistics detected high-rate clusters at Gondar City, Gondar Zuria, East Dembia, Lay Armacho, and Alefa between 2019 and 2022. In conclusion, there has been a spatial, temporal, and spatiotemporal variability of under-5 children's diarrhea in the Central Gondar Zone. Interventional and preventive strategies should be developed and given priority to the areas that has been detected as a hotspot in this study to reduce the mortality and morbidity of under 5 children.
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Affiliation(s)
- Gelila Yitageasu
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Hailemariam Feleke
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewudu Andualem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lidetu Demoze
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kidist Asrat
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, 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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Bandoh DA, Dwomoh D, Yirenya-Tawiah D, Kenu E, Dzodzomenyo M. Prevalence and correlates of diarrhoea among children under five in selected coastal communities in Ghana. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:95. [PMID: 38926857 PMCID: PMC11210189 DOI: 10.1186/s41043-024-00582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Diarrhoea is a preventable disease affecting children under five years disproportionately. Globally, thousands of children die from diarrhoea related diseases each year, most deaths occuring in sub-Saharan Africa where Ghana is located. Coastal communities bear the greatest brunt due to poor sanitary conditions. We assess the prevalence of diarrhoea in selected coastal communities along the eastern coast of Ghana. METHODS We conducted a cross-sectional study in Mumford, Opetekwei, Anyako, Anyauni and Ateteti communities in the Central, Greater Accra and Volta region respectively. We interviewed households with children under five years on the occurrence of diarrhoea and health seeking practices. We also used a checklist to assess the sanitary conditions of the household. Frequencies and proportions were generated. We determined significant differences using modified Poisson regression models at p < 0.05. Results were presented in tables and text. RESULTS The prevalence ratio of diarrhoea was 36% (95% CI 33-40%). Most cases were from Anyako community. All interviewed households in Mumford and Opetekwei used improved water sources whiles 94% in Atetetio used improved water sources. Children who were fully vaccinated had 32% lower prevalence of diarrhoea compared to those who were not (aPR: 0.68, 95% CI 0.55-0.84). CONCLUSION Diarrhoea prevalence was high inspite of the reported use of improved water sources and sanitation facilities by majority of households in the communities. Fully vaccinated children had a relatively lower prevalence of diarrhoea compared to children who were not fully vaccinated. We recommend in-depth analysis of the use of water and sanitation facilities in these settings to understand the reasons for the observed diarrhoea prevalence.
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Affiliation(s)
| | - Duah Dwomoh
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Ernest Kenu
- School of Public Health, University of Ghana, Legon, Accra, Ghana
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11
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Tumusiime S, Asimwe JB, Atuhaire L, Wasswa R, Nsimbe D, Kayera B. Time to treatment-seeking by caretakers of children under-five with diarrhea and associated factors in Uganda: a multilevel proportional hazards analysis. BMC Pediatr 2024; 24:403. [PMID: 38909217 PMCID: PMC11193189 DOI: 10.1186/s12887-024-04879-9] [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: 11/06/2023] [Accepted: 06/10/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Diarrhea is considered to be one of the major public health concerns in developing countries. It has a detrimental impact, reflecting one of the highest child mortality rates globally, especially in Sub-Saharan Africa, where 2 out of every 10 children in Uganda under the age of five die. The objective of this study was to investigate the factors associated with time to treatment seeking by caretakers of children under-five with Diarrhea in Uganda. METHOD DOVE dataset of 745 caretakers in a prospective and retrospective incidence-based study using multi-stage sampling design was used in the assessment. The analysis was done using a time-to-event approach using life tables, Kaplan Meier survival analysis and multilevel proportional hazards model. RESULTS Kaplan-Meier survival analysis indicated the median time to seeking treatment among 745 caretakers of children under-Five after onset of diarrhea was 2 days. The multi-level proportional hazards model of a Weibull distribution showed that the estimated frailty variance was 0.13, indicating heterogeneity of treatment seeking time by caretakers of under-five children with diarrhea across regions in Uganda. Significant factors found to influence time to treatment-seeking by caretakers of children under-five with diarrhea were, male children (HR = 0.82; 95% CI = 0.71-0.95, p = 0.010), belonging to richest wealth quintile (HR = 1.37; 95% CI = 1.05-1.78, p = 0.022), and residing more than 5 km away from a health facility (HR = 0.68; 95% CI = 0.56-0.84, p = 0.000). CONCLUSIONS There are delays in seeking diarrhea treatment in Uganda because two days are enough to claim a life after dehydration.The policymakers should pay attention to formulate effective intervention to sensitize caregivers on the importance of early treatment-seeking behavior to avoid severe malnutrition caused by diarrhea. Community awareness program should also be encouraged particularly in areas of more than 5 km from the health facility to make people aware of the necessity to take prompt action to seek care in the early stage.
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Affiliation(s)
- Sula Tumusiime
- Department of Statistical Methods and Actual Science, School of Statistics and Planning, Makerere University, P.O.Box 7062, Kampala, Uganda.
| | - John Bosco Asimwe
- Department of Statistical Methods and Actual Science, School of Statistics and Planning, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Leonard Atuhaire
- Department of Statistical Methods and Actual Science, School of Statistics and Planning, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Ronald Wasswa
- Department of Statistical Methods and Actual Science, School of Statistics and Planning, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Dick Nsimbe
- Department of Statistical Methods and Actual Science, School of Statistics and Planning, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Brian Kayera
- Department of Statistical Methods and Actual Science, School of Statistics and Planning, Makerere University, P.O.Box 7062, Kampala, Uganda
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12
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Boafo YA, Ohemeng FNA, Ayivor J, Ayitiah JA, Yirenya-Tawiah D, Mensah A, Datsa C, Annang TY, Adom L. Unraveling diarrheal disease knowledge, understanding, and management practices among climate change vulnerable coastal communities in Ghana. Front Public Health 2024; 12:1352275. [PMID: 38947353 PMCID: PMC11211366 DOI: 10.3389/fpubh.2024.1352275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Diarrheal disease is a global public health concern, particularly in low-income countries. In Ghana, widespread issues like inadequate sanitation, unsafe drinking water, malnutrition, and poor hygiene practices contribute to the high incidence of diarrhea. Climate change exacerbates these challenges by increasing the frequency and severity of conditions that spread diarrheal diseases. This study explores households' knowledge, understanding, and management practices for diarrhea in climate change-vulnerable coastal communities. Methods The study is set in Ghana's central (Mumford, Opetekwei) and eastern (Anyako, Anyanui-Atiteti) coastlines. Using a cross-sectional study design, a structured questionnaire was administered to randomly sampled households (n = 419) to collect quantitative data. The study collected qualitative data from focus group discussions (n = 8), with groups separated into men and women, key informant interviews, and observations of food, water, and sanitation conditions across the studied communities. Results and discussion The study found significant variations between the studied communities and socio-demographic variables except for the respondents' gender. Multivariate regression analyses identified significant associations between socio-demographic variables (especially gender and educational status) and perceptions of diarrhea causes. The most used first management action against diarrhea is 'over-the-counter drugs', followed by home-made traditional remedies. Significant differences were observed in the usage of management practices across the studied communities. Trust, affordability, and availability were identified as the main factors influencing households' use of approved pharmaceutical drugs and traditional herbal remedies for managing behavior, with significant differences being observed across communities. The study recommends a multi-sectoral approach, including improved access to regularly flowing, safe water and sanitation facilities, education on preventing diarrhea, and adequate healthcare services. Community-based interventions such as promoting good hygiene practices at homes and community settings such as schools, lorry parks, funeral grounds, and recreational areas can also effectively reduce the burden of diarrhea.
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Affiliation(s)
- Yaw Agyeman Boafo
- Centre for Climate Change and Sustainability Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Fidelia N. A. Ohemeng
- Department of Sociology, College of Humanities, University of Ghana, Legon, Greater Accra, Ghana
| | - Jesse Ayivor
- Institute of Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Joseph Armah Ayitiah
- Institute of Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Dzidzo Yirenya-Tawiah
- Institute of Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Adelina Mensah
- Institute of Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Cecilia Datsa
- Institute of Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Ted Yemoh Annang
- Institute of Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Lois Adom
- Institute of Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
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13
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Black RE, Perin J, Yeung D, Rajeev T, Miller J, Elwood SE, Platts-Mills JA. Estimated global and regional causes of deaths from diarrhoea in children younger than 5 years during 2000-21: a systematic review and Bayesian multinomial analysis. Lancet Glob Health 2024; 12:e919-e928. [PMID: 38648812 PMCID: PMC11099298 DOI: 10.1016/s2214-109x(24)00078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Information on the causes of deaths from diarrhoea in children younger than 5 years is needed to design improved preventive and therapeutic approaches. We aimed to conduct a systematic analysis of studies to report estimates of the causes of deaths from diarrhoea in children younger than 5 years at global and regional levels during 2000-21. METHODS For this systematic review and Bayesian multinomial analysis, we included 12 pathogens with the highest attributable incidence in the Global Enteric Multicenter Study. We searched PubMed, Scopus, Embase, Web of Science, Global Health Index Medicus, Global Health OVID, IndMed, Health Information Platform for the Americas (PLISA), Africa-Wide Information, and Cochrane Collaboration for articles published between Jan 1, 2000, and Dec 31, 2020, using the search terms "child", "hospital", "diarrhea", "diarrhoea", "dysentery", "rotavirus", "Escherichia coli", "salmonella", "shigella", "campylobacter", "Vibrio cholerae", "cryptosporidium", "norovirus", "astrovirus", "sapovirus", and "adenovirus". To be included, studies had to have a patient population of children younger than 5 years who were hospitalised for diarrhoea (at least 90% of study participants), at least a 12-month duration, reported prevalence in diarrhoeal stools of at least two of the 12 pathogens, all patients with diarrhoea being included at the study site or a systematic sample, at least 100 patients with diarrhoea, laboratory tests done on rectal swabs or stool samples, and standard laboratory methods (ie, quantitative PCR [qPCR] or non-qPCR). Studies published in any language were included. Studies were excluded if they were limited to nosocomial, chronic, antibiotic-associated, or outbreak diarrhoea or to a specific population (eg, only children with HIV or AIDS). Each article was independently reviewed by two researchers; a third arbitrated in case of disagreement. If both reviewers identified an exclusion criterion, the study was excluded. Data sought were summary estimates. Data on causes from published studies were adjusted when necessary to account for the poor sensitivity of non-qPCR methods and for attributable fraction based on quantification of pathogens in children who are ill or non-ill. The causes of deaths from diarrhoea were modelled on the causes of hospitalisations for diarrhoea. We separately modelled studies reporting causes of diarrhoea in children who were hospitalised in low-income and middle-income countries (LMICs) and in high-income countries (HICs). FINDINGS Of 74 282 papers identified in the initial database search, we included 138 studies (91 included data from LMICs and 47 included data from HICs) from 73 countries. We modelled estimates for 194 WHO member states (hereafter referred to as countries), including 42 HICs and 152 LMICs. We could attribute a cause to 1 003 448 (83·8%) of the estimated 1 197 044 global deaths from diarrhoea in children younger than 5 years in 2000 and 360 730 (81·3%) of the estimated 443 833 global deaths from diarrhoea in children younger than 5 years in 2021. The cause with the largest estimated global attribution was rotavirus; in LMICs, the proportion of deaths from diarrhoea due to rotavirus in children younger than 5 years appeared lower in 2021 (108 322 [24·4%] of 443 342, 95% uncertainty interval 21·6-29·5) than in 2000 (316 382 [26·5%] of 1 196 134, 25·7-28·5), but the 95% CIs overlapped. In 2000, the second largest estimated attribution was norovirus GII (95 817 [8·0%] of 1 196 134 in LMICs and 225 [24·7%] of 910 in HICs); in 2021, Shigella sp had the second largest estimated attribution in LMICs (36 082 [8·1%] of 443 342), but norovirus remained with the second largest estimated attribution in HICs (84 [17·1%] of 490). INTERPRETATION Our results indicate progress in the reduction of deaths from diarrhoea caused by 12 pathogens in children younger than 5 years in the past two decades. There is a need to increase efforts for prevention, including with rotavirus vaccine, and treatment to eliminate further deaths. FUNDING Bill & Melinda Gates Foundation via Johns Hopkins University and the University of Virginia.
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Affiliation(s)
- Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Jamie Perin
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Diana Yeung
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tushara Rajeev
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacob Miller
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sarah E Elwood
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, Ahmed SA, Ajami M, Aji B, Akara EM, Akbarialiabad H, Akinosoglou K, Akinyemiju T, Akkaif MA, Akyirem S, Al Hamad H, Al Hasan SM, Alahdab F, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Alam M, Alam N, Al-amer RM, Alanezi FM, Alanzi TM, Al-Azzam S, Albakri A, Albashtawy M, AlBataineh MT, Alcalde-Rabanal JE, Aldawsari KA, Aldhaleei WA, Aldridge RW, Alema HB, Alemayohu MA, Alemi S, Alemu YM, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali L, Ali MU, Ali R, Ali S, Ali SSS, Alicandro G, Alif SM, Alikhani R, Alimohamadi Y, Aliyi AA, Aljasir MAM, Aljunid SM, Alla F, Allebeck P, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani L, Almidani O, Alomari MA, Al-Omari B, Alonso J, Alqahtani JS, Alqalyoobi S, Alqutaibi AY, Al-Sabah SK, Altaany Z, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Alwafi H, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Andrei T, Angus C, Anil A, Anil S, Anoushiravani A, Ansari H, Ansariadi A, Ansari-Moghaddam A, Antony CM, Antriyandarti E, Anvari D, Anvari S, Anwar S, Anwar SL, Anwer R, Anyasodor AE, Aqeel M, Arab JP, Arabloo J, Arafat M, Aravkin AY, Areda D, Aremu A, Aremu O, Ariffin H, Arkew M, Armocida B, Arndt MB, Ärnlöv J, Arooj M, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Asaad M, Asadi-Lari M, Asgedom AA, Asghariahmadabad M, Asghari-Jafarabadi M, Ashraf M, Aslani A, Astell-Burt T, Athar M, Athari SS, Atinafu BTT, Atlaw HW, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awedew AF, Aweke AM, Ayala Quintanilla BP, Ayatollahi H, Ayuso-Mateos JL, Ayyoubzadeh SM, Azadnajafabad S, Azevedo RMS, Azzam AY, B DB, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bah S, Bahadorikhalili S, Bahmanziari N, Bai R, Baig AA, Baker JL, Bako AT, Bakshi RK, Balakrishnan S, Balasubramanian M, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik PC, Bansal H, Bansal K, Barbic F, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrero LH, Barrow A, Barteit S, Barua L, Basharat Z, Bashiri A, Basiru A, Baskaran P, Basnyat B, Bassat Q, Basso JD, Basting AVL, Basu S, Batra K, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Bedi N, Beghi M, Behboudi E, Behera P, Behnoush AH, Behzadifar M, Beiranvand M, Bejarano Ramirez DF, Béjot Y, Belay SA, Belete CM, Bell ML, Bello MB, Bello OO, Belo L, Beloukas A, Bender RG, Bensenor IM, Beran A, Berezvai Z, Berhie AY, Berice BN, Bernstein RS, Bertolacci GJ, Bettencourt PJG, Beyene KA, Bhagat DS, Bhagavathula AS, Bhala N, Bhalla A, Bhandari D, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bisulli F, Biswas A, Biswas B, Bitaraf S, Bitew BD, Bitra VR, Bjørge T, Boachie MK, Boampong MS, Bobirca AV, Bodolica V, Bodunrin AO, Bogale EK, Bogale KA, Bohlouli S, Bolarinwa OA, Boloor A, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borhany H, Borzutzky A, Bouaoud S, Boustany A, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brant LC, Brauer M, Brazinova A, Brazo-Sayavera J, Breitborde NJK, Breitner S, Brenner H, Briko AN, Briko NI, Britton G, Brown J, Brugha T, Bulamu NB, Bulto LN, Buonsenso D, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalheiro CG, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Cederroth CR, Cegolon L, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chadwick J, Chahine Y, Chakraborty C, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Chang CK, Chang JC, Chanie GS, Charalampous P, Chattu VK, Chaturvedi P, Chatzimavridou-Grigoriadou V, Chaurasia A, Chen AW, Chen AT, Chen CS, Chen H, Chen MX, Chen S, Cheng CY, Cheng ETW, Cherbuin N, Cheru WA, Chien JH, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho WCS, Chong B, Chopra H, Choudhari SG, Chowdhury R, Christopher DJ, Chukwu IS, Chung E, Chung E, Chung E, Chung SC, Chutiyami M, Cindi Z, Cioffi I, Claassens MM, Claro RM, Coberly K, Cogen RM, Columbus A, Comfort H, Conde J, Cortese S, Cortesi PA, Costa VM, Costanzo S, Cousin E, Couto RAS, Cowden RG, Cramer KM, Criqui MH, Cruz-Martins N, Cuadra-Hernández SM, Culbreth GT, Cullen P, Cunningham M, Curado MP, Dadana S, Dadras O, Dai S, Dai X, Dai Z, Dalli LL, Damiani G, Darega Gela J, Das JK, Das S, Das S, Dascalu AM, Dash NR, Dashti M, Dastiridou A, Davey G, Dávila-Cervantes CA, Davis Weaver N, Davletov K, De Leo D, de Luca K, Debele AT, Debopadhaya S, Degenhardt L, Dehghan A, Deitesfeld L, Del Bo' C, Delgado-Enciso I, Demessa BH, Demetriades AK, Deng K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert 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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2100-2132. [PMID: 38582094 PMCID: PMC11126520 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Seifu BL, Legesse BT, Yehuala TZ, Kase BF, Asmare ZA, Mulaw GF, Tebeje TM, Mare KU. Factors associated with the co-utilization of oral rehydration solution and zinc for treating diarrhea among under-five children in 35 sub-saharan Africa countries: a generalized linear mixed effect modeling with robust error variance. BMC Public Health 2024; 24:1329. [PMID: 38755544 PMCID: PMC11100298 DOI: 10.1186/s12889-024-18827-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Even though childhood diarrhea is treated with a simple treatment solution, it continues to be one of the leading causes of under-five child mortality and malnutrition globally. In resource-limited settings such as Sub-Saharan Africa (SSA), the combination of oral rehydration salts (ORS) and zinc is regarded as an effective treatment for diarrhea; however, its utilization is very low. The purpose of this study was to determine the proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA. METHODS The proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA were determined using secondary data analysis of recent Demographic and Health Surveys (DHS) of 35 SSA countries. The study included a total of 44,341 under-five children with diarrhea in weighted samples. A generalized linear mixed-effects model with robust error variance was used. For the variables included in the final model, adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were estimated. A model with the lowest deviance value were considered as the best-fitted model. RESULT The pooled proportion of co-utilization of ORS and zinc for the treatment of diarrhea among under five children in SSA countries was 43.58% with a 95% CI (43.15%, 44.01%). Sex of the child, maternal age, residence, maternal educational and employment status, wealth index, media exposure, perceived distance to health facility and insurance coverage were statistically significant determinants of ORS and Zinc co-utilization for treating diarrhea among under five children in SSA. CONCLUSION Only less than half of under-five children with diarrhea in SSA were treated with a combination of ORS and zinc. Thus, strengthening information dissemination through mass media, and community-level health education programs are important to scale up the utilization of the recommended combination treatment. Furthermore, increasing health insurance coverage, and establishing strategies to address the community with difficulty in accessing health facilities is also crucial in improving the use of the treatment.
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Affiliation(s)
- Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia.
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institutes of Health Science, Wollega University, Nekemte, Ethiopia
| | - Tirualem Zeleke Yehuala
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getahun Fentaw Mulaw
- School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Nuzhat S, Alam B, Hasan SMT, Shaima SN, Chisti MJ, Faruque ASG, Das R, Ahmed T. Are young and older children with diarrhea presenting in the same way? PLoS One 2024; 19:e0300882. [PMID: 38739609 PMCID: PMC11090295 DOI: 10.1371/journal.pone.0300882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Diarrhoea is a global health problem. More than a quarter of diarrhoeal deaths occur among children less than five years. Different literatures analyzed presentation and outcomes of less than five diarrhoeal children. The world has made remarkable progress in reducing child mortality. So, older children are growing in number. Our aim was to identify clinical differentials and variations of pathogens among younger (less than five) and older (five to nine years) diarrhoeal children. METHOD Data were extracted from the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital (urban site) and Matlab Hospital (rural site) of the International Centre for Diarrhoeal Disease Research, Bangladesh for the period of January 2012 to December 2021. Out of 28,781 and 12,499 surveillance patients in Dhaka and Matlab Hospital, 614 (2.13%) and 278 (2.22%) children were five to nine-years of age, respectively. Among under five children, 2456 from Dhaka hospital and 1112 from Matlab hospital were selected randomly for analysis (four times of five to nine years age children, 1:4). RESULTS Vomiting, abdominal pain, and dehydrating diarrhoea were significantly higher in older children in comparison to children of less than five years age (p-value <0.05) after adjusting study site, gender, antibiotic use before hospitalization, diarrhoeal duration < 24 hours, intake of oral rehydration fluid at home, parental education, WASH practice and history of cough. Vibrio. cholerae, Salmonella, and Shigella were the common fecal pathogen observed among older children compared to under five after adjusting for age, gender and study site. CONCLUSION Although percentage of admitted diarrhoeal children with five to nine years is less than under five years children but they presented with critical illness with different diarrhoeal pathogens. These observations may help clinicians to formulate better case management strategies for children of five to nine years that may reduce morbidity.
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Affiliation(s)
- Sharika Nuzhat
- Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Baharul Alam
- Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - S. M. Tafsir Hasan
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Shamsun Nahar Shaima
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - A. S. G. Faruque
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Rina Das
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, GA, United States of America
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
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Madjirebaye P, Peng Z, Mueed A, Huang T, Peng F, Allasra Y, Benar ME, Hu Z, Xie M, Xiong T. Promising probiotic-fermented soymilk for alleviating acute diarrhea: insights into the microbiome and metabolomics. Food Funct 2024; 15:4462-4474. [PMID: 38563684 DOI: 10.1039/d3fo05690b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Fermented soymilk (FSM4) has attracted much attention due to its nutritional and health characteristics. Exploring FSM4 products to alleviate diarrhea can ensure their effectiveness as a therapeutic food for alleviating gastrointestinal disorders. However, the relationship between gut microbiota and gut metabolite production remains unknown during diarrheal episodes. Therefore, the diarrhea-alleviating role and mechanisms of FSM4 in diarrhea rats were investigated via biochemical, gut microbiota, and serum metabolite analyses. The findings showed that consuming FSM4 improved diarrhea symptoms and reduced systemic inflammation better than non-fermented soymilk (NFSM). It is worth noting that FSM4 promoted the diversity, richness, structure, and composition of gut microbiota. It increased the ability to reduce inflammation associated with harmful bacteria (Anaerofilum, Flavonifractor, Bilophila, Anaerostipes, [Ruminococcus]_torques_group, Clostridium_sensu_stricto_1, Turicibacter, Ruminococcus_1, Ruminiclostridium_6, Prevotellaceae_NK3B31_group and Fusicatenibacter), while stimulating the growth of healthy species (Lactobacillus, Ruminococcaceae_UCG-014, Oscillibacter, [Eubacterium]_coprostanoligenes_group, Negativibacillus, and Erysipelotrichaceae_UCG-003). Moreover, metabolomics analysis showed that lipid metabolites such as lysophosphatidylethanolamine (LysoPE) and sphingolipids were upregulated in the NG group, closely related to pro-inflammatory cytokines (IL-6, IL-1β, TNF-α, and IFN-γ) and the aforementioned pathogenic bacteria. Notably, in treatment groups, especially FSM4, the accumulation of L-ornithine, aspartic acid, ursocholic acid, 18-oxooleate, and cyclopentanethiol was increased, which was robustly associated with the anti-inflammatory factor IL-10 and beneficial bacteria mentioned above. Therefore, it can be inferred that the amino acids, bile acid, 18-oxooleate, and cyclopentanethiol produced in the FSM4 group can serve as metabolic biomarkers, which synergistically act with the gut microbiota to help alleviate inflammation for diarrhea remission. Overall, FSM4 may provide a new alternative, as an anti-inflammatory diet, to alleviate diarrhea.
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Affiliation(s)
- Philippe Madjirebaye
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
| | - Zhen Peng
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
| | - Abdul Mueed
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
| | - Tao Huang
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
- International Institute of Food Innovation, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
| | - Fei Peng
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
| | - Yammadjita Allasra
- Faculty of Human Health Sciences, University of N'Djamena, N'Djamena, BP:117, Chad
| | | | - Zhengchen Hu
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
| | - Mingyong Xie
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
| | - Tao Xiong
- State Key Laboratory of Food Science and Resources, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China.
- School of Food Science and Resources, Nanchang University, No. 235 Nanjing East Road, Nanchang, Jiangxi, 330047, PR China
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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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Li Y, Sun X, Fu Y, You X, Hartwig S. Literature review to identify evidence of secondary transmission of pentavalent human-bovine reassortant rotavirus vaccine (RV5) strains to unvaccinated subjects. Vaccine 2024; 42:1461-1468. [PMID: 38355319 DOI: 10.1016/j.vaccine.2024.01.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Rotavirus is the leading cause of severe diarrhea in infants and young children. Live attenuated vaccines can lead to horizontal transmission with the risk of vaccine-derived disease in contacts. Transmission of pentavalent human-bovine reassortant rotavirus vaccine (RV5) strains leading to clinical disease was not well evaluated in the pivotal clinical trials, and only a few case reports have been described in the literature. METHODS We performed a systematic literature review to investigate secondary transmission of RV5 strains to unvaccinated subjects globally. We searched Embase, Medline for English papers, CNKI, Wan Fang for Chinese papers, and other resources (i.e., conference papers with full text) from January 2005 to June 2021. Eligibility criteria for inclusion were original articles based on non-interventional studies (case-control studies, cohort studies, cross-sectional studies) using RV5 strain transmission as outcomes. Other study or publication types were excluded, such as pre-clinical studies, interventional studies and case reports. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used, and study quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the JBI checklist for cross-sectional studies to assess the risk of bias. RESULTS The search generated 2,089 articles in total. Seven articles met all inclusion criteria, including six cohort studies and one cross-sectional study. All studies underwent quality assessment and complied with the quality criteria of the NOS or JBI checklist, respectively. Overall, none of the seven studies identified RV5 vaccine-type transmission to an unvaccinated population, in either hospitals or nurseries under a close contact environment. One study reported that 1% of unvaccinated infants had gastrointestinal symptoms, but all symptoms were attributed to other clinical conditions. CONCLUSIONS We found no evidence of horizontal transmission of RV5 strains to unvaccinated infants in a context of a limited amount and the descriptive nature of the identified studies.
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Affiliation(s)
- Yuanqiu Li
- MSD Research and Development (China) Co., Ltd., Beijing, China
| | - Xiaojin Sun
- MSD Research and Development (China) Co., Ltd., Beijing, China
| | - Yaqun Fu
- MSD Research and Development (China) Co., Ltd., Beijing, China
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Nguyen DH, Uddin MJ, Al-Tawfiq JA, Memish ZA, Chu DT. RNA therapeutics for diarrhea. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2024; 204:295-309. [PMID: 38458741 DOI: 10.1016/bs.pmbts.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Diarrhea is caused by a variety of bacterial and viral agents, inflammatory conditions, medications, and hereditary conditions. Secretory diarrhea involves several ion and solute transporters, activation of the cyclic nucleotide and Ca2+ signaling pathways, as well as intestinal epithelial secretion. In many cases of secretory diarrhea, activation of Cl- channels, such as the cystic transmembrane conduction regulator and the Ca2+stimulated Cl- channel fibrosis, promote secretion while concurrently inhibiting Na+ transport expressing fluid absorption. Current diarrhea therapies include rehydration and electrolyte replacement via oral rehydration solutions, as well as medications that target peristalsis or fluid secretion. The rising understanding of RNA function and its importance in illness has encouraged the use of various RNAs to operate selectively on "untreatable" proteins, transcripts, and genes. Some RNA-based medications have received clinical approval, while others are currently in research or preclinical studies. Despite major obstacles in the development of RNA-based therapies, many approaches have been investigated to improve intracellular RNA trafficking and metabolic stability.
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Affiliation(s)
| | - Md Jamal Uddin
- ABEx Bio-Research Center, East Azampur, Dhaka, Bangladesh; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ziad A Memish
- Director Research and Innovation Centre, King Saud Medical City, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam; Faculty of Applied Sciences, International School, Vietnam National University, Hanoi, Vietnam.
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Shen X, Wang F, Li Y, Su B, Song Z, Cong B. Changing Patterns in Digestive Diseases Mortality in Urban and Rural Areas - China, 1987-2021. China CDC Wkly 2023; 5:1115-1119. [PMID: 38124886 PMCID: PMC10728559 DOI: 10.46234/ccdcw2023.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
What is already known about this topic? Digestive diseases (DDs) are a global health concern with a substantial epidemiological and economic impact, given their high prevalence. What is added by this report? This study investigated the trends in mortality related to DDs in China from 1987 to 2021, focusing on the urban-rural divide. Additionally, it aimed to determine the specific impacts of age, period, and cohort on DDs mortality. What are the implications for public health practice? There is a need to prioritize and allocate more resources toward the future management of DDs in order to effectively address the challenges posed by urbanization and aging populations.
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Affiliation(s)
- Xinran Shen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Feng Wang
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Yuling Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Binbin Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Zhiqiang Song
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Bin Cong
- Department of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang City, Hebei Province, China
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Clark A, Mahmud S, Debellut F, Pecenka C, Jit M, Perin J, Tate J, Soeters HM, Black RE, Santosham M, Sanderson C. Estimating the global impact of rotavirus vaccines on child mortality. Int J Infect Dis 2023; 137:90-97. [PMID: 37863311 PMCID: PMC10689250 DOI: 10.1016/j.ijid.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVES We estimated the global impact of rotavirus vaccines on deaths among children under five years old by year. METHODS We used a proportionate outcomes model with a finely disaggregated age structure to estimate rotavirus deaths prevented by vaccination over the period 2006-2019 in 186 countries. We ran deterministic and probabilistic uncertainty analyses and compared our estimates to surveillance-based estimates in 20 countries. RESULTS We estimate that rotavirus vaccines prevented 139,000 under-five rotavirus deaths (95% uncertainty interval 98,000-201,000) in the period 2006-2019. In 2019 alone, rotavirus vaccines prevented 15% (95% uncertainty interval 11-21%) of under-five rotavirus deaths (0.5% of child mortality). Assuming global use of rotavirus vaccines and coverage equivalent to other co-administered vaccines could prevent 37% of under-five rotavirus deaths (1.2% of child mortality). Our estimates were sensitive to the choice of rotavirus mortality burden data and several vaccine impact modeling assumptions. The World Health Organization's recommendation to remove age restrictions in 2012 could have prevented up to 17,000 rotavirus deaths in the period 2013-2019. Our modeled estimates of rotavirus vaccine impact were broadly consistent with estimates from post-vaccination surveillance sites. CONCLUSION Rotavirus vaccines have made a valuable contribution to global public health. Enhanced rotavirus mortality prevention strategies are needed in countries with high mortality in under-5-year-old children.
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Affiliation(s)
- Andrew Clark
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Sarwat Mahmud
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
| | - Jamie Perin
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | | | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Mathuram Santosham
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Colin Sanderson
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Zeng M, Niu L. Exploring spatiotemporal trends and impacts of health resources and services on under-5 mortality in West African countries, 2010-2019: a spatial data analysis. Front Public Health 2023; 11:1193319. [PMID: 37771822 PMCID: PMC10524609 DOI: 10.3389/fpubh.2023.1193319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background West African countries experienced the highest under-5 mortality rate (U5MR), the lowest life expectancy, and the poorest economic development. This study aimed to explore the spatiotemporal trend of U5MR and spatial spillover effects of health resources and services to provide a basis for establishing health policies and international cooperative mechanisms in West Africa. Methods We retrieved data from the World Health Organization's Global Health Observatory, the United Nations Human Development Report, and the Global Burden of Disease Study 2019. Joinpoint regression analysis and Moran's I method were used to examine the temporal trend and spatial dependence of U5MR, respectively. Spatial regression analysis was used to examine the spatial spillover effects. Results The long-term downward trends in U5MR were divided into multiple segments by two or three change points in 2013, 2014, or 2015, and the annual percentage change after 2015 was higher than before 2015. Global Moran's I was positive, significantly indicating positive spatial autocorrelation, which increased from 0.2850 (p = 0.0210) to 0.3597 (p = 0.0080). Based on spatial regression analysis, human development index (HDI), physicians density, nurses and midwives density, health center density, percentage of infants lacking immunization for diphtheria and measles, and coverage rate of at least one antenatal visit had negative spatial spillover effects on U5MR. HDI had the strongest negative correlation (β = -0.0187 to -0.1054, p < 0.0001). Current health expenditure (CHE) per capita had positive spatial spillover effects on U5MR. Conclusion This study revealed the spatiotemporal trend of U5MR in West African countries and spatial spillover effects of health resources and services. Promoting economic development, increasing health human resources, health expenditure, vaccination rate, antenatal care coverage, and the proportion of health professionals attending births not only reduced the local U5MR but also exerted spatial spillover effects on adjacent countries. The West African Health Organization may consider regional spillover mechanisms to develop regional health policy and intervention cooperation mechanisms, which will contribute to achieving the sustainable development goal on U5MR, Africa Agenda 2063, and universal health coverage.
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Affiliation(s)
| | - Lu Niu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Bagamian KH, Anderson IV JD, Blohm G, Scheele S. Shigella and childhood stunting: Evidence, gaps, and future research directions. PLoS Negl Trop Dis 2023; 17:e0011475. [PMID: 37699032 PMCID: PMC10497124 DOI: 10.1371/journal.pntd.0011475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Early childhood growth deficits have been shown to have lifelong health and economic impacts, yet their connection to one of their underlying causes, diarrheal diseases, has remained difficult to characterize. Identifying the processes and mechanisms that underlie this link has remained a challenge due to the complexity of the relationship and limitations in access to more advanced laboratory methods. In recent years, however, several large-scale, multisite studies have extensively investigated and reported the prevalence, etiology, and impacts of diarrheal diseases in children under 5 years (CU5) in low- to middle-income countries (LMICs). These studies, in combination with several single-site studies, have applied more advanced laboratory methods to uncover the etiology, true prevalence, infection mechanisms, and inflammation biomarkers of diarrheal disease. Of the multiple pathogens that have been shown to be strongly associated with diarrheal disease in CU5, Shigella is one of the more prevalent and impactful of these pathogens. In this narrative review, we highlight key insights from these studies and identify knowledge gaps and directions for future research. According to these studies, Shigella is most commonly detected in toddlers and young children; however, it can cause more severe disease and has a greater impact on linear growth for infants. Shigella often has a stronger relationship to linear growth faltering (LGF) than other enteropathogens, with higher Shigella loads resulting in greater growth deficits. Future studies should employ more Shigella-specific molecular assays and identify diarrheal etiologies using standardized diagnostics to improve child anthropometric and Shigella surveillance. Also, they should focus on uncovering the mechanisms of the relationship underlying Shigella and growth faltering to better characterize the role of asymptomatic infections and intestinal inflammation in this relationship.
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Affiliation(s)
- Karoun H. Bagamian
- Bagamian Scientific Consulting, LLC, Gainesville, Florida, United States of America
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
| | - John D. Anderson IV
- Bagamian Scientific Consulting, LLC, Gainesville, Florida, United States of America
- Health Affairs Institute, West Virginia University, Morgantown, West Virginia, United States of America
| | - Gabriela Blohm
- Bagamian Scientific Consulting, LLC, Gainesville, Florida, United States of America
| | - Suzanne Scheele
- Center for Vaccine Innovation and Access, Washington, District of Columbia, United States of America
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Al Wazni AB, Chapman MV, Ansong D, Tawfik L. Climate Change, Fragility, and Child Mortality; Understanding the Role of Water Access and Diarrheal Disease Amongst Children Under Five During the MDG Era. JOURNAL OF PREVENTION (2022) 2023; 44:409-419. [PMID: 37036450 DOI: 10.1007/s10935-023-00732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/11/2023]
Abstract
The present study examined the influence of improvements to Water, Sanitation, and Hygiene (WASH) infrastructure on rates of under-five mortality specifically from diarrheal disease amongst children in fragile states. The World Bank's Millennium Development Goals and Sustainable Development Goals both include a specific target of reduction in preventable disease amongst children, as well as goal to improve WASH. Although gains have been made, children under the age of five remain particularly vulnerable to diarrheal mortality in states identified as fragile. Increasingly, climate change is placing undue pressure on states labeled fragile due to their inability to properly prepare for, or respond to, natural disasters that further compromise WASH development and water safety. The impact of climate change upon child health outcomes is neither direct nor linear and necessitates a linkage framework that can account for complex pathways between environmental pressures and public health outcomes. The World Health Organization's Drive Force-Pressure-State-Exposure-Effect-Action conceptual framework was used to draw the connections between seemingly disparate, and highly nuanced, environmental, and social measures. Using a multilevel hierarchical model, this analysis used a publicly available UNICEF data set that reported rates of mortality specifically from diarrheal disease amongst children age five and younger. All 171 formally recognized countries were included, which showed a decline in diarrheal disease over time when investments in WASH infrastructure are compared. As states experience increased pressure because of climate change, this area of intervention is key for immediate health and safety of children under-five, as well as assisting fragile states long-term as the move toward stability.
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Affiliation(s)
- Anderson B Al Wazni
- School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St. CB#3550, Chapel Hill, NC, 27599-3550, USA.
| | - Mimi V Chapman
- School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St. CB#3550, Chapel Hill, NC, 27599-3550, USA
| | - David Ansong
- School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St. CB#3550, Chapel Hill, NC, 27599-3550, USA
| | - Linda Tawfik
- UNC Gillings School of Global Public Health, WHO Collaborating Center for Research Evidence for Sexual and Reproductive Health, 407 Rosenau Hall, Chapel Hill, NC, 27599, USA
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Tankwanchi AS, Asabor EN, Vermund SH. Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6210. [PMID: 37444057 PMCID: PMC10341112 DOI: 10.3390/ijerph20136210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.
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Affiliation(s)
- Akhenaten Siankam Tankwanchi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Emmanuella N. Asabor
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
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Florez ID, Sierra J, Pérez-Gaxiola G. Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children. Cochrane Database Syst Rev 2023; 5:CD013640. [PMID: 37196992 PMCID: PMC10192509 DOI: 10.1002/14651858.cd013640.pub2] [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] [Indexed: 05/19/2023]
Abstract
BACKGROUND Although acute diarrhoea is a self-limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's lactate) are alternatives to 0.9% saline and have been associated with fewer days of hospitalization and better biochemical outcomes. Available guidelines provide conflicting recommendations. It is unclear whether 0.9% saline or balanced intravenous fluids are most effective for rehydrating children with severe dehydration due to diarrhoea. OBJECTIVES To evaluate the benefits and harms of balanced solutions for the rapid rehydration of children with severe dehydration due to acute diarrhoea, in terms of time in hospital and mortality compared to 0.9% saline. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 4 May 2022. SELECTION CRITERIA We included randomized controlled trials in children with severe dehydration due to acute diarrhoea comparing balanced solutions, such as Ringer's lactate or Plasma-Lyte with 0.9% saline solution, for rapid rehydration. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. time in hospital and 2. MORTALITY Our secondary outcomes were 3. need for additional fluids, 4. total amount of fluids received, 5. time to resolution of metabolic acidosis, 6. change in and the final values of biochemical measures (pH, bicarbonate, sodium, chloride, potassium, and creatinine), 7. incidence of acute kidney injury, and 8. ADVERSE EVENTS We used GRADE to assess the certainty of the evidence. MAIN RESULTS Characteristics of the included studies We included five studies with 465 children. Data for meta-analysis were available from 441 children. Four studies were conducted in low- and middle-income countries and one study in two high-income countries. Four studies evaluated Ringer's lactate, and one study evaluated Plasma-Lyte. Two studies reported the time in hospital, and only one study reported mortality as an outcome. Four studies reported final pH and five studies reported bicarbonate levels. Adverse events reported were hyponatremia and hypokalaemia in two studies each. Risk of bias All studies had at least one domain at high or unclear risk of bias. The risk of bias assessment informed the GRADE assessments. Primary outcomes Compared to 0.9% saline, the balanced solutions likely result in a slight reduction of the time in hospital (mean difference (MD) -0.35 days, 95% confidence interval (CI) -0.60 to -0.10; 2 studies; moderate-certainty evidence). However, the evidence is very uncertain about the effect of the balanced solutions on mortality during hospitalization in severely dehydrated children (risk ratio (RR) 0.33, 95% CI 0.02 to 7.39; 1 study, 22 children; very low-certainty evidence). Secondary outcomes Balanced solutions probably produce a higher increase in blood pH (MD 0.06, 95% CI 0.03 to 0.09; 4 studies, 366 children; low-certainty evidence) and bicarbonate levels (MD 2.44 mEq/L, 95% CI 0.92 to 3.97; 443 children, four studies; low-certainty evidence). Furthermore, balanced solutions likely reduces the risk of hypokalaemia after the intravenous correction (RR 0.54, 95% CI 0.31 to 0.96; 2 studies, 147 children; moderate-certainty evidence). Nonetheless, the evidence suggests that balanced solutions may result in no difference in the need for additional intravenous fluids after the initial correction; in the amount of fluids administered; or in the mean change of sodium, chloride, potassium, and creatinine levels. AUTHORS' CONCLUSIONS The evidence is very uncertain about the effect of balanced solutions on mortality during hospitalization in severely dehydrated children. However, balanced solutions likely result in a slight reduction of the time in the hospital compared to 0.9% saline. Also, balanced solutions likely reduce the risk of hypokalaemia after intravenous correction. Furthermore, the evidence suggests that balanced solutions compared to 0.9% saline probably produce no changes in the need for additional intravenous fluids or in other biochemical measures such as sodium, chloride, potassium, and creatinine levels. Last, there may be no difference between balanced solutions and 0.9% saline in the incidence of hyponatraemia.
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Affiliation(s)
- Ivan D Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Paediatric Intensive Care Unit, Clínica Las Américas-AUNA, Medellin, Colombia
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Javier Sierra
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Emergency Department, Hospital General de Medellin, Medellin, Colombia
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Deichsel EL, Powell H, Troeger C, Hossain MJ, Sow SO, Omore R, Jasseh M, Onwuchekwa U, Obor D, Sanogo D, Jones JCM, Nasrin D, Tapia MD, Kotloff KL. Drivers of Decline in Diarrhea Mortality Between GEMS and VIDA Studies. Clin Infect Dis 2023; 76:S58-S65. [PMID: 37074431 PMCID: PMC10116520 DOI: 10.1093/cid/ciad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Statistical modeling suggests that decreasing diarrhea-associated mortality rates in recent decades are largely attributed to improved case management, rotavirus vaccine, and economic development. METHODS We examined data collected in 2 multisite population-based diarrhea case-control studies, both conducted in The Gambia, Kenya, and Mali: the Global Enteric Multicenter Study (GEMS; 2008-2011) and Vaccine Impact on Diarrhea in Africa (VIDA; 2015-2018). Population-level diarrhea mortality and risk factor prevalence, estimated using these study data, were used to calculate the attribution of risk factors and interventions for diarrhea mortality using a counterfactual framework. We performed a decomposition of the effects of the changes in exposure to each risk factor between GEMS and VIDA on diarrhea mortality for each site. RESULTS Diarrhea mortality among children under 5 in our African sites decreased by 65.3% (95% confidence interval [CI]: -80.0%, -45.0%) from GEMS to VIDA. Kenya and Mali had large relative declines in diarrhea mortality between the 2 periods with 85.9% (95% CI: -95.1%, -71.5%) and 78.0% (95% CI: -96.0%, 36.3%) reductions, respectively. Among the risk factors considered, the largest declines in diarrhea mortality between the 2 study periods were attributed to reduction in childhood wasting (27.2%; 95% CI: -39.3%, -16.8%) and an increased rotavirus vaccine coverage (23.1%; 95% CI: -28.4%, -19.4%), zinc for diarrhea treatment (12.1%; 95% CI: -16.0%, -8.9%), and oral rehydration salts (ORS) for diarrhea treatment (10.2%). CONCLUSIONS The VIDA study sites demonstrated exceptional reduction in diarrhea mortality over the last decade. Site-specific differences highlight an opportunity for implementation science in collaboration with policymakers to improve the equitable coverage of these interventions globally.
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Affiliation(s)
- Emily L Deichsel
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Momodou Jasseh
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - David Obor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Joquina Chiquita M Jones
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Deichsel EL, Keita AM, Verani JR, Powell H, Jamka LP, Hossain MJ, Jones JCM, Omore R, Awuor AO, Sow SO, Sanogo D, Tapia MD, Neuzil KM, Kotloff KL. Management of Diarrhea in Young Children in Sub-Saharan Africa: Adherence to World Health Organization Recommendations During the Global Enteric Multisite Study (2007-2011) and the Vaccine Impact of Diarrhea in Africa (VIDA) Study (2015-2018). Clin Infect Dis 2023; 76:S23-S31. [PMID: 37074440 PMCID: PMC10116557 DOI: 10.1093/cid/ciac926] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Reducing diarrhea-related morbidity and mortality is a global priority, particularly in low-resource settings. We assessed adherence to diarrhea case management indicators in the Global Enteric Multisite Study (GEMS) and Vaccine Impact of Diarrhea in Africa (VIDA) study. METHODS GEMS (2007-2010) and VIDA (2015-2018) were age-stratified case-control studies of moderate-to-severe diarrhea (MSD) in children aged <5 years. In this case-only analysis, we included children enrolled in The Gambia, Kenya, and Mali. A case with no dehydration received adherent care at home if they were offered more than usual fluids and at least the same as usual to eat. Children with diarrhea and some dehydration are to receive oral rehydration salts (ORS) in the facility. The recommendation for severe dehydration is to receive ORS and intravenous fluids in the facility. Adherent care in the facility included a zinc prescription independent of dehydration severity. RESULTS For home-based management of children with MSD and no signs of dehydration, 16.6% in GEMS and 15.6% in VIDA were adherent to guidelines. Adherence to guidelines in the facility was likewise low during GEMS (some dehydration, 18.5%; severe dehydration, 5.5%). The adherence to facility-based rehydration and zinc guidelines improved during VIDA to 37.9% of those with some dehydration and 8.0% of children with severe dehydration. CONCLUSIONS At research sites in The Gambia, Kenya, and Mali, suboptimal adherence to diarrhea case management guidelines for children aged <5 years was observed. Opportunities exist for improvement in case management for children with diarrhea in low-resource settings.
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Affiliation(s)
- Emily L Deichsel
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Joquina Chiquita M Jones
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Wu M, Zheng W, Song X, Bao B, Wang Y, Ramanan D, Yang D, Liu R, Macbeth JC, Do EA, Andrade WA, Yang T, Cho HS, Gazzaniga FS, Ilves M, Coronado D, Thompson C, Hang S, Chiu IM, Moffitt JR, Hsiao A, Mekalanos JJ, Benoist C, Kasper DL. Microbiome induced complement synthesized in the gut protects against enteric infections. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.02.523770. [PMID: 36778396 PMCID: PMC9915568 DOI: 10.1101/2023.02.02.523770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Canonically, complement is a serum-based host defense system that protects against systemic microbial invasion. Little is known about the production and function of complement components on mucosal surfaces. Here we show gut complement component 3 (C3), central to complement function, is regulated by the composition of the microbiota in healthy humans and mice, leading to host-specific gut C3 levels. Stromal cells in intestinal lymphoid follicles (LFs) are the predominant source of intestinal C3. During enteric infection with Citrobacter rodentium or enterohemorrhagic Escherichia coli, luminal C3 levels increase significantly and are required for protection. C. rodentium is remarkably more invasive to the gut epithelium of C3-deficient mice than of wild-type mice. In the gut, C3-mediated phagocytosis of C. rodentium functions to clear pathogens. Our study reveals that variations in gut microbiota determine individuals’ intestinal mucosal C3 levels, dominantly produced by LF stromal cells, which directly correlate with protection against enteric infection. Highlights Gut complement component 3 (C3) is induced by the microbiome in healthy humans and mice at a microbiota-specific level.Gut stromal cells located in intestinal lymphoid follicles are a major source of luminal C3 During enteric infections with Citrobacter rodentium or enterohemorrhagic Escherichia coli, gut luminal C3 levels increase and are required for protection. C. rodentium is significantly more invasive of the gut epithelium in C3-deficient mice when compared to WT mice. In the gut, C3-mediated opsonophagocytosis of C. rodentium functions to clear pathogens.
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Negesse Y, Fetene Abebe G, Addisu A, Setegn Alie M, Alemayehu D. The magnitude of oral rehydration salt utilization in diarrhea hot spot regions of Ethiopia and its associated factors among under-five children: A multilevel analysis based on Bayesian approach. Front Public Health 2022; 10:960627. [PMID: 36438299 PMCID: PMC9686366 DOI: 10.3389/fpubh.2022.960627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background Diarrhea leads the children to severe dehydration or death as a result of the loss of water and electrolytes (namely, potassium, chloride, sodium, and bicarbonate). To compensate for the losses, ORS is given to children who experienced diarrhea. Objective To estimate the magnitude of ORS utilization in diarrhea hotspot regions of Ethiopia and to assess its associated factors among under-five children. Methods To conduct this study, we used the 2016 Ethiopian demographic and health survey data. A total of 1,079 weighted sample children were selected. Each sample was selected randomly. Then, to identify factors associated with ORS utilization in diarrhea hotspot regions of Ethiopia, a multilevel analysis based on the Bayesian approach was applied. Finally, the credible interval of AOR that does not include 1 was considered statistically significant. Results The magnitude of ORS utilization for children in diarrhea hotspot regions of Ethiopia was 28%. Being urban resident (AOR = 1.92; 95% CrI: 1.13-3.3), woman household head (AOR = 2.11; 95% CrI: 1.3-3.9), having higher educational level (AOR = 1.52; 95% CrI: 1.04-2.22), member of health insurance (AOR = 1.73; 95% CrI: 1.14-2.43), and being exposed for media (AOR = 1.43; 95% CrI: 1.18-2.5) increases ORS utilization for diarrhea management. Conclusion Residence, educational level, health insurance, and media exposure were the factors of ORS utilization. So, to increase the practice of ORS utilization for diarrhea management in Ethiopia, the Ministry of Health and the Government of Ethiopia should consider those factors when they design diarrhea prevention and control strategies.
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Affiliation(s)
- Yilkal Negesse
- College of Health Science, Debre-Markos University, Debre-Markos, Ethiopia,*Correspondence: Yilkal Negesse
| | - Gossa Fetene Abebe
- College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Abebaw Addisu
- College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Melsew Setegn Alie
- College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dereje Alemayehu
- College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Marginal Zinc Deficiency Aggravated Intestinal Barrier Dysfunction and Inflammation through ETEC Virulence Factors in a Mouse Model of Diarrhea. Vet Sci 2022; 9:vetsci9090507. [PMID: 36136723 PMCID: PMC9503546 DOI: 10.3390/vetsci9090507] [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: 08/02/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Enterotoxigenic Escherichia coli (ETEC) is one of the most common bacterial causes of diarrhea in children and farm animals. Zinc has received widespread attention for its roles in the prevention and treatment of diarrhea. However, zinc is also essential for the pathogenesis of ETEC. This study aimed to explore the accurate effect and mechanisms of marginal zinc deficiency on ETEC k88 infection and host intestinal health. Using the newly developed marginal zinc deficiency and ETEC k88 infection mouse model, we found that marginal zinc deficiency aggravated growth impairment, diarrhea, intestinal morphology, intestinal permeability, and inflammation induced by ETEC k88 infection. Consistently, intestinal ETEC k88 shedding was also higher in mice with marginal zinc deficiency. However, marginal zinc deficiency failed to affect host zinc levels and correspondingly the zinc-receptor GPR39 expression in the jejunum. In addition, marginal zinc deficiency upregulated the relative expression of virulence genes involved in heat-labile and heat-stable enterotoxins, motility, cellular adhesion, and biofilm formation in the cecum content of mice with ETEC infection. These findings provide a new explanation for zinc treatment of ETEC infection. Abstract Zinc is both essential and inhibitory for the pathogenesis of enterotoxigenic Escherichia coli (ETEC). However, the accurate effects and underlying mechanism of marginal zinc deficiency on ETEC infection are not fully understood. Here, a marginal zinc-deficient mouse model was established by feeding mice with a marginal zinc-deficient diet, and ETEC k88 was further administrated to mice after antibiotic disruption of the normal microbiota. Marginal zinc deficiency aggravated growth impairment, diarrhea, intestinal morphology, intestinal permeability, and inflammation induced by ETEC k88 infection. In line with the above observations, marginal zinc deficiency also increased the intestinal ETEC shedding, though the concentration of ETEC in the intestinal content was not different or even decreased in the stool. Moreover, marginal zinc deficiency failed to change the host’s zinc levels, as evidenced by the fact that the serum zinc levels and zinc-receptor GPR39 expression in jejunum were not significantly different in mice with ETEC challenge. Finally, marginal zinc deficiency upregulated the relative expression of virulence genes involved in heat-labile and heat-stable enterotoxins, motility, cellular adhesion, and biofilm formation in the cecum content of mice with ETEC infection. These findings demonstrated that marginal zinc deficiency likely regulates ETEC infection through the virulence factors, whereas it is not correlated with host zinc levels.
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Hartman RM, Cohen AL, Antoni S, Mwenda J, Weldegebriel G, Biey J, Shaba K, de Oliveira L, Rey G, Ortiz C, Tereza M, Fahmy K, Ghoniem A, Ashmony H, Videbaek D, Singh S, Tondo E, Sharifuzzaman M, Liyanage J, Batmunkh N, Grabovac V, Logronio J, Serhan F, Nakamura T. Risk Factors for Mortality Among Children Younger Than Age 5 Years With Severe Diarrhea in Low- and Middle-income Countries: Findings From the World Health Organization-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks. Clin Infect Dis 2022; 76:e1047-e1053. [PMID: 35797157 PMCID: PMC9907489 DOI: 10.1093/cid/ciac561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries. METHODS Data from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality. RESULTS This analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81-4.50), female sex (OR = 1.18; 95% CI, 1.06-1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01-3.25), no vomiting (OR = 1.13; 95% CI, .98-1.30), severe dehydration (OR = 3.79; 95% CI, 3.01-4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92-2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72-422.73), whereas cases from the European Region had the lowest odds of death. CONCLUSIONS Our findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.
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Affiliation(s)
- Rachel M Hartman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Adam L Cohen
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Sebastien Antoni
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Jason Mwenda
- Department of Vaccine Preventable Diseases Program, World Health Organization Regional Office for Africa, Brazzaville, Congo Republic
| | - Goitom Weldegebriel
- Department of Immunization, Vaccines and Biologicals, World Health Organization Regional Office for Africa, Inter-Support Team for East and South Africa, Harare, Zimbabwe
| | - Joseph Biey
- Department of Vaccine Preventable Diseases, World Health Organization Regional Office for Africa, Inter-Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Keith Shaba
- Department of Vaccine Preventable Diseases Program, World Health Organization Regional Office for Africa, Brazzaville, Congo Republic
| | - Lucia de Oliveira
- Pan American Health Organization/Department of Family, Health Promotion, and Life Course, World Health Organization Regional Office for the Americas, Comprehensive Family Immunization Unit, Washington, DC, USA
| | - Gloria Rey
- Pan American Health Organization/Department of Family, Health Promotion, and Life Course, World Health Organization Regional Office for the Americas, Comprehensive Family Immunization Unit, Washington, DC, USA
| | - Claudia Ortiz
- Pan American Health Organization/Department of Family, Health Promotion, and Life Course, World Health Organization Regional Office for the Americas, Comprehensive Family Immunization Unit, Washington, DC, USA
| | - Maria Tereza
- Pan American Health Organization/Department of Family, Health Promotion, and Life Course, World Health Organization Regional Office for the Americas, Comprehensive Family Immunization Unit, Washington, DC, USA
| | - Kamal Fahmy
- Department of Communicable Diseases, Immunization, Vaccines and Biologicals Unit, World Health Organization Eastern Mediterranean Office, Cairo, Egypt
| | - Amany Ghoniem
- Department of Communicable Diseases, Immunization, Vaccines and Biologicals Unit, World Health Organization Eastern Mediterranean Office, Cairo, Egypt
| | - Hossam Ashmony
- Department of Communicable Diseases, Immunization, Vaccines and Biologicals Unit, World Health Organization Eastern Mediterranean Office, Cairo, Egypt
| | - Dovile Videbaek
- Division of Country Health Programmes, Vaccine-Preventable Diseases and Immunization Unit, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Simarjit Singh
- Division of Country Health Programmes, Vaccine-Preventable Diseases and Immunization Unit, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Emmanuel Tondo
- Department of Immunization and Vaccine Development, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Mohammed Sharifuzzaman
- Department of Immunization and Vaccine Development, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Jayantha Liyanage
- Department of Immunization and Vaccine Development, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Nyambat Batmunkh
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Varja Grabovac
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Josephine Logronio
- Division of Programmes for Diseases Control, Vaccine Preventable Diseases and Immunization, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Fatima Serhan
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Tomoka Nakamura
- Correspondence: T. Nakamura, Department of Immunization, Vaccines and Biologicals, World Health Organization, WHO Headquarters, Avenue Appia 20, 1211, Geneva, Switzerland ()
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Prevalence of Diarrhea, Feeding Practice, and Associated Factors among Children under Five Years in Bereh District, Oromia, Ethiopia. Infect Dis Obstet Gynecol 2022; 2022:4139648. [PMID: 35754527 PMCID: PMC9232332 DOI: 10.1155/2022/4139648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Diarrheal disease is a major public health problem among under-five children globally. In Ethiopia, it is the second cause of hospital admission and death among children under five years. Objectives To assess the prevalence of diarrhea, feeding practice, and associated factors among children under five years in Bereh District, Oromia Special Zone Surrounding Finfine, Ethiopia. Methods A community-based cross-sectional study was conducted among children less than 5 years old in Bereh District from May 15 to 29, 2021. A systematic random sampling technique was used to select a total of 455 study participants. Descriptive statistics were used to measure the prevalence of diarrhea as well as to summarize other study variables. A binary logistic regression model with an adjusted odds ratio and a 95% confidence interval (CI) was used to declare the associated factors with childhood diarrhea. Results The prevalence of diarrhea was 17.3% in the past 15 days preceding the study period. About 53.4% of the mothers/caregivers were engaged in poor child feeding practices. Age of children [AOR = 9.146, 95% CI (2.055, 40.707)], birth order [AOR = 0.137, 95% CI (0.057, 0.329)], total family size [AOR: 5.042, 95% CI (2.326, 10.931)], not EBF [AOR: 4.723, 95% CI (1.166, 19.134)], prepare child foods separately [AOR: 0.252, 95% CI (0.091, 0.701)], feeding child immediately after cooking, handwashing method, and source of drinking water were significantly associated with under-five diarrhea. Conclusions The prevalence of diarrhea among children under five is high. More than half of the participants were engaged in poor IYCF practice. Action targeting the factors associated with diarrhea should be taken to improve under-five child's health.
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Sambo J, Bauhofer AFL, Boene SS, Djedje M, Júnior A, Pilale A, Gonçalves L, de Deus N, Chicumbe S. Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data. Healthcare (Basel) 2022; 10:1200. [PMID: 35885727 PMCID: PMC9319856 DOI: 10.3390/healthcare10071200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p < 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p < 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services.
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Affiliation(s)
- Júlia Sambo
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela nº 3943, Distrito de Marracuene, Maputo 1120, Mozambique; (A.F.L.B.); (S.S.B.); (M.D.); (A.J.); (N.d.D.); (S.C.)
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela nº 3943, Distrito de Marracuene, Maputo 1120, Mozambique; (A.F.L.B.); (S.S.B.); (M.D.); (A.J.); (N.d.D.); (S.C.)
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
| | - Simone S. Boene
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela nº 3943, Distrito de Marracuene, Maputo 1120, Mozambique; (A.F.L.B.); (S.S.B.); (M.D.); (A.J.); (N.d.D.); (S.C.)
| | - Marlene Djedje
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela nº 3943, Distrito de Marracuene, Maputo 1120, Mozambique; (A.F.L.B.); (S.S.B.); (M.D.); (A.J.); (N.d.D.); (S.C.)
| | - António Júnior
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela nº 3943, Distrito de Marracuene, Maputo 1120, Mozambique; (A.F.L.B.); (S.S.B.); (M.D.); (A.J.); (N.d.D.); (S.C.)
| | - Adalgisa Pilale
- Pediatria, Hospital Central de Maputo (HCM), Maputo 164, Mozambique;
| | - Luzia Gonçalves
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal;
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela nº 3943, Distrito de Marracuene, Maputo 1120, Mozambique; (A.F.L.B.); (S.S.B.); (M.D.); (A.J.); (N.d.D.); (S.C.)
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane (UEM), Maputo 1100, Mozambique
| | - Sérgio Chicumbe
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela nº 3943, Distrito de Marracuene, Maputo 1120, Mozambique; (A.F.L.B.); (S.S.B.); (M.D.); (A.J.); (N.d.D.); (S.C.)
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
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Wandera EA, Muriithi B, Kathiiko C, Mutunga F, Wachira M, Mumo M, Mwangi A, Tinkoi J, Meiguran M, Akumu P, Ndege V, Kasiku F, Ang'awa J, Mozichuki R, Kaneko S, Morita K, Ouma C, Ichinose Y. Impact of integrated water, sanitation, hygiene, health and nutritional interventions on diarrhoea disease epidemiology and microbial quality of water in a resource-constrained setting in Kenya: A controlled intervention study. Trop Med Int Health 2022; 27:669-677. [PMID: 35700209 PMCID: PMC9541685 DOI: 10.1111/tmi.13793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives We assessed the impact of water, hygiene and sanitation (WASH), maternal, new‐born and child health (MNCH), nutrition and early childhood development (ECD) on diarrhoea and microbial quality of water in a resource‐constrained rural setting in Kenya. Methods Through a controlled intervention study, we tested faecal and water samples collected from both the intervention and control sites before and after the interventions using microbiological, immunological and molecular assays to determine the prevalence of diarrhoeagenic agents and microbial quality of water. Data from the hospital registers were used to estimate all‐cause diarrhoea prevalence. Results After the interventions, we observed a 58.2% (95% CI: 39.4–75.3) decline in all‐cause diarrhoea in the intervention site versus a 22.2% (95% CI: 5.9–49.4) reduction of the same in the control site. Besides rotavirus and pathogenic Escherichia coli, the rate of isolation of other diarrhoea‐causing bacteria declined substantially in the intervention site. The microbial quality of community and household water improved considerably in both the intervention (81.9%; 95% CI: 74.5%–87.8%) and control (72.5%; 95% CI: 64.2%–80.5%) sites with the relative improvements in the intervention site being slightly larger. Conclusions The integrated WASH, MNCH, nutrition and ECD interventions resulted in notable decline in all‐cause diarrhoea and improvements in water quality in the rural resource‐limited population in Kenya. This indicates a direct public health impact of the interventions and provides early evidence for public health policy makers to support the sustained implementation of these interventions.
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Affiliation(s)
- Ernest Apondi Wandera
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya.,Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Betty Muriithi
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
| | - Cyrus Kathiiko
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
| | - Felix Mutunga
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
| | - Mary Wachira
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
| | - Maurine Mumo
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
| | - Anne Mwangi
- Department of Health and Nutrition, World Vision Kenya, Nairobi, Kenya
| | - Joseph Tinkoi
- Department of Health and Nutrition, World Vision Kenya, Nairobi, Kenya
| | - Mirasine Meiguran
- Department of Health and Nutrition, World Vision Kenya, Nairobi, Kenya
| | - Pius Akumu
- Department of Health and Nutrition, World Vision Kenya, Nairobi, Kenya
| | - Valeria Ndege
- Department of Health and Nutrition, World Vision Kenya, Nairobi, Kenya
| | - Fredrick Kasiku
- Department of Health and Nutrition, World Vision Kenya, Nairobi, Kenya
| | - James Ang'awa
- Department of Health and Nutrition, World Vision Kenya, Nairobi, Kenya
| | | | - Satoshi Kaneko
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
| | - Kouichi Morita
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, Kenya
| | - Yoshio Ichinose
- Institute of Tropical Medicine, Nagasaki University-Kenya Medical Research Institute, Nairobi, Kenya
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Pieterse P, Walsh A, Chirwa E, Matthews A. What are the mechanisms and contexts by which care groups achieve social and behavioural change in low- and middle-income countries? Group motivation findings from a realist synthesis. Public Health Nutr 2022; 25:1-12. [PMID: 35642077 PMCID: PMC9991844 DOI: 10.1017/s1368980022001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/27/2022] [Accepted: 05/21/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular handwashing, etc. Community-based volunteer or peer-to-peer mechanisms are cost-effective ways of promoting these lifesaving practices. However, the sustainability and reach of community-based behaviour change promotion remains a challenge. Our inquiry focuses on the utilisation, by non-governmental organisations (NGO), of Care Groups, a peer-to-peer behaviour change intervention. We asked: What are the mechanisms and contexts by which Care Groups achieve social and behavioural change in nutrition, health and other sectors? DESIGN Realist synthesis reviewing forty-two texts that contained empirical evidence about Care Group interventions. SETTING LMIC. PARTICIPANTS We held consultations with a research reference group, which included Care Group and nutrition experts, and Care Group - implementing NGO staff in Malawi. RESULTS Different types of motivation drive the establishment and the sustainability of peer group interventions. A certain amount of motivation was derived from the resources provided by the NGO establishing the Care Groups. Subsequently, both volunteers and neighbourhood group members were motivated by the group dynamics and mutual support, as well as support from the wider community. Finally, volunteers and group members alike became self-motivated by their experience of being involved in group activities. CONCLUSIONS When designing and implementing community-based behaviour change interventions, awareness of the multi-directional nature of the motivating drivers that are experienced by peer- or community group members is important, to optimise these groups' reach and sustainability.
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Affiliation(s)
- Pieternella Pieterse
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin Campus, Dublin, 9, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ellen Chirwa
- Faculty of Midwifery, Neonatal and Reproductive Health Studies, Kamuzu College of Health Sciences, Blantyre, Malawi
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin Campus, Dublin, 9, Ireland
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Asare EO, Hergott D, Seiler J, Morgan B, Archer H, Wiyeh AB, Guo B, Driver M, Giersing B, Hasso-Agopsowicz M, Lingappa J, Lopman BA, Pitzer VE. Case fatality risk of diarrhoeal pathogens: a systematic review and meta-analysis. Int J Epidemiol 2022; 51:1469-1480. [PMID: 35578827 PMCID: PMC9557849 DOI: 10.1093/ije/dyac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/06/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Estimates of the relative contribution of different pathogens to all-cause diarrhoea mortality are needed to inform global diarrhoea burden models and prioritize interventions. We aimed to investigate and estimate heterogeneity in the case fatality risk (CFR) of different diarrhoeal pathogens. METHODS We conducted a systematic review and meta-analysis of studies that reported cases and deaths for 15 enteric pathogens published between 1990 and 2019. The primary outcome was the pathogen-specific CFR stratified by age group, country-specific under-5 mortality rate, setting, study year and rotavirus vaccine introduction status. We developed fixed-effects and multilevel mixed-effects logistic regression models to estimate the pooled CFR overall and for each pathogen, controlling for potential predictors of heterogeneity. RESULTS A total of 416 studies met review criteria and were included in the analysis. The overall crude CFR for all pathogens was 0.65%, but there was considerable heterogeneity between and within studies. The overall CFR estimated from a random-effects model was 0.04% (95% CI: 0.026%-0.062%), whereas the pathogen-specific CFR estimates ranged from 0% to 2.7%. When pathogens were included as predictors of the CFR in the overall model, the highest and lowest odds ratios were found for enteropathogenic Escherichia coli (EPEC) [odds ratio (OR) = 3.0, 95% CI: 1.28-7.07] and rotavirus (OR = 0.23, 95% CI: 0.13-0.39), respectively. CONCLUSION We provide comprehensive estimates of the CFR across different diarrhoeal pathogens and highlight pathogens for which more studies are needed. The results motivate the need for diarrhoeal interventions and could help prioritize pathogens for vaccine development.
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Affiliation(s)
- Ernest O Asare
- Corresponding author. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, PO Box 208034, 60 College Street, New Haven, CT 06520-8034, USA. E-mail: ;
| | - Dianna Hergott
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jessica Seiler
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Brooks Morgan
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Helena Archer
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Alison B Wiyeh
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Boya Guo
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Matt Driver
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Birgitte Giersing
- Vaccine Product Delivery Research, Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Mateusz Hasso-Agopsowicz
- Vaccine Product Delivery Research, Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Jairam Lingappa
- Departments of Global Health, Medicine, and Pediatrics, University of Washington, Seattle, WA, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
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Asare EO, Warren JL, Pitzer VE. Spatiotemporal patterns of diarrhea incidence in Ghana and the impact of meteorological and socio-demographic factors. FRONTIERS IN EPIDEMIOLOGY 2022; 2:871232. [PMID: 35822109 PMCID: PMC9272077 DOI: 10.3389/fepid.2022.871232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Diarrhea remains a significant public health problem and poses a considerable financial burden on Ghana's health insurance scheme. In order to prioritize district-level hotspots of diarrhea incidence for effective targeted interventions, it is important to understand the potential drivers of spatiotemporal patterns of diarrhea. We aimed to identify the spatiotemporal heterogeneity of diarrhea incidence in Ghana and explore how meteorological and socio-demographic factors influence the patterns. METHODS We used monthly district-level clinically diagnosed diarrhea data between 2012 and 2018 obtained from the Centre for Health Information and Management of the Ghana Health Services. We utilized a hierarchical Bayesian spatiotemporal modeling framework to evaluate potential associations between district-level monthly diarrhea incidence and meteorological variables (mean temperature, diurnal temperature range, surface water presence) and socio-demographic factors (population density, Gini index, District League Table score) in Ghana. In addition, we investigated whether these associations were consistent across the four agro-ecological zones. RESULTS There was considerable spatial heterogeneity in diarrhea patterns across the districts, with clusters of high diarrhea risk areas mostly found in the transition and savannah zones. The average monthly temporal patterns of diarrhea revealed a weak biannual seasonality with major and minor peaks in June and October, respectively, coinciding with the major and minor rainy seasons. We found a significant association between both meteorological and socio-demographic factors and diarrhea risk, but the strength and direction of associations differed across the four agro-ecological zones. Surface water presence demonstrated consistently positive, while diurnal temperature range and population density demonstrated consistently negative associations with diarrhea both overall and across the agro-ecological zones. CONCLUSIONS Although overall diarrhea incidence is declining in Ghana, our results revealed high-risk districts that could benefit from district-specific tailored intervention strategies to improve control efforts. Ghana health sector policy-makers can use these results to assess the effectiveness of ongoing interventions at the district level and prioritize resource allocation for diarrhea control.
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Affiliation(s)
- Ernest O. Asare
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT USA
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT USA
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Improved Water and Waste Management Practices Reduce Diarrhea Risk in Children under Age Five in Rural Tanzania: A Community-Based, Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074218. [PMID: 35409904 PMCID: PMC8998175 DOI: 10.3390/ijerph19074218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022]
Abstract
Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain communities. This study analyzes the adoption and effect of WASH-based practices on diarrhea in children under age five in the rural Busiya chiefdom in northwestern Tanzania. In a cross-sectional analysis spanning July-September 2019, 779 households representing 1338 under-five children were surveyed. Among households, 250 (32.1%) reported at least one child with diarrhea over a two-week interval. Diarrhea prevalence in under-five children was 25.6%. In per-household and per-child analyses, the strongest protective factors against childhood diarrhea included dedicated drinking water storage (OR 0.25, 95% CI 0.18−0.36; p < 0.001), improved waste management (OR 0.37, 95% CI 0.27−0.51; p < 0.001), and separation of drinking water (OR 0.38, 95% CI 0.24−0.59; p < 0.001). Improved water sources were associated with decreased risk of childhood diarrhea in per-household analysis (OR 0.72, 95% CI 0.52−0.99, p = 0.04), but not per-child analysis (OR 0.83, 95% CI 0.65−1.05, p = 0.13). Diarrhea was widely treated (87.5%), mostly with antibiotics (44.0%) and oral rehydration solution (27.3%). Targeting water transportation, storage, and sanitation is key to reducing diarrhea in rural populations with limited water access.
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Fischer Walker CL, Walker N, Black RE. Updating the assumptions on the impact of household water, sanitation and hygiene interventions on diarrhea morbidity in young children. J Glob Health 2022; 12:08003. [PMID: 35310420 PMCID: PMC8910783 DOI: 10.7189/jogh.12.08003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The Lives Saved Tool (LiST) is a publicly available and widely used model used to estimate the impact of scaling up interventions on maternal and child health. A strength of the model is that it is continuously updated with country-specific information about intervention coverage, risk factors and causes of death. This paper reports an updated review and meta-analysis on the efficacy of water, sanitation and hygiene (WASH) interventions in reducing diarrhea morbidity among children under the age of five years. Methods We updated previous LiST systematic reviews for improved WASH interventions according to standard LiST criteria. We sought to identify more recent WASH studies to update LiST efficacy estimates for each WASH intervention on diarrhea morbidity. In addition, we conducted a search to identify studies that reported an effect size for combined improved WASH interventions. For interventions where we found new studies, we conducted a weighted meta-analysis to produce an updated effect size estimate. Results We did not find new studies demonstrating an effect of improved water source alone on diarrhea morbidity among children under 5 years of age. For improved sanitation, we conducted an updated meta-analysis among 4 studies and found no difference between intervention and control arms (weighted mean difference (WMD) = -5% (95% confidence interval (CI) = -11% to 2%). We identified four trials that assessed the effect of combined interventions targeting improved water, sanitation and hygiene. The weighted mean difference also showed no effect on diarrhea morbidity among children under 5 years of age (WMD = -6%, 95% CI = -15% to 4%). Our updated results for handwashing promotion estimate the effects to results in a 17% reduction in childhood diarrhea morbidity (95% CI = 7% to 27%). Conclusions Despite widespread acceptance that WASH interventions can improve diarrhea morbidity, the evidence supporting this specifically for children under 5 years of age remains weak. Children interact with the environment in ways that differ from adults and these constant exposures may limit the effect that these WASH interventions can have on diarrhea morbidity.
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Affiliation(s)
- Christa L Fischer Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Whole genome analysis of rotavirus strains circulating in Benin before vaccine introduction, 2016-2018. Virus Res 2022; 313:198715. [PMID: 35247484 DOI: 10.1016/j.virusres.2022.198715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/21/2022]
Abstract
Species A Rotaviruses (RVA) still play a major role in causing acute diarrhea in children under five years old worldwide. Currently, an 11-gene classification system is used to designate the full genotypic constellations of circulating strains. Viral proteins and non-structural proteins in the order VP7-VP4-VP6-VP1-VP2-VP3-NSP1-NSP2-NSP3-NSP4-NSP5/6 are represented by the genotypes Gx-P[x]-Ix-Rx-Cx-Mx-Ax-Nx-Tx-Ex-Hx, respectively. In Benin, ROTAVAC® vaccine was introduced into the Expanded Programme on Immunization in December 2019. To monitor circulating RVA strains for changes that may affect vaccine performance, in-depth analysis of strains prior to vaccine introduction are needed. Here we report, the whole-gene characterization (11 ORFs) for 72 randomly selected RVA strains of common and unusual genotypes collected in Benin from the 2016-2018 seasons. The sequenced strains were 15 G1P[8], 20 G2P[4], 5 G9P[8], 14 G12P[8], 9 G3P[6], 2 G1P[6], 3 G2P[6], 2 G9P[4], 1 G12P[6], and 1 G1G9P[8]/P[4]. The study strains exhibited two genetic constellations designed as Wa-like G1/G9/G12-P[6]/P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1 and DS-1-like G2/G3/G12-P[4]/P[6]-I2-R2-C2-M2-A2-N2-T2-E2-H2. Genotype G9P[4] strains possessed a DS-1-like genetic constellation with an E6 NSP4 gene, G9-P[4]-I2-R2-C2-M2-A2-N2-T2-E6-H2. The mixed genotype showed both Wa-like and DS-1-like profiles with a T6 NSP3 gene G1/G9P[8]/[4]-I1/I2-R1/R2-C1/C2-M1/M2-A1/A2-N1/N2-T1/T6-E1/E6-H1/H2. At the allelic level, the analysis of the Benin strains, reference strains (with known alleles), vaccine strains (with known alleles) identified 2-13 and 1-17 alleles for DS-1-like and Wa-like strains, respectively. Most of the study strains clustered into previously defined alleles, but we defined 3 new alleles for the VP7 (G3=1 new allele and G12=2 new alleles) and VP4 (P[4]=1 new allele and P[6]=2 new alleles) genes which formed the basis of the VP7 and VP4 gene clusters, respectively. For the remaining 9 genes, 0-6 new alleles were identified for both Wa-like and DS-1-like strains. This analysis of whole genome sequences of RVA strains circulating in Benin described genetic point mutations and reassortment events as well as novel alleles. Further detailed studies on these new alleles are needed and these data can also provide a baseline for studies on RVA in the post-vaccination period.
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Camelina sativa Oil Treatment Alleviates Castor Oil-Induced Diarrhea in ICR Mice by Regulating Intestinal Flora Composition. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5394514. [PMID: 35178105 PMCID: PMC8846971 DOI: 10.1155/2022/5394514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/15/2022] [Indexed: 01/02/2023]
Abstract
Diarrhea, occurring due to intestinal flora disturbance, is potentially lethal, and its current treatments have adverse effects such as constipation and vomiting. Camelina sativa oil (CSO) is a cooking ingredient and natural remedy used in several countries; however, its pharmacological effects on intestinal health remain unknown. Here, we explored the CSO treatment effects on intestinal flora in male ICR mice with castor oil-induced diarrhea. The rate and degree of loose stools, the diarrhea index, serum inflammatory indices, fecal short-chain fatty acids (SCFAs), and the diversity and abundance of intestinal flora were measured. Castor oil-administered mice experienced diarrhea, reduced intestinal flora diversity and fecal SCFAs concentrations, altered intestinal flora composition, and increased serum proinflammatory indices. In contrast, CSO treatment relieved diarrhea, improved intestinal flora composition, and increased the relative abundance of Lactobacillus and Lachnospiraceae. Additionally, CSO significantly increased the concentrations of fecal propionic acid, valeric acid, isovaleric acid, and serum sIgA, while it reduced those of serum interleukin-17. These findings suggest that CSO could be a promising preventive agent against diarrhea.
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Arostegui D, Wallach T. The Cutting Edge of Gastroenteritis: Advances in Understanding of Enteric Infection. J Pediatr Gastroenterol Nutr 2022; 74:180-185. [PMID: 34560728 DOI: 10.1097/mpg.0000000000003304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT In recent years, multiple advances have been made in the care, diagnosis, and mechanistic understanding of acute gastroenteritis (AGE). In this review, we discuss the current state of the art of diagnosis and management, as well as how changes in practice can improve care and decrease costs. We will discuss present study demonstrating the effect of AGE on the microbiome and how that may be linked to secondary effects or long-term changes. We will explore the use of novel technologies to further our capacity to understand how gastrointestinal infections occur and promulgate. Finally, will discuss advances in our understanding of how gastrointestinal infections capacitate other changes such as post-viral motility or other post viral intestinal dysfunction.
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Affiliation(s)
- Dalia Arostegui
- SUNY Downstate Department of Pediatrics, Division of Pediatric Gastroenterology, Brooklyn, NY
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Girma D, Abita Z, Wale A, Fetene G. Determinants of oral rehydration salt utilization among under-five children with diarrhea in Ethiopia: A multilevel mixed-effect analysis. SAGE Open Med 2022; 10:20503121221074781. [PMID: 35111326 PMCID: PMC8801655 DOI: 10.1177/20503121221074781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Oral rehydration salt therapy is a critical intervention to reduce mortality and morbidity of children with diarrheal diseases. However, it remains underused in low- and middle-income countries. In Ethiopia, only less than half of children with diarrheal diseases were treated with oral rehydration salt solution. Therefore, the objective of this study was to identify the determinants of oral rehydration salt utilization among children with diarrhea in Ethiopia. METHOD A secondary data analysis was done using the 2016 Ethiopian Demographic and Health Survey. A weighted sample of 1227 children who had diarrhea in the last 2 weeks with their index mothers during the 5 years survey was included in the study. A multilevel mixed logistic regression model was fitted to identify factors associated with oral rehydration salt utilization. Finally, statistical significance was declared at p-value < 0.05. RESULT The overall prevalence of oral rehydration salt utilization for children with diarrhea was 29.5%. In this study, age of mother ⩾35 (adjusted odds ratio = 1.66, 95% confidence interval = 1.05, 2.64), mothers with formal education (adjusted odds ratio = 1.52, 95% confidence interval = 1.09, 2.11), media exposure (adjusted odds ratio = 1.72, 95% confidence interval = 1.25, 2.38), living in Metropolitan regions (Addis Ababa and Dire Dawa (adjusted odds ratio = 1.76, 95% confidence interval = 1.14, 2.69)), and small peripheral regions (Afar, Gambela, Somalia, Benishangul-Gumuz (adjusted odds ratio = 1.69, 95% confidence interval = 1.22, 2.34)) were associated with higher odd of oral rehydration salt utilization for children with diarrhea. CONCLUSION The study concludes that the age of mothers, educational status of the mother, media exposure, and regions of mothers were determinants of oral rehydration salt utilization for children with diarrhea. Therefore, media advertising regarding diarrhea management should be scaled up to increase oral rehydration salt utilization for children with diarrhea. Special attention to socio-cultural constraints or beliefs regarding diarrhea management should be given to mothers from large to center (Tigray, Amhara, Oromia, Southern Nations Nationalities, and People's Region, and Harari) regions.
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Affiliation(s)
- Desalegn Girma
- Department of Midwifery, College of Health Science, Mizan–Tepi University, Mizan-Teferi, Ethiopia
| | - Zinie Abita
- Department of Reproductive Health, School of Public Health, College of Health Science, Mizan–Tepi University, Mizan-Teferi, Ethiopia
| | - Alemnew Wale
- Department of Midwifery, College of Health Science, Mizan–Tepi University, Mizan-Teferi, Ethiopia
| | - Gossa Fetene
- Department of Midwifery, College of Health Science, Mizan–Tepi University, Mizan-Teferi, Ethiopia
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Liu P, Zou R, Zhao J, Hao J, Zeng Y, Liu W, Tian J, Wang H. Changes in humoral immunity, myocardial damage, trace elements, and inflammatory factor levels in children with rotavirus enteritis. Am J Transl Res 2022; 14:452-459. [PMID: 35173864 PMCID: PMC8829652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the changes and significance of humoral immunity, myocardial damage, trace elements and inflammatory factors levels in children with rotavirus enteritis. METHODS One hundred children with rotavirus enteritis admitted to our hospital from January 2019 to December 2020 were retrospectively selected as the case group, and they were divided into a no dehydration group (33 cases), mild dehydration group (41 cases), and moderate dehydration group (26 cases). Another 100 children with rotavirus-negative enteritis during the same period were selected as the control group. Serum immunoglobulin, cardiac enzyme profile, trace elements, and interleukin-6 (IL-6) levels were compared between the two groups, and among the case groups for different degrees of dehydration. RESULTS Serum immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), zinc, magnesium, and calcium in the case group were lower than in controls (P<0.05). Serum lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) in the case group were higher than in controls (P<0.05). Serum IL-6, interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) were also higher in cases than controls (P<0.05). Serum IgA, IgG, IgM, zinc, magnesium, and calcium in children with rotavirus enteritis with mild dehydration were lower than those without dehydration, but higher than those with moderate dehydration (P<0.05). Serum LDH, α-HBDH, CK, and CK-MB in children with rotavirus enteritis with mild dehydration were higher than those without dehydration, but lower than those with moderate dehydration (P<0.05). Serum IL-6, IL-8, and TNF-α in children with rotavirus enteritis with mild dehydration were higher than those without dehydration, but lower than those with moderate dehydration (P<0.05). CONCLUSION Children with rotavirus enteritis with more severe dehydration exhibited lower levels of humoral immunity and trace elements and greater myocardial damage and inflammatory response. Early detection can accurately assess the condition and provide a reference for clinical treatment.
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Affiliation(s)
- Peihui Liu
- Department of Pediatrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
| | - Rong Zou
- Department of Pharmacy, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
| | - Jie Zhao
- Department of Neonatology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
| | - Jindou Hao
- Department of Pediatrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
| | - Yongmei Zeng
- Department of Pediatrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
| | - Wanqu Liu
- Department of Pediatrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
| | - Jia Tian
- Department of Pediatrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
| | - Hao Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical UniversityShenzhen City, Guangdong Province, China
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Ahmed T, Chisti MJ, Rahman MW, Alam T, Ahmed D, Parvin I, Kabir MF, Sazawal S, Dhingra P, Dutta A, Deb S, Chouhan A, Sharma AK, Jaiswal VK, Dhingra U, Walson JL, Singa BO, Pavlinac PB, McGrath CJ, Nyabinda C, Deichsel EL, Anyango M, Kariuki KM, Rwigi D, Tornberg-Belanger SN, Kotloff KL, Sow SO, Tapia MD, Haidara FC, Mehta A, Coulibaly F, Badji H, Permala-Booth J, Tennant SM, Malle D, Bar-Zeev N, Dube Q, Freyne B, Cunliffe N, Ndeketa L, Witte D, Ndamala C, Cornick J, Qamar FN, Yousafzai MT, Qureshi S, Shakoor S, Thobani R, Hotwani A, Kabir F, Mohammed J, Manji K, Duggan CP, Kisenge R, Sudfeld CR, Kibwana U, Somji S, Bakari M, Msemwa C, Samma A, Bahl R, De Costa A, Simon J, Ashorn P. Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2136726. [PMID: 34913980 PMCID: PMC8678692 DOI: 10.1001/jamanetworkopen.2021.36726] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/21/2021] [Indexed: 12/25/2022] Open
Abstract
Importance World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth. Objective To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth. Design, Setting, and Participants The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat. Interventions Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea. Main Outcomes and Measures Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment. Results A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis. Conclusions and Relevance The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged. Trial Registration ClinicalTrials.gov Identifier: NCT03130114.
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Affiliation(s)
- Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Muhammad Waliur Rahman
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dilruba Ahmed
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Irin Parvin
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Farhad Kabir
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sunil Sazawal
- Center for Public Health Kinetics, New Delhi, Delhi, India
| | | | - Arup Dutta
- Center for Public Health Kinetics, New Delhi, Delhi, India
| | - Saikat Deb
- Center for Public Health Kinetics, New Delhi, Delhi, India
| | | | | | | | - Usha Dhingra
- Center for Public Health Kinetics, New Delhi, Delhi, India
| | - Judd L Walson
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
- Department of Medicine (Allergy and Infectious Diseases), University of Washington, Seattle
| | - Benson O Singa
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Emily L Deichsel
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | | | | | - Doreen Rwigi
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Fadima Cheick Haidara
- Division of Advanced Primary Health Care Research and Clinical Trials, Centre pour le Développement des Vaccins, Bamako, Mali
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Flanon Coulibaly
- Division of Advanced Primary Health Care Research and Clinical Trials, Centre pour le Développement des Vaccins, Bamako, Mali
| | - Henry Badji
- Division of Clinical Microbiology and Molecular Biology, Centre pour le Développement des Vaccins, Bamako, Mali
| | - Jasnehta Permala-Booth
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Sharon M Tennant
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Dramane Malle
- Division of Clinical Microbiology and Molecular Biology, Centre pour le Développement des Vaccins, Bamako, Mali
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Queen Dube
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bridget Freyne
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Institute of Infection, Veterinary and Ecological Sciences, The University of Liverpool, Blantyre, Malawi
| | - Nigel Cunliffe
- National Institutes of Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Latif Ndeketa
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Liverpool School of Tropical Medicine, Blantyre, Malawi
| | - Desiree Witte
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Chifundo Ndamala
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jennifer Cornick
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Institute of Infection, Veterinary and Ecological Sciences, The University of Liverpool, Blantyre, Malawi
| | - Farah Naz Qamar
- Department of Pediatrics and Child Heath, Aga Khan University, Karachi, Pakistan
| | | | - Shahida Qureshi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Rozina Thobani
- Department of Pediatrics and Child Heath, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Heath, Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Heath, Aga Khan University, Karachi, Pakistan
| | - Jan Mohammed
- Department of Pediatrics and Child Heath, Aga Khan University, Karachi, Pakistan
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher P Duggan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Upendo Kibwana
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mohamed Bakari
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cecylia Msemwa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abraham Samma
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rajiv Bahl
- Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Ayesha De Costa
- Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Jonathon Simon
- Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Per Ashorn
- Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
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Karambizi NU, McMahan CS, Blue CN, Temesvari LA. Global estimated Disability-Adjusted Life-Years (DALYs) of diarrheal diseases: A systematic analysis of data from 28 years of the global burden of disease study. PLoS One 2021; 16:e0259077. [PMID: 34705878 PMCID: PMC8550424 DOI: 10.1371/journal.pone.0259077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 10/12/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Diarrheal disease (DD)-associated mortality has declined since 1990; however, the incidence of DD has experienced a less-pronounced decrease. Thus, it is important to track progress in managing DD by following loss of healthy years. A disability-adjusted life-year (DALY), which combines data on years-of-life lost (YLL) and years-lived with-disability (YLD), is a metric that can track such a burden. METHODS AND FINDINGS Using all 28 years of data in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we compared DD DALYs among different demographic subsets including sex, age, country, and World Bank (WB) income level. We also evaluated DD DALYs as a function of the socio-demographic index (SDI), a measure of a region's socio-demographic development. On a global level, DD DALYs have decreased by approximately 85.43% from 1990 to 2017. Incidence and prevalence have decreased by 1.53% and 4.45%, respectively. A dramatic decrease in DD DALYs were observed for WB low-income countries, but not for WB high-income constituents. The temporal decrease in DD DALY rates in WB low-income countries was likely driven by a decrease in YLL. Alternatively, temporal increases in both YLL and YLD may have contributed to the apparent lack of progress in WB high-income countries. Regardless of WB income classification, children under the age of five and the elderly were the most vulnerable to DD. In nearly every year from 1990 to 2017, DD DALYs for females were higher than those for males in WB high-income regions, but lower than those for males in WB low-income constituents. The reason for these differences is not known. We also observed that the rate of DD DALYs was highly correlated to SDI regardless of WB income classification. CONCLUSIONS To the best of our knowledge, this is the only temporal study of DD DALYs that encompasses all 28 years of data available from the GBD. Overall, our analyses show that temporal reductions in DD DALYs are not equivalent across regions, sexes and age groups. Therefore, careful attention to local and demography-specific risk factors will be necessary to tailor solutions in region- and demography-specific manners.
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Affiliation(s)
- Natacha U. Karambizi
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, United States of America
- Eukaryotic Pathogens Innovations Center (EPIC), Clemson University, Clemson, South Carolina, United States of America
| | - Christopher S. McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Carl N. Blue
- Department of Graphic Communications, Clemson University, Clemson, South Carolina, United States of America
| | - Lesly A. Temesvari
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, United States of America
- Eukaryotic Pathogens Innovations Center (EPIC), Clemson University, Clemson, South Carolina, United States of America
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Melo ESJ, de Oliveira BSB, Melo FMDS, da Silva MJN, de Oliveira RKL, Bezerra JC, Braga HFGM, de Sabino LMM, do Nascimento LA, da Penha JC, Freitas DJN, Mendes ERDR, Martins IM, Barbosa LP. Audiovisual and printed technology to prevent childhood diarrhea: A clinical trial. Public Health Nurs 2021; 39:423-430. [PMID: 34529864 DOI: 10.1111/phn.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the effect of using an educational booklet and a video alone or together in promoting maternal self-efficacy to prevent childhood diarrhea. DESIGN AND SAMPLE Randomized multicenter clinical trial with 522 mothers of children under 5 years of age from northeastern Brazil. They were allocated into eight groups, according to the city: metropolis - video alone (N = 61), booklet alone (N = 60), booklet and video along (N = 60), without intervention (N = 60); countryside - booklet alone (N = 70), video alone (N = 70), booklet and video along (N = 71), without intervention (N = 70). MEASUREMENTS A sociodemographic form and the Maternal Self-Efficacy Scale for preventing early childhood diarrhea. RESULTS Increases in self-efficacy scores were observed in all experimental groups after the educational intervention. Urban mothers living had greater self-efficacy than rural mothers. This result was verified in the video alone group (p = .036) and without intervention group (p = .003). Mothers in all intervention groups, regardless of the educational intervention used, had higher self-efficacy scores than the comparison group mothers (p < .05). CONCLUSION The tested educational technologies promoted maternal self-efficacy to prevent childhood diarrhea, regardless of whether they are applied alone or in combination.
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Affiliation(s)
| | | | - Francisca Mayra de Sousa Melo
- University of International Integration of Afro-Brazilian Lusophony, Redencao, Ceará, Brazil.,West Princess College, Crateús, Ceará, Brazil
| | | | | | - Jallyne Colares Bezerra
- University of International Integration of Afro-Brazilian Lusophony, Redencao, Ceará, Brazil
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Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abd-Elsalam SM, Abdoli A, Abedi A, Abolhassani H, Abreu LG, Abu-Gharbieh E, Abu-Rmeileh NME, Abushouk AI, Adamu AL, Adebayo OM, Adegbosin AE, Adekanmbi V, Adetokunboh OO, Adeyinka DA, Adsuar JC, Afshari K, Aghaali M, Agudelo-Botero M, Ahinkorah BO, Ahmad T, Ahmadi K, Ahmed MB, Aji B, Akalu Y, Akinyemi OO, Aklilu A, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Al-Eyadhy A, Ali T, Alicandro G, Alif SM, Alipour V, Alizade H, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Amini S, Amini-Rarani M, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antriyandarti E, Anvari D, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Ärnlöv J, Artanti KD, Arzani A, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari Jafarabadi M, Athari SS, Athari SM, Atnafu DD, Atreya A, Atteraya MS, Ausloos M, Awan AT, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, B DB, Babaee E, Badiye AD, Baig AA, Banach M, Banik PC, Barker-Collo SL, Barqawi HJ, Bassat Q, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Beghi M, Bell ML, Bendak S, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bezabih YM, Bhagavathula AS, Bhandari D, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bikbov B, Biondi A, Birihane BM, Biswas RK, Bohlouli S, Bragazzi NL, Breusov AV, Brunoni AR, Burkart K, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Camargos P, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Cerin E, Chang JC, Chanie WF, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chaturvedi S, Chen S, Cho DY, Choi JYJ, Chu DT, Ciobanu LG, Cirillo M, Conde J, Costa VM, Couto RAS, Dachew BA, Dahlawi SMA, Dai H, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darmstadt GL, Das JK, Dávila-Cervantes CA, Davis AC, Davletov K, De la Hoz FP, De Leo D, Deeba F, Denova-Gutiérrez E, Dervenis N, Desalew A, Deuba K, Dey S, Dharmaratne SD, Dhingra S, Dhungana GP, Dias da Silva D, Diaz D, Dorostkar F, Doshmangir L, Dubljanin E, Duraes AR, Eagan AW, Edinur HA, Efendi F, Eftekharzadeh S, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, El-Jaafary SI, Emami A, Enany S, Eyawo O, Ezzikouri S, Faris PS, Farzadfar F, Fattahi N, Fauk NK, Fazlzadeh M, Feigin VL, Ferede TY, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fischer F, Fisher JL, Foigt NA, Folayan MO, Foroutan M, Franklin RC, Freitas M, Friedman SD, Fukumoto T, Gad MM, Gaidhane AM, Gaidhane S, Gaihre S, Gallus S, Garcia-Basteiro AL, Garcia-Gordillo MA, Gardner WM, Gaspar Fonseca M, Gebremedhin KB, Getacher L, Ghashghaee A, Gholamian A, Gilani SA, Gill TK, Giussani G, Gnedovskaya EV, Godinho MA, Goel A, Golechha M, Gona PN, Gopalani SV, Goudarzi H, Grivna M, Gugnani HC, Guido D, Guimarães RA, Gupta RD, Gupta R, Hafezi-Nejad N, Haider MR, Haj-Mirzaian A, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hasaballah AI, Hasan MM, Hasan SS, Hassan A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hayat K, Heidari-Soureshjani R, Henry NJ, Herteliu C, Hole MK, Holla R, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iavicoli I, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inamdar S, Inbaraj LR, Iqbal K, Iqbal U, Islam MM, Islam SMS, Iso H, Iwagami M, Iwu CCD, Jaafari J, Jacobsen KH, Jagnoor J, Jain V, Janodia MD, Javaheri T, Javanmardi F, Jayaram S, Jayatilleke AU, Jenabi E, Jha RP, Ji JS, John O, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kamyari N, Kanchan T, Kapoor N, Karami Matin B, Karch A, Karimi SE, Kassahun G, Kayode GA, Kazemi Karyani A, Kemmer L, Khalid N, Khalilov R, Khammarnia M, Khan EA, Khan G, Khan M, Khan MN, Khang YH, Khatab K, Khater AM, Khater MM, Khayamzadeh M, Khosravi A, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissoon N, Kopec JA, Kosen S, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Kuate Defo B, Kucuk Bicer B, Kulkarni V, Kumar GA, Kumar M, Kumar N, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lalloo R, Lami FH, Landires I, Larsson AO, Lasrado S, Lassi ZS, Lauriola P, Lee PH, Lee SWH, Lee YH, Leigh J, Leonardi M, Lewycka S, Li B, Li S, Liang J, Lim LL, Limenih MA, Lin RT, Liu X, Lodha R, Lopez AD, Lozano R, Lugo A, Lunevicius R, Mackay MT, Madhava Kunjathur S, Magnani FG, Mahadeshwara Prasad DR, Maheri M, Mahmoudi M, Majeed A, Maled V, Maleki A, Maleki S, Malekzadeh R, Malik AA, Malta DC, Mamun AA, Mansouri B, Mansournia MA, Martinez G, Martini S, Martins-Melo FR, Masoumi SZ, Maulik PK, McAlinden C, McGrath JJ, Medina-Solís CE, Mehrabi Nasab E, Mejia-Rodriguez F, Memish ZA, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mini GK, Miri M, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Moazen B, Moghadaszadeh M, Mohajer B, Mohamad O, Mohammad Y, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Mondello S, Moni MA, Moore CE, Moradi G, Moradi M, Moradzadeh R, Moraga P, Morawska L, Morrison SD, Mosser JF, Mousavi Khaneghah A, Mustafa G, Naderi M, Nagarajan AJ, Nagaraju SP, Naghavi M, Naghshtabrizi B, Naimzada MD, Nangia V, Narasimha Swamy S, Nascimento BR, Naveed M, Nazari J, Ndejjo R, Negoi I, Negoi RI, Nena E, Nepal S, Netsere HB, Nguefack-Tsague G, Ngunjiri JW, Nguyen CTY, Nguyen CT, Nguyen HLT, Nigatu YT, Nigussie SN, Nixon MR, Nnaji CA, Nomura S, Noor NM, Noubiap JJ, Nuñez-Samudio V, Nwatah VE, Oancea B, Odukoya OO, Ogbo FA, Olusanya BO, Olusanya JO, Omar Bali A, Onwujekwe OE, Ortiz A, Otoiu A, Otstavnov N, Otstavnov SS, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pakshir K, Pal PK, Palladino R, Pana A, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pangaribuan HU, Pardo-Montaño AM, Park EK, Patel SK, Patton GC, Pawar S, Pazoki Toroudi H, Peden AE, Pepito VCF, Peprah EK, Pereira J, Pérez-Gómez J, Perico N, Pesudovs K, Pilgrim T, Pinheiro M, Piradov MA, Pirsaheb M, Platts-Mills JA, Pokhrel KN, Postma MJ, Pourjafar H, Prada SI, Prakash S, Pupillo E, Quazi Syed Z, Rabiee N, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahimzadeh S, Rahman MHU, Rahmani AM, Ramezanzadeh K, Rana J, Ranabhat CL, Rao SJ, Rasella D, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawasia WF, Rawassizadeh R, Reiner Jr RC, Remuzzi G, Renzaho AMN, Reshmi B, Resnikoff S, Rezaei N, Rezaei N, Rezapour A, Riahi SM, Ribeiro D, Rickard J, Roever L, Ronfani L, Rothenbacher D, Rubagotti E, Rumisha SF, Ryan PM, Saddik B, Sadeghi E, Saeedi Moghaddam S, Sagar R, Sahebkar A, Salahshoor MR, Salehi S, Salem MR, Salimzadeh H, Salomon JA, Samodra YL, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sarker AR, Sarrafzadegan N, Sarveazad A, Sathian B, Sathish T, Sattin D, Saxena S, Saya GK, Saylan M, Schiavolin S, Schlaich MP, Schwebel DC, Schwendicke F, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Sha F, Shafaat O, Shahabi S, Shahbaz M, Shaheen AA, Shahid I, Shaikh MA, Shakiba S, Shalash AS, Shams-Beyranvand M, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Sidemo NB, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silverberg JIS, Simonetti B, Singh BB, Singh JA, Singhal D, Sinha DN, Skiadaresi E, Skryabin VY, Skryabina AA, Sleet DA, Sobaih BH, Sobhiyeh MR, Soltani S, Soriano JB, Spurlock EE, Sreeramareddy CT, Steiropoulos P, Stokes MA, Stortecky S, Sufiyan MB, Suliankatchi Abdulkader R, Sulo G, Swope CB, Sykes BL, Szeto MD, Szócska M, Tabarés-Seisdedos R, Tadesse EG, Taherkhani A, Tamiru AT, Tareque MI, Tehrani-Banihashemi A, Temsah MH, Tesfay FH, Tessema GA, Tessema ZT, Thankappan KR, Thapar R, Tolani MA, Tovani-Palone MR, Traini E, Tran BX, Tripathy JP, Tsapparellas G, Tsatsakis A, Tudor Car L, Uddin R, Ullah A, Umeokonkwo CD, Unim B, Unnikrishnan B, Upadhyay E, Usman MS, Vacante M, Vaezi M, Valadan Tahbaz S, Valdez PR, Vasankari TJ, Venketasubramanian N, Verma M, Violante FS, Vlassov V, Vo B, Vu GT, Wado YD, Waheed Y, Wamai RG, Wang Y, Wang Y, Wang YP, Ward P, Werdecker A, Westerman R, Wickramasinghe ND, Wilner LB, Wiysonge CS, Wu AM, Wu C, Xie Y, Yahyazadeh Jabbari SH, Yamagishi K, Yandrapalli S, Yaya S, Yazdi-Feyzabadi V, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yousefi Z, Yousefinezhadi T, Yu C, Yusuf SS, Zaidi SS, Zaman SB, Zamani M, Zamanian M, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhao XJG, Ziapour A, Hay SI, Murray CJL, Wang H, Kassebaum NJ. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet 2021; 398:870-905. [PMID: 34416195 PMCID: PMC8429803 DOI: 10.1016/s0140-6736(21)01207-1] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. METHODS We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. FINDINGS Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. INTERPRETATION Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. FUNDING Bill & Melinda Gates Foundation.
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