Abstract
Introduction: Despite its recent status of middle-income country in WHO’s South-East Asia Region, diarrhea remains an important yet unresearched public health issue in the Republic of Maldives. Methodology: We conducted a one-month cross-sectional study in children and adults with acute diarrhea at three regional hospitals in Maldives in August-September 2007 to investigate the point-prevalence of diarrhea etiologic agents. Enteric Bacteria was identified by a standard microbiology technique and isolates were submitted for antimicrobial susceptibility testing. Rotavirus, astrovirus and adenovirus were detected by enzyme-linked immunosorbent assays (ELISA). Real-time reverse-transcription polymerase chain reaction (RT-PCR) was used to test for norovirus. Results: We enrolled 73 children and 57 adults with acute diarrhea. The most common pathogens detected in children were norovirus (43%) and rotavirus (18%). Vibrio parahaemolyticus (18%) and rotavirus (17%) were the most common pathogens found in adults. Multiple and mixed infections were common. All noroviruses were identified as genogroup II/type 4(GII/4). The genotype distributions of rotaviruses were G2P[4] (48%), G12P[6] (37%), G2P[6] (5%), G9P[8] (5%), and non-typeable G2 (5%). Conclusions: This study provides preliminary data on the importance of norovirus and rotavirus as diarrhea etiologic agents in Maldives. A systematic prospective diarrhea surveillance documenting disease burden, etiology, seasonal variation, as well as risk factors should be conducted for the development of public health interventions to reduce diarrhea morbidity and mortality in Maldives.
Highlights
Despite its recent status of middle-income country in WHO’s South-East Asia Region, diarrhea remains an important yet unresearched public health issue in the Republic of Maldives
The study was conducted at the Indira Gandhi Memorial Hospital (IGMH), a central-level hospital in Male, the capital of Maldives; Kulhudhuffushi Regional Hospital (KRH) and Hithadhoo Regional Hospital (HRH), two hospitals in the northern and southern regions of Maldives, respectively (Figure 1)
The most common organisms identified in children were norovirus (43%), rotavirus (18%) and Enteropathogenic E. coli (EPEC; 13%) (Table 2)
Summary
Despite its recent status of middle-income country in WHO’s South-East Asia Region, diarrhea remains an important yet unresearched public health issue in the Republic of Maldives. Methodology: We conducted a one-month cross-sectional study in children and adults with acute diarrhea at three regional hospitals in Maldives in August-September 2007 to investigate the pointprevalence of diarrhea etiologic agents. The most common pathogens detected in children were norovirus (43%) and rotavirus (18%). Conclusions: This study provides preliminary data on the importance of norovirus and rotavirus as diarrhea etiologic agents in Maldives. While the etiology of diarrhea has been extensively studied in other South or Southeast Asian countries, such data are still lacking for Maldives. The purpose of this study was to explore the etiology of acute diarrhea and the antimicrobial susceptibility patterns in Maldives during one diarrhea peak season
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