Burden Of Diarrheal Disease Research Articles

Acute diarrhoeal disease among under-five children presenting at a paediatric referral Facility in Lagos, Nigeria

Background: The morbidity and mortality from acute diarrhoeal disease remain significantly high especially in low and middle income countries. Aim: This study was carried out to determine the prevalence of acute diarrhoea, and the associated risk factors among under-five children seen at a paediatric referral facility in Lagos, Nigeria. Methods: This was a cross-sectional descriptive study of under-five children who presented with acute diarrhoeal disease at the Children Emergency Room and General Out-Patient Clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, South-Western Nigeria. Information was obtained on socio-demographic characteristics, environmental/ hygienic practices, feeding practices and immunization status. Results: The prevalence of acute diarrhoea was 400 of 4836(8.3%) under-five children. Three hundred and ninety-five (73.7%) of these children were aged less than two years. The identified associated risk factors for acute diarrhoea among children aged less than two years were use of feeding bottles (OR 12.4; 95% CI 1.8-7.2; p= 0.000), failure to complete immunization(OR 13.0; 95% CI 3.1-43.3; p= 0.000), attendance of crèches (OR 47.1; 95% CI 15.6-141.1; p= 0.000), failure to exclusively breastfeed (OR 6.7; 95% CI 1.3-6.7; p= 0.010) and malnutrition (OR 3.9; 95% CI 1.0-20.3; p= 0.049). Conclusions: Acute diarrhoea remain a significant public health burden affecting majorly children aged less than two years. Efforts at prevention of diarrhoeal disease burden should focus on improvement of hygienic and feeding practices.

A prototype early warning system for diarrhoeal disease to combat health threats of climate change in the asia-pacific region

Abstract Ongoing climate variability and change are increasing the burden of diarrhoeal disease worldwide. Meaningful early warning systems with adequate lead times (weeks to months) are needed to guide public health decision–making and enhance community resilience against health threats posed by climate change. Toward this goal, we trained various machine-learning models to predict diarrhoeal disease rates in Nepal (2002–2014), Taiwan (2008–2019), and Vietnam (2000–2015) using temperature, precipitation, previous disease rates, and El Niño Southern Oscillation phases. We also compared the performance of shallow time-series neural network (NN), Random Forest Regressor, artificial nn, gradient boosting regressor, and long short-term memory–based methods for their effectiveness in predicting diarrhoeal disease burden across multiple countries. We evaluated model performance using a test dataset and assessed the accuracy of predicted diarrhoeal disease incidence rates for the last year of available data in each district. Our results suggest that even in the absence of the most recent disease surveillance data, a likely scenario in most low- and middle-income countries, our NN-based early warning system using historical data performs reasonably well. However, future studies are needed to perform prospective evaluations of such early warning systems in real-world settings.

Molecular Epidemiology and AMR Perspective of Diarrhoeagenic Escherichia coli in Africa: A Systematic Review and Meta-analysis.

Diarrhoeagenic Escherichia coli (DEC) persistently challenges public health in Africa, contributing substantially to the diarrhoeal disease burden. This systematic review and meta-analysis illuminate the distribution and antimicrobial resistance (AMR) patterns of DEC pathotypes across the continent. The review selectively focused on pathotype-specific studies reporting prevalence and/or AMR of human-derived DEC pathotypes from African nations, excluding data from extra-intestinal, animal, and environmental sources and studies focused on drug and mechanism experiments. Pertinent studies were retrieved from SCOPUS, PubMed, and EBSCOhost, processed with Covidence, and screened in alignment with PRISMA guidelines. The reviewed studies were predominantly hospital-based (80%) and paediatric-focused (91%), with a meagre 4.4% documenting DEC outbreaks. Seven DEC pathotypes were discerned, with Enteroaggregative E. coli (EAEC) being notably prevalent (43%, 95% CI 30-55%) and Enteroinvasive E. coli (EIEC) least prevalent (24%, 95% CI 17-32%). Identified non-susceptibilities were noted against essential antibiotics including ciprofloxacin, ceftriaxone, and ampicillin, while instances of carbapenem and Extended-Spectrum ß-Lactamase (ESBL) resistance were scarce. Despite sporadic data on DEC prevalence and AMR in Africa, particularly in community settings, a palpable gap remains in real-time outbreak surveillance and comprehensive data documentation. Augmenting surveillance and embracing advancements in molecular/genomic characterisation techniques are crucial to precisely discerning DEC's actual impact and resistance continuum in Africa.

Effects of iron supplements and iron-containing micronutrient powders on the gut microbiome in Bangladeshi infants: a randomized controlled trial

Anemia is highly prevalent globally, especially in young children in low-income countries, where it often overlaps with a high burden of diarrheal disease. Distribution of iron interventions (as supplements or iron-containing multiple micronutrient powders, MNPs) is a key anemia reduction strategy. Small studies in Africa indicate iron may reprofile the gut microbiome towards pathogenic species. We seek to evaluate the safety of iron and MNPs based on their effects on diversity, composition, and function of the gut microbiome in children in rural Bangladesh as part of a large placebo-controlled randomized controlled trial of iron or MNPs given for 3 months (ACTRN12617000660381). In 923 infants, we evaluate the microbiome before, immediately following, and nine months after interventions, using 16S rRNA gene sequencing and shotgun metagenomics in a subset. We identify no increase in diarrhea with either treatment. In our primary analysis, neither iron nor MNPs alter gut microbiome diversity or composition. However, when not adjusting for multiple comparisons, compared to placebo, children receiving iron and MNPs exhibit reductions in commensal species (e.g., Bifidobacterium, Lactobacillus) and increases in potential pathogens, including Clostridium. These increases are most evident in children with baseline iron repletion and are further supported by trend-based statistical analyses.

Impacts of climate change on diarrhoeal disease hospitalisations: How does the global warming targets of 1.5-2°C affect Dhaka, Bangladesh?

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.

The global disease burden attributable to unsafe water, sanitation, and handwashing with unqualified facilities from 1990 to 2019.

Water, sanitation, and hygiene (WaSH) are crucial determinants of human health. However, the spatio-temporal trends in the global burden of disease attributable to unsafe WaSH remain poorly understood. This study aimed to estimate the disease burden attributable to unsafe WaSH from 1990 to 2019 using data from the Global Burden of Disease (GBD) Study 2019, providing new insights into the associated health conditions. We extracted data on deaths and disability-adjusted life years (DALYs) attributable to unsafe WaSH from 1990 to 2019 from the GBD 2019. The disease burden was evaluated by region, sociodemographic index (SDI), sex, age, risk factor, and specific disease. Globally, unsafe WaSH was responsible for 1 656 887.37 (95% uncertainty interval (UI) = 1 198 864.94, 2 312 688.33) deaths in 2019, a 49% decrease from 1990. The global age-standardised DALY rate due to unsafe WaSH was 1244.29 (95% UI = 993.20, 1544.13) per 100 000 in 2019, a 66% reduction since 1990. Western sub-Saharan Africa had the highest age-standardised death rate (ASDR) and age-standardised DALY rate in both 1990 and 2019. Among the 21 regions studied, only high-income North America witnessed an increasing ASDR from 1990 to 2019. Countries and territories in low SDI regions had higher ASDRs and age-standardised DALY rates. U-shaped associations were observed between the estimated annual percentage change (EAPC) of ASDR, EAPC of age-standardised DALY rate, and SDI. Both rates were slightly lower in females, with the burden concentrated in those under five and over 80 years old. In 2019, unsafe water source and diarrhoeal diseases remained the leading risk factor and cause of unsafe WaSH-related disease burden, respectively. Despite substantial improvements in hygiene awareness and health education, unsafe WaSH persists as a significant global health risk and a major contributor to the burden of diarrhoeal diseases. Disparities across regions and age groups remain evident. Increased efforts are needed to raise awareness and strengthen water and sanitation infrastructure, particularly in low SDI settings, to mitigate the health risks associated with unsafe WaSH.

Water, sanitation, and hygiene–specific risk factors of recent diarrheal episodes in children aged under 5 years: analysis of secondary data from the multiple indicator cluster survey (MICS 2019)

ObjectivesAccess to safe drinking water, sanitation, and hygiene, collectively called WASH, is a fundamental human right and a cornerstone of public health. However, inadequate WASH practices and environments significantly contribute to the global burden of diarrheal diseases, particularly, in children aged under 5 years. Inadequate WASH conditions are the primary drivers of various infectious diseases, including cholera, dysentery, hepatitis A, typhoid, and polio. MethodsWe conducted secondary data analysis using the 2019 Zimbabwe Multiple Indicator Cluster Survey to investigate the specific WASH risk factors associated with recent diarrheal episodes in children aged under 5 years. ResultsA total of 853 (14%) of 6092 children were reported to have experienced an episode of diarrhea in the last 2 weeks preceding the survey. Having insufficient water in the household was associated with 17.0% diarrhea episodes compared with 13.6% in those who did not face this problem. The availability of soap or detergents to wash hands was associated with a risk of diarrhea, with an odds ratio and 95% confidence interval of 1.19 (1.01-1.40), P = 0.033. The use of surface water, including rivers, dams, lakes, ponds, streams, canals, and irrigation channels, was associated with differences in diarrheal episodes, although this was of borderline significance, P = 0.082. Of the children who had a recent episode of diarrhea, 41.0% had their parents or caregivers seeking medical attention. ConclusionsThere is need for an improvement in safe water supply to households and an improvement in health education on the importance of using soap after using the toilet to avoid contamination of food and water.

Exploring disease dynamics of acute diarrhoeal disease in cold desert Ladakh-India: A geographical analysis

Background/AimAcute Diarrhoeal disease (ADD) has a significant impact on public health and is the most common cause of mortality and morbidity. The present study attempts to study the spatiotemporal distribution of incidences of ADD and also tries to identify the geographical risk factors by associating socioeconomic and environmental factors with the prevalence of ADD. MethodsThis cross-sectional study conducted micro-level analysis in 24 randomly chosen villages, representing 5 % of Ladakh's medical blocks, to gather household data on diarrhoeal diseases, encompassing demographic, socio-economic, and residential environmental factors. Our dataset combines primary and secondary data. We utilized binary logistic regression to evaluate associations between these factors and diarrhoeal disease prevalence. ResultsSpatio-temporal analysis in Ladakh's medical blocks revealed significant variations in diarrhoeal disease incidence, with Leh district showing higher rates compared to Kargil. The under-14 age group exhibited the highest ADD incidence (163.46 per 1000 persons), followed by the over-59 age group (43.73) and the 14–59 age group (8.90), with an overall prevalence rate of 38.91 per 1000 population. Factors such as education levels, household income, sewage drainage facilities, residential environment, and drinking water sources showed statistically significant associations with diarrhoea prevalence among surveyed households of Ladakh. ConclusionsThis research highlights the importance of addressing environmental and socio-economic determinants to mitigate the burden of diarrhoeal diseases in Ladakh. Effective interventions targeting improved sanitation, access to clean water, and socio-economic development are crucial for reducing diarrhoeal disease prevalence in the region.

Coupling enterotoxigenic Escherichia coli heat-stable peptide toxin with 8-arm PEG enhances immunogenicity.

Enterotoxigenic Escherichia coli (ETEC) strains, which produce the heat-stable enterotoxin (ST) either alone or in combination with the heat-labile enterotoxin, contribute to the bulk of the burden of child diarrheal disease in resource-limited countries and are associated with mortality. Developing an effective vaccine targeting ST presents challenges due to its potent enterotoxicity, non-immunogenicity, and the risk of autoimmune reaction stemming from its structural similarity to the human endogenous ligands, guanylin, and uroguanylin. This study aimed to assess a novel synthetic vaccine carrier platform employing a single chemical coupling step for making human ST (STh) immunogenic. Specifically, the method involved cross-linking STh to an 8-arm N-hydroxysuccinimide (NHS) ester-activated PEG cross-linker. A conjugate of STh with 8-arm structure was prepared, and its formation was confirmed through immunoblotting analysis. The impact of conjugation on STh epitopes was assessed using ELISAs with polyclonal and monoclonal antibodies targeting various epitopes of STh. Immunization of mice with the conjugate induced the production of anti-STh antibodies, exhibiting neutralizing activity against STh.

Post-introduction evaluation (PIE) of rotavirus vaccine in India

BackgroundIndia became the first country in the WHO South-East Asia Region (SEAR) to introduce the rotavirus vaccine (RVV) in the Universal immunization programme (UIP) in 2016 with nationwide expansion by 2019. It was a landmark move to reduce the diarrheal disease burden in under-five children. To assess the implementation process of introduction of RVV, Post Introduction Evaluation (PIE) was conducted in March 2022. MethodsThe evaluation was conducted across 14 states, 28 districts and 28 health facilities to obtain a nationwide geographical inclusion. Stakeholders involved in program decision-making, planning, training, vaccine delivery, logistics, and communication from all levels (National, state, district, health facility, health worker, caregiver) were interviewed using standardized data collection tool for PIE (adapted from the standard WHO PIE questionnaire) and scripted on a digital tool. ResultsA total of 260 interviews were conducted. Political willingness, well-planned preparedness activities, securing vaccines timely, strong supply chain monitoring, availability of domestic RVV products, quality trainings and intense communication activities were the key factors identified for the successful RVV introduction. Key activities during the introduction included cold chain space assessment, trainings of healthcare workforce, dissemination of job aids, updation of recording & reporting formats and strengthening of AEFI surveillance. Lack of community awareness for immunization in a few areas, fear of AEFI amongst some caregivers and local issues with Alternate Vaccine Delivery (AVD) were some reported challenges in achieving high coverage for RVV. ConclusionsOverall, the nationwide roll-out of RVV was smooth and the vaccine has been well-accepted in the community. The assessment emphasizes on having a well-strategized operational and communication planning, which is very crucial for any new vaccine introduction.

Determinants of diarrheal disease in children undergoing complementary feeding in a low-income urban setting in Kenya.

This study aimed to identify and characterise the determinants influencing the occurrence of diarrheal diseases in children aged 6-24 months undergoing complementary feeding within a low-income urban community in Kenya. This study followed a cross-sectional design and recruited caregivers of children aged 6-24 months from 302 households. The dependent variable was the 2-week diarrhoea prevalence among children, with independent variables including sociodemographic characteristics, child immunisation and feeding status, and water and sanitation facilities. Data analysis was performed using SPSS. Descriptive statistics and logistic regression analyses were used to assess associations between independent variables and the occurrence of diarrheal diseases. The majority of caregivers were female (n = 282, 93.4%), aged 25-34 years (n = 156, 51.7%), had attained secondary school education (n = 154, 51%), were unemployed (n = 162, 53.6%), and earned Ksh 10,000 (USD 100) or less. 296 (98%) indexed children were fully vaccinated against rotavirus. Most households used improved drinking water sources (n = 272, 90.1%). Most caregivers did not regularly wash their hands with soap and water (n = 225, 74.5%). The 2-week diarrhoea prevalence among children was 34.1% (103/302), with 69.9% (72/103) of these cases seeking care at a healthcare facility. Logistic regression analysis revealed that children of caregivers earning Ksh 20,000 and below (aOR = 2.9[1.3-6.5], p = 0.01), and those from households using unimproved sanitation facilities (aOR = 1.9 [CI 1-3.4], p = 0.042), had significantly higher odds of having diarrhoea. The study found a high prevalence of diarrhoea in Kenyan children aged 6-24 months, with caregiver income and household sanitation facilities significantly impacting the occurrence of the disease. The study suggests integrated approaches, including education, income generation, hygiene, and improved nutrition, to address the burden of diarrheal disease.

Improved water supply infrastructure to reduce acute diarrhoeal diseases and cholera in Uvira, Democratic Republic of the Congo: Results and lessons learned from a pragmatic trial.

Safely managed drinking water is critical to prevent diarrhoeal diseases, including cholera, but evidence on the effectiveness of piped water supply in reducing these diseases in low-income and complex emergency settings remains scarce. We conducted a trial of water supply infrastructure improvements in Uvira (DRC). Our primary objective was to estimate the relationship between a composite index of water service quality and the monthly number of suspected cholera cases admitted to treatment facilities and, as a secondary analysis, the number of cases confirmed by rapid diagnostic tests. Other exposures included the quantity of supplied water and service continuity. We used Poisson generalised linear models with generalised estimating equations to estimate incidence rate ratios. Associations between suspected cholera incidence and water service quality (RR 0·86, 95% CI 0·73-1·01), quantity (RR 0·80, 95% CI 0·62-1·02) and continuity (RR 0·81, 95% CI 0·77-0·86) were estimated. The magnitudes of the associations were similar between confirmed cholera incidence and water service quality (RR 0·84, 95% CI 0·73-0·97), quantity (RR 0·76, 95% CI 0·61-0·94) and continuity (RR 0·75, 95% CI 0·69-0·81). These results suggest that an additional 5 L/user/day or 1.2 hour per day of water production could reduce confirmed cholera by 24% (95% CI 6-39%) and 25% (95% CI 19-31%), respectively. Ensuring a sufficient and continuous piped water supply may substantially reduce the burden of endemic cholera and diarrhoeal diseases but evaluating this rigorously is challenging. Pragmatic strategies are needed for public health research on complex interventions in protracted emergency settings. The trial is registered in ClinicalTrials.gov ID NCT02928341. https://classic.clinicaltrials.gov/ct2/show/NCT02928341.

Burden of Childhood Diarrhea and Its Associated Factors in Ethiopia: A Review of Observational Studies.

Objectives: This systematic review and meta-analysis aimed to: i) determine the pooled prevalence of acute diarrhea; and ii) synthesize and summarize current evidence on factors of acute diarrheal illnesses among under-five children in Ethiopia. Methods: A comprehensive systematic search was conducted in PubMed, SCOPUS, HINARI, Science Direct, Google Scholar, Global Index Medicus, Directory of Open Access Journals (DOAJ), and the Cochrane Library. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The methodological quality of each included article was assessed using the Joanna Briggs Institute (JBI) quality assessment tool for cross-sectional and case-control studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of diarrheal illnesses. Heterogeneity and publication bias were assessed using I2 test statistics and Egger's test, respectively. The statistical analysis was done using STATA™ software version 14. Results: Fifty-three studies covering over 27,458 under-five children who met the inclusion criteria were included. The pooled prevalence of diarrhea among under-five children in Ethiopia was found to be 20.8% (95% CI: 18.69-22.84, n = 44, I2 = 94.9%, p < 0.001). Our analysis revealed a higher prevalence of childhood diarrhea in age groups of 12-23 months 25.42% (95%CI: 21.50-29.35, I2 = 89.4%, p < 0.001). In general, the evidence suggests that diarrheal risk factors could include: i) child level determinants (child's age 0-23 months, not being vaccinated against rotavirus, lack of exclusive breastfeeding, and being an under-nourished child); ii) parental level determinants {mothers poor handwashing practices [pooled odds ratio (OR) = 3.05; 95% CI:2.08-4.54] and a history of maternal recent diarrhea (pooled OR = 3.19, 95%CI: 1.94-5.25)}; and iii) Water, Sanitation and Hygiene (WASH) determinants [lack of toilet facility (pooled OR = 1.56, 95%CI: 1.05-2.33)], lack handwashing facility (pooled OR = 4.16, 95%CI: 2.49-6.95) and not treating drinking water (pooled OR = 2.28, 95% CI: 1.50-3.46). Conclusion: In Ethiopia, the prevalence of diarrhea among children under the age of five remains high and is still a public health problem. The contributing factors to acute diarrheal illnesses were child, parental, and WASH factors. A continued focus on improving access to WASH facilities, along with enhancing maternal hygiene behavior will accelerate reductions in diarrheal disease burden in Ethiopia.

Influence of hydrometeorological risk factors on child diarrhea and enteropathogens in rural Bangladesh.

A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change. Our objectives were to identify weather and environmental risk factors associated with diarrhea and enteropathogen prevalence in young children in rural Bangladesh, a population with high diarrheal disease burden and vulnerability to weather shifts under climate change. We matched temperature, precipitation, surface water, and humidity data to observational longitudinal data from a cluster-randomized trial that measured diarrhea and enteropathogen prevalence in children 6 months-5.5 years from 2012-2016. We fit generalized additive mixed models with cubic regression splines and restricted maximum likelihood estimation for smoothing parameters. Comparing weeks with 30°C versus 15°C average temperature, prevalence was 3.5% higher for diarrhea, 7.3% higher for Shiga toxin-producing Escherichia coli (STEC), 17.3% higher for enterotoxigenic E. coli (ETEC), and 8.0% higher for Cryptosporidium. Above-median weekly precipitation (median: 13mm; range: 0-396mm) was associated with 29% higher diarrhea (adjusted prevalence ratio 1.29, 95% CI 1.07, 1.55); higher Cryptosporidium, ETEC, STEC, Shigella, Campylobacter, Aeromonas, and adenovirus 40/41; and lower Giardia, sapovirus, and norovirus prevalence. Other associations were weak or null. Higher temperatures and precipitation were associated with higher prevalence of diarrhea and multiple enteropathogens; higher precipitation was associated with lower prevalence of some enteric viruses. Our findings emphasize the heterogeneity of the relationships between hydrometeorological variables and specific enteropathogens, which can be masked when looking at composite measures like all-cause diarrhea. Our results suggest that preventive interventions targeted to reduce enteropathogens just before and during the rainy season may more effectively reduce child diarrhea and enteric pathogen carriage in rural Bangladesh and in settings with similar meteorological characteristics, infrastructure, and enteropathogen transmission.

The Planetary Child Health & Enterics Observatory (Plan-EO): A protocol for an interdisciplinary research initiative and web-based dashboard for mapping enteric infectious diseases and their risk factors and interventions in LMICs.

Diarrhea remains a leading cause of childhood illness throughout the world that is increasing due to climate change and is caused by various species of ecologically sensitive pathogens. The emerging Planetary Health movement emphasizes the interdependence of human health with natural systems, and much of its focus has been on infectious diseases and their interactions with environmental and human processes. Meanwhile, the era of big data has engendered a public appetite for interactive web-based dashboards for infectious diseases. However, enteric infectious diseases have been largely overlooked by these developments. The Planetary Child Health & Enterics Observatory (Plan-EO) is a new initiative that builds on existing partnerships between epidemiologists, climatologists, bioinformaticians, and hydrologists as well as investigators in numerous low- and middle-income countries. Its objective is to provide the research and stakeholder community with an evidence base for the geographical targeting of enteropathogen-specific child health interventions such as novel vaccines. The initiative will produce, curate, and disseminate spatial data products relating to the distribution of enteric pathogens and their environmental and sociodemographic determinants. As climate change accelerates there is an urgent need for etiology-specific estimates of diarrheal disease burden at high spatiotemporal resolution. Plan-EO aims to address key challenges and knowledge gaps by making and disseminating rigorously obtained, generalizable disease burden estimates. Pre-processed environmental and EO-derived spatial data products will be housed, continually updated, and made publicly available for download to the research and stakeholder communities. These can then be used as inputs to identify and target priority populations living in transmission hotspots and for decision-making, scenario-planning, and disease burden projection. PROSPERO protocol #CRD42023384709.

Climate Changes and Distribution of Water Borne Diseases in Eastern, Afghanistan

Subject to a high burden of diarrheal disease, the east provinces of Afghansitan are also suceptable to climate changes. The most devastating consequences are the occurrence of flash floods and aridity. The climate changes trends will exacerbate the health risks associated with deficiencies in water, sanitation and hygiene. This study investigated the distribution of diarrheal disease in the east provinces and how linked with climate variables. Using monthly aggregated new cases of acute diarrhea reported between 2018 and 2023 by Health Management information system department, Ministry of public health of Afghanistan. We found seasonal variation and temperature are positively linked with diarrhea incidence. Initial analysis shows a seasonal trend in diarrhea cases, with peak incidence occurring in summer and reduced incidence during winter months. The recorded diarrhea cases show marked increment in the incidence of acute watery diarrhea in 2023 in eastern region. the incidence of diarrhea cases increased in 2023 (480/1000 population at risk) compared to 2019 (360/1000 population at risk) in eastern region. The impact of flash floods and Aridity as a consequences of climate change in Afghanistan cannot be underestimated. Increasing the incidence of water borne diseases like diarrhea and other infectious diseases outbreaks are important issues that could be assessed. Allowing for policymakers to account for potential impacts of climate change in their public health assessments, and provides a framework that could be extended to similar settings.

Features of &lt;i&gt;ESCHERICHIA COLI&lt;/i&gt; samples from patients with diarrheal syndrome in the Republic of Guinea

Introduction. Diarrheal diseases are a global public health issue and cause 15% of deaths in children under 5 years old, of which about 80% occur in the regions of Africa and Southeast Asia. According to the Global Enteric Multicentre Study (GEMS) conducted in a number of African countries, one of the leading pathogens of high risk of death in infants and young children is diarrheagenic E. coli (DEC). In recent decades, antimicrobial resistance (AMR) has become globally ubiquitous. The Republic of Guinea urgently needs large-scale studies devoted to assessing DEC distribution and antibiotic resistance. The purpose of the study is to assess the pattern of E. coli infections and to test the susceptibility to antibiotics in strains of diarrheagenic E. coli sampled from individuals residing in the Republic of Guinea.&#x0D; Materials and methods. From 2019 to 2022, we studied 724 samples of faeces of patients with acute diarrhea, among them 72 (9.9%) children aged 1–5 years, 128 (17.7%) children aged 6–17 years, and 524 (72.4%) people aged 18 years and older; a method of polymerase chain reaction (PCR) was applied with the use of the AmpliSense® Escherichioses-FL reagent kit to identify the genetic determinants of DEC: EPEC, EHEC, ETEC, EIEC, and EAgEC (Central Research Institute of Epidemiology of Rospotrebnadzor, Russia). Susceptibility to 15 antimicrobial agents was found by the disc-diffusion method using Mueller–Hinton agar (Russia) and Oxoid discs (UK). Results were interpreted according EUCAST criteria, versions 2019–2022 (https://www.eucast.org/ast_of_bacteria/previous_versions_of_documents).&#x0D; Results. For the period from 2019 to 2022, the percentage of E. coli infections in the etiological pattern of acute intestinal infections amounted to 51.7%. In the age-related manner, DEC was significantly more common in young children aged 0–5 (96.9%, p 0.05) as compared to school age children aged 6–17 (53.9%) and adults (45.6%). In all years of observation, EAgEC strains prevailed, accounting for 38.4%. Other DEC pathotypes, EPEC, ETEC, EIEC and STEC, accounted for 27.2%, 17.5%, 11.8%, and 5.1%, respectively. DEC strains are susceptible to meropenem, amikacin, and nitrofurantoin. The activity of other antibiotics ranged from 11.3% for ampicillin, 28.3% for trimethoprim-sulfamethoxazole, and 34.0% for tetracycline to 73.6% for cephalosporins, 84.0% for aminoglycosides, and 98.1% for fluorinated quinolones.&#x0D; Conclusion. To reduce the burden of diarrheal diseases in the Republic of Guinea, it may be necessary to conduct targeted epidemiological and microbiological studies to identify DEC and monitor the development of antimicrobial resistance of E. coli infection pathogens in the population.

Estimation of Rotavirus Associated Diarrheal Disease Burden Amongst Primary School Children of Sindh

Introduction: Human Rotavirus Virus (HRV) is amongst the common enteric viral diarrheal diseases that indirectly or directly influence school-going children in low-income countries. Inadequate information exists on the presence of rotavirus, with reference to drinking water supplies of primary schools in Sindh, Pakistan. Aims &amp; Objectives: We estimated the risk of rotavirus-associated diarrhea through drinking water. The study further compared the HRV-associated risk of diarrheal disease by a type of water source. Place and Duration of Study: A cross-sectional survey was conducted in ten representative districts of Sindh from February 2022 to December 2022. The samples for drinking water were collected from primary schools of ten representative districts of Sindh. This study was a part of the WASH Project funded by USAID (USPCASW Seed Grant P-II) Material &amp; Methods: We selected 425 samples of drinking water from primary schools based on pre-defined selection criteria. We used a Quantitative Microbial Risk Analysis using indicator organisms, i.e., E. coli, to predict the possible health risks of rotavirus. Data was entered and analyzed on SPSS version 26. The graphs were developed using Arc GIS version 3. Morbidity and mortality were predicted using the Quantitative Microbial Risk Assessment (QAMRA) model. Results: Our data revealed that the highest daily risk of HRV-associated diarrhea amongst school children was 11 per 10,000 schoolchildren, resulting in 8.4% annual risk, and the minimum risk was estimated to be 1 in 10,000 children. The burden of diseases for rotavirus using the QAMRA model revealed the severity of the diarrhea. Majority of the children presented with mild diarrhea (86%) followed by severe, and the probability of death was less than &lt;1%. The daily risk of HRV infection was highest (estimated to be 7 and 11%) in pupils of Southern Sindh, with an annual risk of 17.4% to 40%. Conclusion: Our study concluded that the children in the primary schools of Sindh were exposed to poor drinking water quality. The surface water source poses the highest risk of HRV-related diarrhea to school children. Thus, it is highly recommended that point-of-use drinking water treatment systems be adopted. The water sanitation and hygiene (WASH) resources are interlinked, so each resource impacts the other; hence, schools urgently need to invest in providing adequate WASH facilities to stop enteric virus transmission through drinking water sources.

Estimating disease burden of rotavirus in floodwater through traffic in the urban areas: A case study of Can Tho city, Vietnam

AbstractMicrobial pathogens in urban floodwaters pose risks to human health, potentially causing diseases such as diarrhea. However, the disease burden related to urban traffic exposure from citizens passing through floodwaters is not easily quantified and therefore not included in many studies. Notably, this problem has received little attention in low‐to‐middle‐income countries, with frequent flood events and the heavy diarrheal disease burden. This article calculates the infection risks and disease burden, considering traffic associated with exposure to floodwater contaminated with rotavirus for the first time in Ninh Kieu District, Can Tho city. Can Tho city in the Vietnamese Mekong Delta is well known to have many flood events every year, with many diarrheal cases during the flood season. The methodology comprises two steps. First, we applied quantitative microbial risk assessment that proposes the inclusion of exposure to traffic due to rotavirus in floodwater. Second, the disease burden was expressed in disability‐adjusted life years (DALYs). The exposed groups are child pedestrians, adult pedestrians, motorcyclists, and cyclists. We used video footage to monitor the traffic. The results show that total DALYs per flood event were 1.35 × 104 for 63,390 exposed people (i.e., 2129 DALYs per 10,000 cases). Motorcyclists are the strongest contributors to the DALYs (95%), followed by cyclists (2.8%), adult pedestrians (2%), and child pedestrians (0.2%). The population in Ninh Kieu District may suffer from waterborne diseases through traffic activities during flooding times. Our approach can be applied in other areas worldwide and helps identify main risk groups and focus areas for interventions.

Network analysis of patterns and relevance of enteric pathogen co-infections among infants in a diarrhea-endemic setting.

Despite significant progress in recent decades toward ameliorating the excess burden of diarrheal disease globally, childhood diarrhea remains a leading cause of morbidity and mortality in low-and-middle-income countries (LMICs). Recent large-scale studies of diarrhea etiology in these populations have revealed widespread co-infection with multiple enteric pathogens, in both acute and asymptomatic stool specimens. We applied methods from network science and ecology to better understand the underlying structure of enteric co-infection among infants in two large longitudinal birth cohorts in Bangladesh. We used a configuration model to establish distributions of expected random co-occurrence, based on individual pathogen prevalence alone, for every pathogen pair among 30 enteropathogens detected by qRT-PCR in both diarrheal and asymptomatic stool specimens. We found two pairs, Enterotoxigenic E. coli (ETEC) with Enteropathogenic E. coli (EPEC), and ETEC with Campylobacter spp., co-infected significantly more than expected at random (both pairs co-occurring almost 4 standard deviations above what one could expect due to chance alone). Furthermore, we found a general pattern that bacteria-bacteria pairs appear together more frequently than expected at random, while virus-bacteria pairs tend to appear less frequently than expected based on model predictions. Finally, infants co-infected with leading bacteria-bacteria pairs had more days of diarrhea in the first year of life compared to infants without co-infection (p-value <0.0001). Our methods and results help us understand the structure of enteric co-infection which can guide further work to identify and eliminate common sources of infection or determine biologic mechanisms that promote co-infection.