Burden Of Diarrheal Disease Research Articles

The effects of seasonal variations on household water security and burden of diarrheal diseases among under 5 children in an urban community, Southwest Nigeria

BackgroundHousehold water security encompasses water-related factors that pose threats to public health at the household level. It presents a reliable access to water in sufficient quantity and quality towards meeting basic human needs. This study assessed the dynamics of seasonal variations in household water security and the association between household water security and diarrheal disease across dry and wet seasons in an urban settlement in Southwest Nigeria.MethodsA panel study design was employed to study 180 households selected using a multistage sampling technique. The selected households were studied during dry and rainy seasons. Household water security was assessed through the application of the all or none principle to 9 indicators associated with household water security. The intensity of water insecurity was also assessed using the nine indicators. The higher the number of indicators a household failed, the higher the intensity of household water insecurity. The association between the intensity of household water insecurity and the burden of diarrheal disease across the seasons was assessed using the Mantel-Haenszel test.ResultsNo household was water-secure in both dry and rainy seasons; however, the intensity of insecurity was more pronounced during the dry season compared with the rainy season. Ninety households (52.0%), had water insecurity intensity scores above fifty percentiles during the dry season while 21 (12.1%) households had a water insecurity score above the 50th percentile during raining season, p < 0.001. The burden of diarrheal disease was significantly higher among households with a water insecurity intensity score above the 50th percentile, 9 (8.1%) compared to households with a water insecurity intensity score below the 50th percentile 7 (3.0%), p = 0.034.There was no statistically significant association between the intensity of water insecurity and diarrheal disease burden across the dry and rainy seasons, p = 0.218.ConclusionThe high burden of household water insecurity deserves concerted efforts from all concerned stakeholders, a panacea to an important health threat in the developing world.

The Impact of Rotavirus Vaccine on Diarrheal Diseases Among Children Under Five Years: A Retrospective Analysis of Data From 2012 To 2015 In the Yilo Krobo Municipality of Ghana

Introduction: Diarrhea is an important childhood disease with high morbidity and mortality among children under 5 years of age in developing countries such as Ghana. Rotavirus vaccine was introduced in Ghana in 2012 to reduce the incidence of diarrhea among children in Ghana. The objective of the study is to assess the impact of rotavirus vaccines on the burden of diarrheal diseases among children under five years reported in the Yilo Krobo Municipality from 2012 to 2015.Methods: A retrospective analysis of routinely collected and reported data on the monthly outpatient department (OPD) morbidity returns and vaccination reports from health facilities in the Yilo Krobo Municipality was done.Results: The burden of diarrheal diseases in children under five years declined from 2012 to 2014 with a slight increase in 2015. Diarrhea formed 9.71% of OPD cases in children under five years in 2012 with a reduction to 7.73% between 2013 and 2015.Conclusion: The rotavirus vaccine has had some impact on the incidence of diarrheal diseases reported at the outpatient departments.

The burden of diarrhoeal diseases in the Democratic Republic of Congo: a time-series analysis of the global burden of disease study estimates (1990–2019)

BackgroundDiarrhoeal diseases are important causes of disability and mortality being one of the main causes of mortality in the Democratic Republic of Congo (DRC). One of the largest and wealthiest African countries, DRC has been for long subjected to continuous political and economic instability, conflicts and disease outbreaks. This study aimed to address the knowledge gap in understanding how prevalence, mortality and burden of diseases in DRC changed over time and examine the influence of specific factors in these disease-related outcomes.MethodsA time-series analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 estimates was performed to describe prevalence, years lived with disabilities (YLDs) and mortality due to diarrhoeal diseases, by age-group and sex, between 1990–2019 in DRC. The contribution of water, sanitation and hygiene (WASH) and child malnutrition risk factors to these outcomes was also analysed. Piecewise regression analysis was used to assess trends over time.ResultsThe overall age-standardised prevalence of diarrhoeal diseases for both sexes in DRC was 1350.84 (UI:1240.16—1461.62) cases per 100,000 people in 1990. The prevalence increased until 2019, also fuelled by the movement of Rwandan refugees to DRC and First/Second Congo wars between 1996–2003. Age-standardised prevalence and mortality were consistently higher in males, compared to females, decreasing by 42% and 54%, respectively, between 1990 and 2019. Overall prevalence was also usually higher in over 70 years old, except between 1998–2003 when mortality in under five years old was the highest. Unsafe water sources and child wasting among under five years old were the main contributors to YLDs and deaths associated to diarrhoeal diseases in DRC.ConclusionDiarrhoeal diseases are important and preventable causes of disability and mortality in DRC. National measures of surveillance and cost-effective interventions targeting the identified risk groups could be effective in reducing its prevalence and associated burden.

Effects of Climatic Factors on Diarrheal Diseases among Children below 5 Years of Age at National and Subnational Levels in Nepal: An Ecological Study.

Introduction: The incidence of diarrhea, a leading cause of morbidity and mortality in low-income countries such as Nepal, is temperature-sensitive, suggesting it could be associated with climate change. With climate change fueled increases in the mean and variability of temperature and precipitation, the incidence of water and food-borne diseases are increasing, particularly in sub-Saharan Africa and South Asia. This national-level ecological study was undertaken to provide evidence linking weather and climate with diarrhea incidence in Nepal. Method: We analyzed monthly diarrheal disease count and meteorological data from all districts, spanning 15 eco-development regions of Nepal. Meteorological data and monthly data on diarrheal disease were sourced, respectively, from the Department of Hydrology and Meteorology and Health Management Information System (HMIS) of the Government of Nepal for the period from 2002 to 2014. Time-series log-linear regression models assessed the relationship between maximum temperature, minimum temperature, rainfall, relative humidity, and diarrhea burden. Predictors with p-values < 0.25 were retained in the fitted models. Results: Overall, diarrheal disease incidence in Nepal significantly increased with 1 °C increase in mean temperature (4.4%; 95% CI: 3.95, 4.85) and 1 cm increase in rainfall (0.28%; 95% CI: 0.15, 0.41). Seasonal variation of diarrheal incidence was prominent at the national level (11.63% rise in diarrheal cases in summer (95% CI: 4.17, 19.61) and 14.5% decrease in spring (95% CI: −18.81, −10.02) compared to winter season). Moreover, the effects of temperature and rainfall were highest in the mountain region compared to other ecological regions of Nepal. Conclusion: Our study provides empirical evidence linking weather factors and diarrheal disease burden in Nepal. This evidence suggests that additional climate change could increase diarrheal disease incidence across the nation. Mountainous regions are more sensitive to climate variability and consequently the burden of diarrheal diseases. These findings can be utilized to allocate necessary resources and envision a weather-based early warning system for the prevention and control of diarrheal diseases in Nepal.

Contribution of microbial genomics to cholera epidemiology.

In 2022, the burden of cholera-an acute watery diarrheal disease caused by Vibrio cholerae serogroup O1 (or more rarely O139) bacteria, which produce cholera toxin-remains high in many African and Asian countries. In the last few years, microbial genomics has made it possible to define the bacterial populations responsible for cholera more precisely. It has been shown that the current, seventh pandemic is due to a single lineage with a reservoir in the countries of the Bay of Bengal (India and Bangladesh). There have been several transmissions of the causal agent of cholera from this region to Africa, Asia and Latin America, suggesting a human-to-human transmission of the disease. Microbial genetics can help to fight this scourge by providing insight into cholera epidemiology and through its use in disease monitoring, thereby contributing to the achievement of the World Health Organization's goal of reducing cholera deaths by 90% by 2030.

​Burden of Diarrhoeal Diseases through Complementary Foods: A Review

Diarrhoeal disease is considered a public health problem with high morbidity and mortality worldwide, especially among children under the age of five years. In India, like other developing countries, diarrhoeal diseases are important child health problem. Food is an important factor in transmitting pathogens that cause diarrheal illness. Diarrhea can be caused by numerous pathogens and transmitted through multiple vehicles. Complementary foods prepared under unhygienic conditions are frequently heavily contaminated with pathogens and may thus be a major factor in causing diarrhoea diseases. Diarrheal diseases are major causes of malnutrition, delayed physical development and early childhood mortality. Diarrhea can cause acute wasting and is the most important infectious determinant of stunting of children’s linear growth. The prevention of diarrhoea in infants and children requires a multidisciplinary approach, including the promotion of safe preparation and handling of complementary food. Food contamination can be reduced using a Hazard Analysis and Critical Control Point (HACCP) methodology at the household level. Mothers and caregivers must wash their hands before feeding children and preparing food.

Occurrence of Diarrheal Disease among Under-Five Children and Associated Sociodemographic and Household Environmental Factors: An Investigation Based on National Family Health Survey-4 in Rural India.

Diarrheal disease is a significant public health problem leading to mortality and morbidity among children aged 0–59 months in rural India. Therefore, the rationale of this study was to identify the sociodemographic and environmental predictors associated with diarrhea among under-five children in rural India. A total of 188,521 living children (0–59 months) were studied from the National Family Health Survey-4, (NFHS-4) 2015–2016. Bivariate and binary logistic regression models were carried out from the available NFHS-4 data for selected sociodemographic and environmental predictors to identify the relationship of occurrence of diarrhea using STATA 13.1. In rural India, children aged 12–23 months, 24–35 months, 36–47 months, and 48–59 months were significantly improbable to suffer diarrheal disease. Children of the female sex, as well as children of scheduled tribes (ST) and other backward classes (OBC), were less likely to experience diarrhea. The disease was more likely to occur among children of scheduled castes (SC); Muslim or other religions; children belonging to central, eastern, and western regions; children with low birth weight; as well as children with improper stool disposal and rudimentary roof materials. In the rural parts of India, sociodemographic and household environmental factors were most influential. Effective community education; improved handwashing practices; pure water supply; and proper waste disposal, including building and utilizing latrines, would help reduce the burden of diarrheal disease in children.

Oral Rehydration Salts, Cholera, and the Unfinished Urban Health Agenda.

Cholera has played an outsized role in the history of how cities have transformed from the victims of disease into great disease conquerors. Yet the current burden of cholera and diarrheal diseases in the fast-urbanizing areas of low-income nations shows the many ways in which the urban health agenda remains unfinished and must continue to evolve.

El Niño Southern Oscillation, monsoon anomaly, and childhood diarrheal disease morbidity in Nepal.

Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002-2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña, vs. ENSO neutral) monsoon rainfall anomaly (below normal, above normal, vs. normal), and changes in timing of monsoon onset, and withdrawal (early, late, vs. normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios [IRR]: 1.21; 95% CI: 1.16-1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under-5 diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19-1.92). Our findings suggest that under-5 diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.

SAFE DRINKING WATER IN INDIA: CONSTITUTIONAL AND JUDICIAL PERSPECTIVE

Clean and safe drinking water is very important for human health. It can reduce the burden of common illnesses, diarrheal and other diseases. Unfortunately, it is found that the people in villages and urban areas drank water that is not safe for their health. Drinking water which is also called potable water. The Supreme Court of India addressed in different judgments the sanitation difficulties in context of the Constitution and makes a liberal interpretation of the right to life in Article- 21. Supreme Court has interpreted that the right to life includes the right to safe drinking water.

Determinants of diarrheal diseases among under five children in Jimma Geneti District, Oromia region, Ethiopia, 2020: a case-control study

BackgroundGlobally, in 2017, there were nearly 1.7 billion cases of childhood diarrheal diseases, and it is the second most important cause of morbidity and mortality among under-five children in low-income countries, including Ethiopia. Sanitary conditions, poor housing, an unsanitary environment, insufficient safe water supply, cohabitation with domestic animals that may carry human pathogens, and a lack of food storage facilities, in combination with socioeconomic and behavioral factors, are common causes of diarrhea disease and have had a significant impact on diarrhea incidence in the majority of developing countries.MethodsA community-based unmatched case-control study was conducted on 407 systematically sampled under-five children of Jimma Geneti District (135 with diarrhea and 272 without diarrhea) from May 01 to 30, 2020. Data was collected using an interview administered questionnaire and observational checklist adapted from the WHO/UNICEF core questionnaire and other related literature. Descriptive, bivariate, and multivariate binary logistic regression analyses were done by using SPSS version 20.0.ResultSociodemographic determinants such as being a child of 12–23 months of age (AOR 3.3, 95% CI 1.68–6.46; P < 0.05) and mothers’/caregivers’ history of diarrheal diseases (AOR 7.38, 95% CI 3.12–17.44; P < 0.05) were significantly associated with diarrheal diseases among under-five children. Environmental and behavioral factors such as lack of a hand-washing facility near a latrine (AOR 5.22, 95% CI 3.94–26.49; P < 0.05), a lack of hand-washing practice at critical times (AOR 10.6, 95% CI 3.74–29.81; P < 0.05), improper domestic solid waste disposal (AOR 2.68, 95% CI 1.39–5.18; P < 0.05), and not being vaccinated against rotavirus (AOR 2.45, 95% CI 1.25–4.81; P < 0,05) were found important determinants of diarrheal diseases among under-five children.ConclusionThe unavailability of a hand-washing facility nearby latrine, mothers’/caregivers’ history of the last 2 weeks’ diarrheal diseases, improper latrine utilization, lack of hand-washing practice at critical times, improper solid waste disposal practices, and rotavirus vaccination status were the determinants of diarrheal diseases among under-five children identified in this study. Thus, promoting the provision of continuous and modified health information programs for households on the importance of sanitation, personal hygiene, and vaccination against rotavirus is fundamental to decreasing the burden of diarrheal disease among under-five children.

Molecular diversity survey on diarrheagenic Escherichia coli isolates among children with gastroenteritis inFars, Iran.

Aim: To differentiate Escherichia coli isolates from diarrheal pediatric patients in clinical laboratories. Materials & methods: Patients with watery diarrhea were selected for sampling and tested for diarrheagenic E. coli(DEC)by APIkit. DEC isolates were tested for phylotyping, pathotyping and presence of determined virulence-encoding genes by specific molecular methods. Results: About 50% of isolates were detected as DECs (>55and >31% were categorized B2 and D phylotypes respectively). Enterotoxigenic E. coli was the most and enteroinvasive E. coli was the lowest prevalent pathotypes. csgand fim genes were the most present virulence factors. Conclusion: Typing of E. coli isolates from stool specimens will help to determine the diversity of diarrheal pathogens and take proper decisions to reduce the health burden of diarrheal diseases.

Association of enteropathogen detection with diarrhoea by age and high versus low child mortality settings: a systematic review and meta-analysis

SummaryBackgroundThe odds ratio (OR) comparing pathogen presence in diarrhoeal cases versus asymptomatic controls is a measure for diarrhoeal disease cause that has been integrated into burden of disease estimates across diverse populations. This study aimed to estimate the OR describing the association between pathogen detection in stool and diarrhoea for 15 common enteropathogens by age group and child mortality setting.MethodsWe did a systematic review to identify case-control and cohort studies published from Jan 1, 1990, to July 9, 2019, which examined at least one enteropathogen of interest and the outcome diarrhoea. The analytical dataset included data extracted from published articles and supplemented with data from the Global Enteric Multicenter Study and the Malnutrition and Enteric Disease study. Random effects meta-analysis models were fit for each enteropathogen, stratified by age group and child mortality level, and adjusted for pathogen detection method and study design to produce summary ORs describing the association between pathogen detection in stool and diarrhoea.Findings1964 records were screened and 130 studies (over 88 079 cases or diarrhoea samples and 135 755 controls or non-diarrhoea samples) were available for analysis. Heterogeneity (I2) in unadjusted models was substantial, ranging from 27·6% to 86·6% across pathogens. In stratified and adjusted models, summary ORs varied by age group and setting, ranging from 0·4 (95% CI 0·2–0·6) for Giardia lamblia to 54·1 (95% CI 7·4–393·5) for Vibrio cholerae.InterpretationIncorporating effect estimates from diverse data sources into diarrhoeal disease cause and burden of disease models is needed to produce more representative estimates.FundingWHO, Bill & Melinda Gates Foundation, and National Institutes of Health.

Vaccines for Protecting Infants from Bacterial Causes of Diarrheal Disease.

The global diarrheal disease burden for Shigella, enterotoxigenic Escherichia coli (ETEC), and Campylobacter is estimated to be 88M, 75M, and 75M cases annually, respectively. A vaccine against this target trio of enteric pathogens could address about one-third of diarrhea cases in children. All three of these pathogens contribute to growth stunting and have demonstrated increasing resistance to antimicrobial agents. Several combinations of antigens are now recognized that could be effective for inducing protective immunity against each of the three target pathogens in a single vaccine for oral administration or parenteral injection. The vaccine combinations proposed here would result in a final product consistent with the World Health Organization’s (WHO) preferred product characteristics for ETEC and Shigella vaccines, and improve the vaccine prospects for support from Gavi, the Vaccine Alliance, and widespread uptake by low- and middle-income countries’ (LMIC) public health stakeholders. Broadly protective antigens will enable multi-pathogen vaccines to be efficiently developed and cost-effective. This review describes how emerging discoveries for each pathogen component of the target trio could be used to make vaccines, which could help reduce a major cause of poor health, reduced cognitive development, lost economic productivity, and poverty in many parts of the world.

Burden and etiology of moderate and severe diarrhea in children less than 5\xa0years of age living in north and south of China: Prospective, population-based surveillance

BackgroundDiarrhea remains the leading cause of childhood illness in China. Better understanding of burden and etiology of diarrheal diseases is important for development of effective prevention measures.MethodsPopulation-based diarrhea surveillance was conducted in Sanjiang (southern China) year-round and Zhengding (northern China) in autumn/winter. Stool specimens were collected from children < 5 years of age experiencing diarrhea. The TaqMan Array Card (TAC), based on multiplex real-time PCR, was applied to detect multiple enteric microbial agents simultaneously. Results using these methods were compared to those derived from conventional PCR assays.ResultsDuring the study period, 6,380 children in Zhengding and 3,581 children in Sanjiang < 5 years of age participated. Three hundred and forty (31.2%) and 279 (22.9%) diarrhea episodes were identified as moderate-to-severe in the two counties, with incidence of 60.4 and 88.3 cases per 1,000 child-years in Zhengding and Sanjiang, respectively. The five most frequently detected bacterial and viral agents in Sanjiang were adenovirus, enterovirus, enteroaggregative Escherichia coli (EAEC), rotavirus, and sapovirus all the year round, while the most common viral agents in Zhengding were rotavirus, followed by astrovirus and adenovirus during the cool season. Compared to conventional PCR assay, the average incremental detection via the TAC method was twofold.ConclusionOur study demonstrated high diversity and prevalence of multiple major bacterial and viral agents, including rotavirus and calicivirus, among children in China. Further studies are needed to define the public health significance of neglected but frequently detected pathogens such as EAEC, enterotoxigenic E. coli, Campylobacter, adenovirus, and enterovirus.

Aetiology of acute diarrhoea in children in Shanghai, 2015-2018.

Diarrhoea remains a major cause of childhood morbidity and mortality worldwide. This study aimed to monitor the aetiology of acute diarrhoea in children in Shanghai. Paediatric outpatients with acute diarrhoea were enrolled in the study from Jan 2015 to Dec 2018. Faecal samples were collected for testing. Enteric bacteria were identified and typed by culture and serotyping, respectively. Enteric viruses were identified by real-time PCR. Enteric pathogens were identified in 1572 (58.4%) of the 2692 enrolled children with acute diarrhoea. Viruses were detected more frequently than bacteria (41.3% versus 25.0%). Nontyphoidal Salmonella spp. (NTS) was the most common (10.3%) bacteria isolated, followed by enteropathogenic Escherichia coli (EPEC) (6.5%), enteroaggregative Escherichia coli (EAEC) (6.2%), Campylobacter spp. (3.6%), enterotoxigenic Escherichia coli (ETEC) (1.1%), Shigella spp. (0.2%), and enterohemorrhagic Escherichia coli (EHEC) (0.1%). Rotavirus was the most common (16.0%) virus detected, followed by norovirus (15.5%), adenovirus (7.2%), sapovirus (3.0%) and astrovirus (2.7%). Rotavirus, norovirus and NTS were the major pathogens responsible for diarrhoea in Shanghainese children. Improving uptake of the rotavirus vaccine and strengthening foodborne-pathogen prevention will aid in reducing the burden of diarrhoeal disease in children in Shanghai.

Formative research for the development of baby water, sanitation, and hygiene interventions for young children in the Democratic Republic of the Congo (REDUCE program)

BackgroundResearch exploring the unique exposure pathways to fecal pathogens for young children and innovative water, sanitation, and hygiene (WASH) interventions for susceptible pediatric populations is needed to reduce the burden of diarrheal diseases and stunting globally. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to 1) identify exposure pathways to fecal pathogens that are significant contributors to morbidity for young children in South Kivu, Democratic Republic of the Congo, and 2) develop and evaluate scalable interventions that reduce fecal contamination and exposure from these pathways. The formative research portion of the project sought to identify feasible and acceptable WASH interventions to modify behaviors found to be associated with diarrheal disease and impaired growth in our REDUCE cohort study.MethodsNinety-one semi-structured interviews, 6 focus group discussions, and a pilot study of 102 households were conducted during 24 months of formative research. Thirty-one interviews and six focus group discussions were conducted with caregivers, community health workers, and village leaders to explore existing WASH practices and to identify barriers and facilitators to WASH behaviors. Findings were organized using the Integrated Behavioral Model for Water, Sanitation and Hygiene to facilitate interpretation and identify determinants to Baby WASH behaviors in this setting. Care Group modules and enabling technology were developed based on exploratory findings and then revised during a two-part, iterative pilot study. Sixty interviews were conducted with participants in a pilot study of the REDUCE Baby WASH Care Group modules to learn about their experiences with the intervention.ResultsSix REDUCE Baby WASH Care Group modules were developed based on formative research findings and covered the following topics: 1) living with animals; 2) child mouthing of fomites and feces; 3) composting animal feces; 4) child feces disposal; 5) handwashing with soap; and 6) water treatment.ConclusionThis study took a theory-driven and evidence-based approach to formative research and the development of the REDUCE Baby WASH Care Group modules. Intervention design focused on interrupting the exposure routes for infants and young children to fecal pathogens in the environment and promoting low-cost, low-burden Baby WASH behavioral recommendations and enabling technology. These developed REDUCE Baby WASH Care Group modules are currently being rolled out to over 1,000,000 beneficiaries in Democratic Republic of the Congo.

High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya.

Introduction Clostridioides difficile is a neglected pathogen in many African countries as it is generally not regarded as one of the major contributors toward the diarrheal disease burden in the continent. However, several studies have suggested that C. difficile infection (CDI) may be underreported in many African settings. The aim of this study was to determine the prevalence of CDI in hospitalized patients, evaluate antimicrobial exposure, and detect toxin and antimicrobial resistance profiles of the isolated C. difficile strains.MethodsIn this cross-sectional study, 333 hospitalized patients with hospital-onset diarrhoea were selected. The stool samples were collected and cultured on cycloserine-cefoxitin egg yolk agar (CCEY). Isolates were presumptively identified by phenotypic characteristics and Gram stain and confirmed by singleplex real-time PCR (qPCR) assays detecting the species-specific tpi gene, toxin A (tcdA) gene, toxin B (tcdB) gene, and the binary toxin (cdtA/cdtB) genes. Confirmed C. difficile isolates were tested against a panel of eight antimicrobials (vancomycin, metronidazole, rifampicin, ciprofloxacin, tetracycline, clindamycin, erythromycin, and ceftriaxone) using E-test strips.Results C. difficile was detected in 57 (25%) of diarrheal patients over the age of two, 56 (98.2%) of whom received antimicrobials before the diarrheal episode. Amongst the 71 confirmed isolates, 69 (97.1%) harbored at least one toxin gene. More than half of the toxigenic isolates harbored a truncated tcdA gene. All isolates were sensitive to vancomycin, while three isolates (2.1%) were resistant to metronidazole (MIC >32 mg/L). High levels of resistance were observed to rifampicin (65/71, 91.5%), erythromycin (63/71, 88.7%), ciprofloxacin (59/71, 83.1%), clindamycin (57/71, 80.3%), and ceftriaxone (36/71, 50.7.8%). Among the resistant isolates, 61 (85.9%) were multidrug-resistant.ConclusionMultidrug-resistant C. difficile strains were a significant cause of healthcare facility-onset C. difficile infections in patients with prior antimicrobial exposure in this Kenyan hospital.

Creating the Healthiest Nation: Climate Change and Environmental Health Impacts in Nigeria: A Narrative Review

Climate change is a “threat multiplier and a prime cause of universal threat to health in the 21st century, including 4th industrial revolution. The health effects of climate change will increase dramatically over the next few years and pose a risk to human life and the well-being of billions of people. As we all know, the milieu is fundamental to our sustained earth survival and environmental changes (natural and artificial) affect it either to the benefit or detriment of humans. Climate change is one of such changes in the physical environment which has grave consequences for the existence of mankind. Climate change is interestingly, no longer a speculative subject. There is a good international scientific consensus existing to show that this phenomenon is real and if recent global warming movements continue, temperature rise, ocean levels and more frequently weather conditions that is extreme (storms, heat-waves, droughts, floods, cyclones, etc.) may perhaps cause severe food shortages, loss of shelter, water, livelihoods, extinction of flora and fauna species. In the recent past, the earth has witnessed devastating weather-related events in different portions of the globe including hurricanes (e.g., Katrina and Rita in USA), tsunamis, typhoons, flooding especially in the Asian Continent, wild fires especially in Australia, USA, etc. Currently, the on-going flood incident in Pakistan that has so far claimed about 1,600 lives and rendered another four million people homeless is a sad reminder of the ugly and devastating consequences of global warming on the environment. There is no gainsaying the fact that humankind is paying dearly for the massive alterations in the environment that have induced changes in climate. This is because of frequent incidence of changes in climate related disasters in the world today. There is hardly any month that passes without an incident occurring in one part of the globe or another since the advent of the 21st century. Changes in climate has significant and potentially devastating health consequences, whether through direct actions (e.g., deaths resulting from heat wave and weather disasters) or disruption of complex biological methods (e.g., changes in infectious diseases patterns, supplies in fresh water and production of food).The report of the fourth assessment of the United Nations Intergovernmental Panel on Climate Change (IPCC) have globally submitted that “it is estimated that the health of millions of people is affected, for instance, malnutrition increases; deaths increase, diseases and injury; burden of increase diarrheal diseases; frequency of increased cardio-respiratory diseases caused by high levels of ground-level ozone in cities due to climate change; besides altered spatial distribution of some communicable diseases”. The association amongst changes in climate, its drivers, systemic effects, health and socioeconomic growth, mitigation and adaptation has been specified.

Burden of Diarrheal Disease among under Five Children in Ethiopia, 2000-2016: Findings from the Global Health Estimates 2016

Introduction: Globally diarrhea among under five children remains one of the high burden diseases particularly in developing countries. Ethiopia is one of the sub-Saharan countries highly under five mortality due to diarrhea. Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality and morbidity rate related to diarrhea still magnificently a burden. Objective: This study aimed to assess the burden of diarrheal for under five children in terms of death and Disability-Adjusted Life Years lost (DALY) between 2000 and 2016. Patients and methods: The research used data from Global Health Estimate 2016; that originally collected the information through vital registration, verbal autopsy, surveys, reports, published scientific articles, Global Burden of Disease study (GBD 2016) and modeling. The magnitude of Diarrheal disease death was estimated 14,894 under five children in 2016. Death from diarrheal disease has also contributed to 38.4% (14894/38777) of deaths from infectious and parasitic diseases and 7.96% (14894/187,065) of the total death reported by the same year. Meanwhile, YLD, YLL and DALYs for under five children were 61,709 and 1408.4 thousand respectively in 2016. Themagnitudeof deaths due to diarrheal disease was declined by 76.7% from the2000’s record of 49,021 deaths within 16 years. In 2016, Mortality due to Diarrheal disease was highest among males. Of the 14,894 diarrheal disease related mortalities, more than 1405 deaths were among males. Conclusion: Even if the burden of diarrhea for under five mortality is sharply declining in Ethiopia; but, it still remained one of the public health problems and second leading cause of morbidity. Therefore, strengthening hand washing practice and accessing prevention program is important to eliminate death within the target period.