Diarrhea In Children Research Articles

The characteristics of intestinal microflora in infants with rotavirus enteritis, changes in microflora before and after treatment and their clinical values

Rotavirus (RV) is a leading pathogen causing diarrhea in children. In this study, a total of 51 fecal samples from children with RV enteritis, 29 post-treatment fecal samples, and 38 fecal samples from age-matched healthy controls were collected. Microbial DNA was isolated from the samples followed by high throughput Illumina sequencing targeting 16 S rRNA gene. Compared to the healthy group, the RV-infected group exhibited reduced microbial diversity. Both groups shared Firmicutes as the dominant phylum. Additionally, the abundance of Proteobacteria increased significantly in the RV-infected group. At the genus level, among the top 50 most abundant genera, 34 showed significant differences, with these differential genera correlating with certain clinical indicators such as dehydration levels and C-reactive protein (CRP). Notably, there were no significant differences in the microbiota before and after treatment in RV-infected children. Only 8.82% (3/34) of the differential genera in the post-treatment group showed a recovery trend towards the healthy state. This study enhances the understanding of how RV infection alters the gut microbiota structure in children and provides a scientific basis for improving clinical diagnosis and treatment strategies.

A Rapid Assessment of Knowledge, Attitudes and Practices of Mothers and Caregivers on Childhood Diarrhea in Zanzibar, Tanzania

Childhood diarrhea is the third cause of admission and deaths with overall incidence remaining unacceptably high while knowledge, attitude and practices (KAP) of the mothers present affecting vitality of the childhood in most affected communities of Tanzania. Therefore, this study aimed to assessment of knowledge, attitudes and practices of mothers and caregivers on childhood diarrhoea in Zanzibar, Tanzania. A quantitative cross-sectional study was conducted from October, 2019 to February, 2020. Twenty-four health facilities were selected from west urban region of Zanzibar in Tanzania. A total of 384 mothers and caregivers with diarrhoea in children under-five years were enrolled. Information on socio-demographic characteristics was obtained by asking the parents/guardians. Questionnaires were interview administered to the participants and data were analyzed using statistical package for social science (SPSS) version 16.0. A total of mothers and caregivers were studied. From the respondents 365(95%) had satisfactory level of knowledge on childhood diarrhea while 20 (5%) had unsatisfactory knowledge. A total of 196 (51%) rejected the use of oral Rehydration Sugars (ORS) at home due to taste and smell and 188 (49%) agree its use. Collectively mothers and caregivers 177 (46%) reported drinking treated or boiling water. A total of 181 (47%) respondents reported hand washing after helping children with defecation while only 73 (19%) respondents reported washing hands before preparing food. Limited use of water sanitation and hygiene (WASH) practices was observed among mothers and caregivers of under-five in the prevention and management of childhood diarrhea. Therefore, there is a need to endorse effective community health education, dissemination of information and community conversation to create a positive practice towards moving knowledge into WASH practices.

Cytolethal distending toxin-producing Escherichia coli clinical isolates from Mexican children harbor different cdt types causing CDT-induced epithelial pathological phenotypes

Cytolethal distending toxins (CDTs), encoded by cdtABC genes, have DNase activity leading to cellular and nuclear distention, resulting in actin remodeling, irreversible cell cycle arrest and apoptosis of target cells. PCR cdt-positive Escherichia coli strains have been isolated from children with diarrhea worldwide. However, toxin production and biological activity of cdt+ strains are rarely confirmed. Here, we characterized the biological activity of cdt+E. coli of clinical isolates from Mexican children with severe diarrhea and its relationship with the harbored cdt type. Ten isolates from seven patients containing cdt+E. coli, one isolate from a patient containing cdt− E. coli, and a prototype CDT-producing E. coli were used to determine the harbored cdt-type, cell distention, actin remodeling and cell cycle arrest on epithelial cells. Three isolates harbored cdt type I, one type II, two type III, two type IV and two simultaneously type II and III. Lysates from eight cdt+E. coli isolates caused cell distention, actin cytoskeletal remodeling and cell cycle arrest but two isolates from the same patient harboring simultaneously cdt type II/III did not. The cdt genes were necessary and enough to cause the cytolethal distending pathology. Mutants in cdtABIC (O86:H34 strain; cdt-I) and cdtABIIC (isolate; cdt-II) were complemented by cdtABIIC genes and both recovered the CDT-induced phenotypes. Transformation of E. coli BL21 by cdtABIIC genes caused this cytolethal distending pathology. These data indicate that cdt + E. coli isolates are potentially dangerous bacteria to cause serious epithelial cell damage and cell death to aggravate childhood diarrhea.

Rotavirus vaccine effectiveness and coverage among children younger than 5years old in Shanghai, China: A test-negative case control study.

The number of post-marketing studies assessing the vaccine effectiveness (VE) of the Lanzhou lamb rotavirus vaccine (LLR, licensed in 2000 exclusively in China) and the oral human attenuated pentavalent rotavirus vaccine (RotaTeq, licensed in China in 2018) in China is limited. A test-negative case-control study based on prospective surveillance was conducted among diarrhea patients aged 5years and younger at five hospitals in Shanghai, China. Cases and controls were defined based on the results of real-time fluorescent quantitative reverse transcription polymerase chain reaction (rRT-PCR) of fecal samples for rotavirus. Both matched and unmatched case-control study designs were employed using logistic regression models, with adjustments for age at onset age and the rotavirus epidemic season. In the LLR-specific analysis (247 cases, 2191 controls), the VE of partial LLR vaccination (2 doses) was 49.09% (95% CI: 1.69%∼73.64%) in multivariate analyses. In the RotaTeq-specific analysis (42 cases and 523 controls), the VE of complete RotaTeq vaccination was 87.13% (95% CI: 45.87%∼96.94%), 89.46% (95% CI: 55.03%∼97.53%), and 85.69% (95% CI: 33.43%∼96.93%) respectively in univariate, multivariate, and matched analyses, respectively. The vaccination coverage for any dose among 2893 patients with rotavirus-negative diarrhea born between 2011 and 2022 was 49.78%. Following the licensure of RotaTeq in 2018, this coverage increased from 45.02% to 61.77%. RotaTeq demonstrates a robust protective effectiveness, while LLR provides a certain level of protection against mild to moderate rotavirus diarrhea in children in Shanghai. For privately purchased (non-NIP) vaccines, we estimate that the coverage for rotavirus vaccines among children in Shanghai is high. Complete rotavirus vaccination is recommended for age-eligible children. Further post-marketing research on rotavirus vaccines is necessary to inform decision-making regarding the introduction of rotavirus vaccination in China.

Differential Effectiveness of Water, Sanitation, and Handwashing Interventions to Reduce Child Diarrhea in Dry and Rainy Seasons: A Systematic Review and Meta-Analysis of Intervention Trials.

Studies evaluating how water, sanitation, and/or handwashing (WASH) interventions in low- and middle-income countries impact diarrheal diseases have shown inconsistent results. The prevalence of enteric pathogen infections and diarrhea are highly seasonal and climate-sensitive, which could explain heterogeneous findings. Understanding how season influences the effectiveness of WASH interventions is critical for informing intervention approaches that will be resistant under the varying weather conditions that climate change will bring. We conducted a systematic review of the literature and meta-analysis to test whether and to what extent the impact of WASH interventions on diarrhea differs by season. We searched the literature for randomized and nonrandomized controlled WASH intervention trials and identified the season in which data were collected-rainy, dry, or both-for each study using proximate land station weather datasets. We compared the relative risk (RR) estimates for the impact of interventions on diarrhea for each study, stratified by season, and analyzed estimates using meta-analysis and meta-regression. This study is registered with PROSPERO, CRD42021231137. A total of 50 studies met the inclusion criteria, resulting in 34 drinking water intervention estimates, 8 sanitation intervention estimates, and 14 handwashing intervention estimates. Of the total studies, 60% () spanned more than one season, with most single-season studies (75%, ) occurring exclusively in the dry season. The effect of WASH interventions was stronger in dry seasons than in rainy seasons, with a 33% [95% confidence interval (CI): 24%, 41%] and 18% reduction (95% CI: 5%, 29%) in diarrhea risk, respectively. When stratified by type of intervention, the stronger effect size in dry seasons was consistent for water and handwashing interventions but not for sanitation interventions. Estimates of the seasonal impact of WASH interventions revealed larger effects in the dry season than in the rainy season overall and for water and handwashing interventions in particular. These patterns likely affected previous estimates of intervention effectiveness, which included more dry season estimates. These findings suggest the need to collect data across seasons and report seasonally stratified results to allow for more accurate estimates of the burden of disease impacted by WASH investments and to improve projections of potential impacts of these interventions under future climate conditions. These findings also underscore the need for robust WASH interventions designed to be resistant to seasonal variations in temperature and rainfall now and under future climate change scenarios. https://doi.org/10.1289/EHP14502.

P-1135. Influence of Antibiotic and Laxative Use on Clostridioides difficile Testing in Post-Operative Children

Abstract Background Antibiotic exposure in surgical patients poses risks, contributing both to Clostridioides difficile infection (CDI) and to antibiotic associated diarrhea. While CDI may cause diarrhea, we hypothesized that negative CDT could be a proxy for non-infectious diarrhea and aimed to discern if broad-spectrum (BS) antibiotics or laxatives influenced negative CDT. Broad Spectrum Antibiotics and Laxative Use In Post-Operative Children with Negative C difficile Test Compared to Matched Controls CDT: C difficile Testing, DOT: Days of Therapy, SAAR: Standardized Antibiotic Administration Ratio Methods A matched case-control study (Jan 2013-Feb 2022) examined risk factors for negative CDT in children (2-18 years) undergoing sedated procedures with preoperative antibiotic prophylaxis at a large referral hospital. Perioperative data was merged with antibiotic and laxative data from the Electronic Medication Administration Record (eMAR). Cases with PCR-negative CDT on postoperative days 3-90 were matched with untested controls based on age, gender, year of testing, and procedure category. We assessed Days of Therapy (DOT) of antibiotics or laxatives for various periods. Results Among 14,229 children (mean age 10 ± 5.2 years) undergoing 18,705 procedures, 108 cases and 108 controls were selected. Children with negative CDT received more BS antibiotics 3 days before the test date (1000DOT/LOS = 410) than controls (1000DOT/LOS = 271; OR 1.9 (1.06 – 3.5); P =0.031). Conversely, cases received fewer laxatives postoperatively and 3 days before CDT (1000DOT/LOS =148) than controls (1000DOT/LOS = 346; OR 0.35 (0.17-0.73); P=0.005). No difference was observed in pre-operative laxative use. Conclusion Our data suggests that BS antibiotics are a more important contributor to post-operative non-infectious diarrhea in children than laxatives. Antimicrobial stewardship efforts targeting BS antibiotic use in post-operative children could mitigate diarrhea and unnecessary CDT. Disclosures Abhishek Deshpande, MD, PhD, AHRQ: Grant/Research Support|Clorox Healthcare: Grant/Research Support

Influence of Enterocytozoon bieneusi Infection on Child Growth: A Secondary Analysis of the MAL-ED Birth Cohort Study.

Malnutrition in the early days of life is a global public health concern that affects children's growth. It results from a variety of factors, including pathogenic infections. Enterocytozoon bieneusi is a microsporidian parasite that can cause diarrhea and malnutrition in children. The study aimed to assess the impact of E. bieneusi on child growth. The MAL-ED study, a multicountry birth cohort research project, investigated the relationship between enteric infections and malnutrition in participating children from eight countries. A customized real-time polymerase chain reaction-based TaqMan array card was used in this study to identify enteropathogens from stool samples, where E. bieneusi was one of the target pathogens. The impacts of E. bieneusi infection on growth measures were assessed. Mixed-effect linear models were used to investigate the relationship between E. bieneusi and growth outcomes, including length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z scores. At the endpoint (last month of measurement), the infected group had significantly lower scores than the noninfected group for all outcomes. The adjusted difference-in-difference (D-in-D) values were -0.53 (95% CI: -0.67 to -0.38) for LAZ, -0.38 (95% CI: -0.52 to -0.23) for WAZ, and -0.22 (95% CI: -0.38 to -0.06) for WLZ. Enterocytozoon bieneusi infection has been identified as a factor associated with reduced linear growth, weight gain, and weight gain relative to linear growth in children, underscoring the importance of treating this infection.

Changyanning tablet alleviates Crohn's disease by inhibiting GPX4-mediated ferroptosis.

Changyanning tablets (CYN) are a marketed traditional Chinese medicine composed of Diijincao (Euphorbia humifusa Willd.), Jinmaoercao (Hedyotis chrysotricha (Palib.) Merr.), Zhangshugen (root of Cinnamomum camphora (L.) J.Presl), Xiangru (Elsholtzia ciliate (Thunb.) Hyl.), and Fengxiangshuye (leaf of Liquidambar formosana Hance). They possess the functions of clearing heat, removing dampness, and regulating qi. CYN is used for the treatment of diarrhea and dysentery caused by damp heat in the large intestine, with symptoms such as diarrhea, or stools with pus and blood, tenesmus, abdominal pain and distension, acute and chronic gastroenteritis, diarrhea, bacterial diarrhea, and indigestion in children. This study aims to explore the intervention effects of CYN on Crohn's disease (CD) and its potential mechanisms. The therapeutic effect and potential mechanism of CYN on CD were investigated based on the 2,4,6-Trinitrobenzenesulfonic acid solution (TNBS)-induced rat model. In vivo and in vitro experiments confirmed that CYN can alleviate CD by inhibiting GPX4-mediated ferroptosis. siRNA was used to knock down GPX4 for reverse validation. Finally, active components of CYN inhibiting ferroptosis were identified using UPLC-MS and the RSL3-induced HCoEpiC ferroptosis cell model. CYN significantly improved ferroptosis-related indicators (GSH, MDA, GPX4, and SLC7A11) in the colons of TNBS-induced CD rats. Screening with three ferroptosis inducers (RSL3, FINO2, and erastin) revealed that CYN was most effective against RSL3 (a ferroptosis inducer targeting GPX4)-induced apoptosis. Subsequently, the resistance effect of CYN on RSL3-induced ferroptosis was confirmed in vitro. Further in vivo experiments showed that CYN alleviated local CD-like intestinal injury induced by RSL3 enema. siRNA knockdown of GPX4 in HCoEpiC cells further validated GPX4 as major target of CYN in inhibiting ferroptosis. Finally, UPLC-MS and in vitro experiments identified rutin, rosmarinic acid, and kaempferol-3-O-sophoroside as key active components of CYN for inhibiting ferroptosis. CYN alleviates CD by inhibiting GPX4-mediated ferroptosis, highlighting its clinical potential for treating CD and enhancing the understanding of the pathogenic and therapeutic mechanisms associated with CD.

Prevalence and Determinants of Fever, Acute Respiratory Infections, and Diarrhea among Children in Bangladesh

Background: Childhood illnesses, including fever, acute respiratory infections (ARI), and diarrhea, remain leading causes of morbidity and mortality among children under five in low- and middle-income countries like Bangladesh. These conditions are influenced by socioeconomic, environmental, and behavioral factors, necessitating a comprehensive understanding of their prevalence and determinants to inform public health strategies. Objective: This study aims to determine the prevalence and associated demographic, socioeconomic, and environmental factors for fever, ARIs, and diarrhea among children under five in Bangladesh, thereby providing insights for targeted interventions. Methodology: Utilizing data from the Bangladesh Demographic and Health Survey (BDHS) 2017–18, this cross-sectional study examined a weighted sample of 8,421 children under five. Variables including demographics, socioeconomic status, and health-related factors were analyzed. Prevalence of fever, ARI, and diarrhea was recorded, with logistic regression models estimating odds ratios to identify associations between childhood illnesses and selected predictors. Results: Among children aged 0–59 months, boys exhibited a higher prevalence of fever and ARI compared to girls. Children younger than 12 months showed the highest rates of all three illnesses, particularly ARI. Breastfeeding status, maternal age, and socioeconomic factors (e.g., parental education, wealth index) significantly influenced illness prevalence. Additionally, safe water access and sanitation were linked to lower fever and ARI prevalence. Vaccination status was also associated with illness patterns, highlighting complex health disparities. Conclusion: The study identifies critical factors affecting the prevalence of fever, ARI, and diarrhea in children, emphasizing the need for interventions addressing environmental and socioeconomic risks. Improved water, sanitation, vaccination coverage, and healthcare access are recommended to reduce disease burden among children in Bangladesh.

Multilevel analysis of prevalence and determinants of diarrhea among under-five children in Somalia: insights from the Somalia demographic and health survey 2020

BackgroundDiarrheal diseases remain a critical public health challenge, particularly for children under five in low- and middle-income countries such as Somalia. This study aimed to assess the prevalence and determinants of diarrhea in this vulnerable population, utilizing data from the 2020 Somalia Demographic and Health Survey.MethodsThis investigation employed secondary data from the 2020 Somalia Demographic and Health Survey. The analysis involved the extraction and cleaning of variables using STATA version 17. The primary outcome variable was childhood diarrhea, analyzed alongside 19 explanatory variables encompassing sociodemographic and environmental factors. Descriptive statistics, chi-square tests, and multilevel logistic regression models were employed to elucidate associations.ResultsThe study identified a diarrhea prevalence of 5.24%. Notably, sociodemographic factors significantly influenced this prevalence. Families within the second wealth category exhibited reduced odds of diarrhea (AOR = 0.699; 95% CI: 0.522–0.936), with those in the middle wealth category experiencing even lower odds (AOR = 0.524; CI: 0.391–0.702). Vitamin A supplementation was found to be critical; children lacking recent supplementation had increased odds of diarrhea (AOR = 1.790; CI: 1.440–2.225). Furthermore, feeding practices indicated that children not using bottle nipples faced higher odds of diarrhea (AOR = 1.377; CI: 1.172–1.617). Maternal age also played a significant role, with mothers aged 45–49 presenting higher odds of their children experiencing diarrhea (AOR = 7.650; CI: 1.762–33.184). Institutional births were associated with lower odds of diarrhea (AOR = 0.693; CI: 0.568–0.847), while children of educated fathers exhibited increased odds (AOR = 1.414; CI: 1.090–1.833). Additionally, lack of deworming medication significantly heightened the odds of diarrhea (AOR = 4.450; CI: 3.619–5.482).ConclusionThe prevalence of diarrhea among children under five relatively high in Somalia. Key determinants include vitamin A supplementation, feeding with bottle, household wealth, age of mothers, place of delivery, paternal education, and deworming medication. Public health interventions should focus on enhancing household economic status, and ensuring regular deworming. Increasing the coverage and frequency of vitamin A supplementation could enhance children’s immune systems and reduce diarrhea incidence. Moreover, targeted economic support, health care programs for older mothers are essential to mitigate the adverse effects of socioeconomic factors on child health, ultimately leading to a substantial reduction in diarrheal diseases among young children.

Examining the impact of implementing routine rotavirus vaccination on the number of paediatric admissions due to diarrhoea and dehydration in Kenyan hospitals: A study using interrupted time series analysis.

Dehydration secondary to diarrhoea is a major cause of hospitalization and mortality in children aged less than five years. Most diarrhoea cases in childhood are caused by rotavirus, and routine introduction of rotavirus vaccine is expected to reduce the incidence and severity of dehydration secondary to diarrhoea in vaccinated infants. Previously, studies have examined changes in admissions with stools positive for rotavirus but this study reports on all admissions with dehydration secondary to diarrhoea regardless of stool rotavirus results. We aimed to assess the changes in all-cause severe diarrhoea and dehydration (DAD) admissions following the vaccine's introduction. We examined changes in admissions of all clinical cases of DAD before and after introduction of routine vaccination with rotavirus vaccine in July 2014 in Kenya. We use data from 13 public hospitals currently involved in a clinical network, the Clinical Information Network (CIN). Routinely collected data for children aged 2-36 months were examined. We used a segmented mixed effects model to assess changes in the burden of diarrhoea and dehydration after introduction of rotavirus vaccine. For sensitivity analysis, we examined trends for non-febrile admissions (surgical or burns). There were 17,708 patients classified as having both diarrhoea and dehydration. Average monthly admissions due to DAD for each hospital before vaccine introduction (July 2014) was 35 (standard deviation: ±22) and 17 (standard deviation: ±12) after vaccine introduction. Segmented mixed effects regression model showed there was a 33% (95% CI, 30% to 38%) decrease in DAD admissions immediately after the vaccine was introduced to the Kenya immunization program in July 2014. There was no change in admissions due to non-febrile admissions pre-and post-vaccine introduction. The rotavirus vaccine, after introduction into the Kenya routine immunization program resulted in reduction of all-cause admissions of diarrhoea and dehydration in children to public hospitals.

The Prevalence and Determinants of Undernutrition Among Infants and Children Aged 6 Months to 5 Years in Sub-Saharan African Countries: A Systematic Scoping Review.

To explore the prevalence and determinants of undernutrition among infants and children aged 6 months to 5 years in sub-Saharan African countries. Despite substantial progress over the past 20 years, undernutrition has remained an alarming global challenge. Sub-Saharan Africa is the only region where the prevalence of stunting in children younger than 5 years has significantly increased. This study seeks to update the evidence on the prevalence and determinants of childhood undernutrition in this vulnerable region. This systematic scoping review was conducted following the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched on December 14, 2022, with no date or language restrictions. Primary studies presenting evidence on the prevalence and determinants of childhood undernutrition among infants and children aged 6 months to 5 years were included. Data on the prevalence of stunting, wasting, and underweight, and on determinants of undernutrition were extracted, described, and compared with national survey data. A total of 59 publications from 11 countries were included, with most studies conducted in Ethiopia (n = 38) and Tanzania (n = 7). Stunting prevalence ranged from 8% to 64%, wasting prevalence ranged from 1% to 58%, and the prevalence of underweight ranged from 2% to 63%. The most frequently reported determinants of undernutrition were the child's age (>24 months), male sex, maternal illiteracy, diarrhea or illness in the past 2 weeks, low household socioeconomic status, or living in a larger household (n > 4 members). Overall, 56% of the included studies reported higher stunting prevalence, 60% reported higher wasting prevalence, and 57% reported a higher prevalence of underweight than reported by relevant national surveys. The prevalence of childhood undernutrition reported by primary studies is often higher than that reported by national surveys. Several immediate and underlying determinants influence childhood undernutrition. Future research should incorporate the findings from primary research to develop holistic, multistrategy approaches to address childhood undernutrition in sub-Saharan African countries.

Outbreak of acute diarrhea in children: Clinical manifestations, treatment, source of drinking water, and fecal microbiome analysis in region of West Sumatra Province, Indonesia

Outbreak of acute diarrhea in children: Clinical manifestations, treatment, source of drinking water, and fecal microbiome analysis in region of West Sumatra Province, Indonesia

Child diarrhea in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with diarrhea in children under five years.

Diarrhea is a global public health problem that is the third leading cause of death in under five years, with an estimated 1.7 billion cases in 2023 and 1.8 million deaths from diarrhea diseases every year. To better understand child diarrhea in Cambodia, we examined to describe temporal and geospatial trends of diarrhea and used multiple logistic regression to analyze its association with individual and household characteristics and diarrhea among children aged 0-59 months using combined data from the Cambodia Demographic and Health Survey for 2005 to 2022. This study included 29,742 weighted children aged 0-59 months; there were 7,220 in 2005, 7,758 in 2010, 7,010 in 2014, and 7,754 in 2022, respectively. The prevalence of diarrhea among children aged 0-59 months decreased from 19.7% in 2005 to 6.2% in 2022. The highest prevalence of childhood diarrhea was observed in Kampong Cham (30.1%), in Mondul Kiri/Ratanak Kiri (24.6%), Battambang/Pailin (20.9%), and Mondul Kiri/Ratanak Kiri (12.9%) for the years 2005, 2010, 2014 and 2022. After adjusting for other variables, factors independently associated with a protective effect against childhood diarrhea included mothers aged 25-34 years (adjusted odds ratio (AOR) = 0.68; 95% CI: 0.48-0.96), 35-49 years (AOR = 0.60; 95% CI: 0.42-0.87), completed higher education (AOR = 0.61; 95% CI: 0.41-0.91), and employed (AOR = 0.79; 95% CI: 0.72-0.96). Children were less likely to have diarrhea if they were older than 36 months, belonged to the richest households (AOR = 0.69; 95% CI: 0.55-0.86), or lived in coastal region (AOR = 0.53; 95% CI: 0.41-0.69). Conversely, children born to mothers who smoke had increased odds of diarrhea (AOR = 1.61; 95% CI: 1.25-2.08), had barrier access to healthcare services (AOR = 1.20; 95% CI: 1.07-1.35), or children aged 6-23 months. Diarrhea remains highly prevalent among children in Cambodia. Public health interventions and policies to alleviate diarrhea should be prioritized to address these factors across geographical.

FilmArray® Effectively Detects All Clades of F41 but Encounters Challenges with Other Adenovirus Species.

The BioFire FilmArray® Gastrointestinal (GI) Panel, a widely used diagnostic tool, is designed to detect the genetic material of 22 common pathogens responsible for gastroenteritis, including viruses, bacteria, and parasites. It can detect human adenovirus (HAdV) species F, particularly serotypes F40 and F41, which are the major causes of diarrhea and mortality in children. However, its potential shortcomings in detecting other HAdV species limit its effectiveness in broader HAdV detection in clinical settings and outbreak investigations. The aim of this study was to evaluate the ability of the GI Panel to detect three clades of HAdV-F41 and other HAdV species (viz., A31, B3, C1, C2, C5, C2/6, and D56) in Japan. Eighteen stool samples were analyzed, five of which contained HAdV-F41, and 13 contained other HAdV species, as confirmed via PCR and sequencing. Although the GI Panel reliably detected all clades of HAdV-F41, it failed to detect any other species, highlighting its limited diagnostic utility beyond F40/41 serotypes. Considering the high false-negative rate for non-F40/41 species, integrating complementary diagnostic methods such as PCR is crucial for comprehensive HAdV detection. These findings underscore the limitations of the GI Panel in detecting non-F40/41 species, such as HAdV-C (commonly associated with pediatric gastroenteritis) and other species that are important in immunocompromised patients. Complementary diagnostic methods, such as PCR or immunochromatographic assays, are essential to ensure accurate HAdV detection, especially in vulnerable populations.

Molecular characterization of Cryptosporidium spp. in symptomatic children from Cape Verde.

Cryptosporidiosis has been identified as one of the leading causes of diarrhea and diarrhea-associated deaths in young children in sub-Saharan Africa. In Cape Verde, available data on human infections caused by Cryptosporidium spp. are limited. The aim of the present study was to analyze the molecular epidemiology of Cryptosporidium spp. in Cape Verde. Stool samples were obtained from patients on the Santiago and Sal islands (Cape Verde), 10/105 (9.5% CI: 4.7; 16.8) from the Santiago Island and 4/85 (4.7% CI: 1.3; 11.6) from the Sal Island presented Cryptosporidium sp., and were analyzed by nested-PCR of the SSU rRNA gene and nested-PCR of the 60 kDa glycoprotein gene for subtyping. The analyses were performed by nested-PCR of the SSU rRNA gene 18Sribosomal RNA gene, and nested-PCR of the 60 kDa glycoprotein gene for subtyping. Two species, Cryptosporidium hominis and Cryptosporidium felis, were identified. In Santiago Island, only C. hominis was detected, while both species were found in Sal Island. The C. hominis IfA14G1R5 subtype was the only identified in children from Santiago and Sal. Although the consumption of non-bottled water is a risk factor for infection by Cryptosporidium spp. on Santiago Island, none of the factors analysed (age, gender, clinical symptoms, source of drinking water, presence of animals at home, attending kindergarten or school, and having a bathroom at home) were significantly related to the presence of Cryptosporidium spp. in Sal Island. Cryptosporidium hominis is the most commonly identified species associated with cryptosporidiosis in the studied population, indicating a predominance of anthroponotic transmission. This study provides the first data on C. hominis subtyping in Cape Verde and the first report of C. felis in humans from this region, demonstrating the possibility of zoonotic transmission. The obtained results highlight the need for further molecular and epidemiological studies of Cryptosporidium spp. infections in human and animals from Cape Verde, in order to investigate the transmission dynamics of cryptosporidiosis and develop effective control strategies to prevent the spread of the disease.

Prevalence of Diarrhea Disease and Associated Factors Among Children Under 5 Years in Geshiyaro Project Implementation Sites in Ethiopia: A Cross-Sectional Study.

Globally, infectious diseases such as pneumonia, diarrhea, and malaria are the leading causes of death for children under 5. Diarrheal disease is a significant public health concern and causes the death of approximately 525,000 children under the age of 5 every year. In Ethiopia, studies revealed that the prevalence of diarrhea among children under 5 years is alarming. However, there has been a shortage of studies regarding the predictors of diarrheal disease in Geshiyaro project implementation sites in Ethiopia. Therefore, this study aimed to fill this gap. A community-based cross-sectional study was conducted from June to July 2023. A total of 2937 participants were enrolled in this investigation. Descriptive and multivariate logistic regression analysis was performed using STATA version 16. The 2-week prevalence of diarrhea among children under 5 years was 11.8%. The following factors were significantly associated (p < 0.05) with the occurrence of childhood diarrhea: sex of the child (AOR: 1.6; 95% CI, 1.17-2.19), child age in a month (AOR: 0.5; 95% CI, 0.26-0.94), drinking water service (AOR: 2.6; 95% CI, 1.33-5.25), knowledge on diarrhea prevention (AOR: 1.4; 95% CI, 1.05-1.98), open defecation practice (AOR: 1.9; 95% CI, 1.33-2.74), and rotavirus vaccination (AOR: 1.8; 95% CI, 1.20-2.56). This study identified several factors contributing to diarrhea. Besides, it also studied and showed a larger number of children who were not receiving basic vaccines. Therefore, the government and partner organizations should implement effective interventions to increase vaccine coverage and reduce diarrhea.

Epidemiology of viral gastroenteritis in children and genetic diversity of rotavirus strains in Kolkata, West Bengal after introduction of rotavirus vaccine.

Despite global rotavirus vaccination efforts, rotavirus remains a leading cause of childhood deaths from acute gastroenteritis. Post-vaccination studies in India, particularly in eastern India, have been limited, despite high prevalence of rotavirus in this region prior to vaccine introduction. This study was conducted to assess the impact of rotavirus vaccine on the epidemiology of rotavirus and other enteric viruses, as well as the changes in the diversity of rotavirus strains among children (≤5years) with acute gastroenteritis. A total of 877 stool samples from children hospitalized with acute diarrhea during 2022-2023, were screened for enteric viruses using multiplex PCR. Rotavirus positive samples were genotyped by sequencing and phylogenetic analysis of VP4 and VP7 genes were done. Out of 877 diarrheal cases, 47% tested positive for at least one enteropathogenic virus. Rotavirus was most prevalent (25.9%), followed by norovirus (11.4%), adenovirus-F (10.6%), and astrovirus (5.3%). Among mixed infections, rotavirus and norovirus co-infections were the most common. Rotavirus infection was highest in children aged 12-24months, while other enteric viruses were more common in the 6-24month age group. Clinical severity was higher among rotavirus-infected patients compared to those infected with other enteric viruses. The G3P[8] genotype of rotavirus predominated, with notable increase in G2P[4] and the detection of rare strains like G3P[6] and G11P[25]. G3P[6] was identified for the first time in this region showing Wa-like genome constellation. Unlike pre-vaccine period, G9 genotype was not detected. Mutations in antigenic epitope of circulating strains compared to vaccine strains may affect vaccine efficacy. The study highlights the persistent burden of childhood diarrhea despite rotavirus vaccination. Subtle alterations in the proportion of other enteric viruses and diversity of circulating rotavirus genotypes in the post-vaccination period were observed. Continuous long-term surveillance is required to evaluate the impact of vaccine in this region.

Comparative Effectiveness of Zinc Supplementation Combined with Probiotic Therapy Versus Zinc Alone in Reducing Acute Diarrhea Duration, Severity, and Recurrence Rates in Pediatric Populations: A Meta-Analysis

Background: Diarrhea remains a significant concern for children under five, particularly in developing countries. While zinc supplementation is a standard intervention for managing diarrheal diseases, the potential role of probiotics in restoring gut flora is gaining recognition. However, limited research has compared the efficacy of zinc alone versus zinc combined with probiotics. Objective: This meta-synthesis aimed to evaluate evidence from comparative studies to determine whether combining zinc with probiotics is superior to zinc alone in reducing the incidence, severity, and recurrence of diarrhea in children. Methods: A systematic review of 24 studies published in English, including 18 randomized controlled trials (RCTs) and six observational studies, was conducted following PRISMA guidelines. The focus was on children aged 0–12 years with acute diarrhea. Outcomes assessed included fecal and diarrheal frequency, episode duration, and relapse rates within three months. Standardized mean differences (SMDs) and odds ratios (ORs) were calculated for quantitative synthesis. Results: Combination therapy significantly reduced diarrhea duration by 1.25 standard deviations (p &lt; 0.001) and recurrence rates by a factor of 0.65 (p = 0.002) compared to zinc monotherapy. Notably, Saccharomyces boulardii and Lactobacillus rhamnosus GG exhibited the highest efficacy. Sensitivity analysis confirmed the robustness of these findings. Conclusion: Probiotics enhance the effectiveness of zinc in managing acute diarrhea in children. These findings support incorporating combination therapy into pediatric care globally, aligning with public health recommendations to improve outcomes for children

Hubungan Tingkat Pengetahuan Ibu tentang Cuci Tangan Pakai Sabun dengan Kejadian Diare di Wilayah Kerja Puskesmas Andalas Kota Padang

Diarrhea in children can lead to dehydration, hypovolemic shock, hypokalemia, seizures, malnutrition, and even death. The role of mothers in preventing diarrhea is crucial and depends on their knowledge of handwashing with soap (HWWS), as this knowledge is an important factor. This study aims to investigate the relationship between mothers' knowledge of HWWS and the incidence of diarrhea in toddlers in the working area of the Andalas Health Center in Padang City. This observational analytic study employs a cross-sectional design, with data collection conducted from September 2023 to May 2024. The study population consists of 438 mothers who bring their children to the KIA outpatient clinic, with a sample of 88 participants selected using accidental sampling. Data was collected through questionnaires and processed via editing, coding, entry, cleaning, and tabulation. Analysis utilized the Chi-square test (CI 95%). Preliminary results showed that 58 toddlers (65.9%) had diarrhea without dehydration, and a majority of mothers (53.4%) exhibited poor knowledge. A significant relationship was found between mothers' knowledge of HWWS and diarrhea incidence, with a p-value of (0.000). The conclusion is that higher levels of knowledge about HWWS are associated with a lower incidence of diarrhea in toddlers. Ongoing health education and outreach programs are recommended to improve community knowledge of HWWS.