Diarrheal Disease In Children Research Articles

Prevalence of Diarrheal Disease Among Under-Five Children in Worabe Town, Southern Ethiopia

<i>Background:</i> Globally, childhood diarrheal diseases accounts for 18% of childhood death. Diarrhea was most common among children of age 6-23 months. It is the second most common cause of child deaths next to pneumonia. <i>Objective:</i> To assess the determinants of diarrheal disease among under -five years of children in Worabe town Silte zone, Southern Ethiopia. <i>Methodology:</i> A community based cross-sectional study was conducted in 02 kebele, Worabe town from April to June 2018. Systematic random sampling method was used to get samples. Data was collected using questionnaire developed from different literatures. Data was analyzed by online bivariate analysis and p-value less than 0.05 was used to determine association. <i>Result:</i> A total of two hundred and twenty two respondents were included in the study. The prevalence of diarrhea among under-five children in 02 kebele was 69 (30.9%). From the total 69 under-five children affected by diarrhea, 32 (46.4%) were males and 37 (53.6%) were females. There was significant association between diarrhea morbidity and age of the child (X² = 16.42 (p<0.05)), children feeding status (on exclusive breast feeding and complementary feeding) (X² = 7.9009 (p<0.05)), hand washing during preparing food for children (X² = 49.55 (p<0.001)), and solid waste disposal (X² = 21.56 (p<0.001)). <i>Conclusion and Recommendation:</i> The prevalence of diarrhea among under-five children in Worabe town was high. There was significant association between risk of having diarrhea with age of the child, exclusive breast feeding and complementary feeding, hand washing when preparing food for children, and solid waste disposal. Health Extension workers, woreda health office, kebele administrators and responsible bodies should educate communities on exclusive breast feeding, hygienic practices while preparing food and feeding children. Further research should be done using qualitative methods.

Diarrheal correlates associated with enteric bacterial infections among children below five years in Murang'a County, Kenya.

IntroductionThe burden of childhood diarrheal disease has resulted in massive mortality and morbidity globally. Children below 5 years in sub-Saharan Africa are most implicated by diarrheal illnesses resulting in numerous medical consultations, admissions, and deaths despite the disease being easy to prevent and control. The study aimed to determine the correlates of enteric bacterial infection causing diarrhea.MethodsDuring the months of April-October 2017, 163 children below five years presenting with diarrhea were randomly selected in Murang'a and Muriranja's hospitals. Bacterial agents were identified and correlates of diarrhea determined. The study used a hospital-based cross-sectional study design. A standardized questionnaire was used to collect information from the guardian. Statistical analyses were performed using STATA v. 13.ResultsForty-nine children were infected with enteric pathogenic bacteria (Enterotoxigenic Escherichia coli, Enteropathogenic Escherichia coli, Enteroaggregative Escherichia coli, Salmonella, Shigella, and Vibrio species). Factors associated with infection by these bacteria among the 49 children were evaluated. Children between 0-12 months (OR 0.3, 95% CI 0.1-0.8), those fed exclusively on breast milk (OR 0.3, 95% CI 0.09-0.9) and children weighing 1-5 kilograms (OR 0.2, 95% CI 0.04-0.9) were less likely to be infected with these enteric pathogenic bacteria. Female participants (OR 1.8, 95% CI 1.1-3.4) were nearly twice likely to be infected with enteric pathogenic bacteria. Children who presented with watery stool (OR 0.4, 95% CI 0.2-0.9) or mucoid stool (OR 0.3, 95% CI 0.2-0.7) remained associated with enteric pathogenic bacterial infection but less likely to be infected compared to those who presented with watery-blood stained stools. Piped water (OR 0.01, 95% CI 0.01-0.4) was less associated with enteric bacterial infection than water stored in jerry-cans while storing water without a lid (OR 1.9, 95% CI 1.1-3.7) was more likely to lead to bacterial infection. Hand washing after toilet use (OR 1.6, 95% CI 1.1-2.7) was associated with enteric bacterial infection compared to hand washing before meal preparation.ConclusionSanitation, hygiene, nutritional and clinical factors were associated with enteric bacterial infections causing diarrhea among children below five years in the study area. Childhood diarrhea in Murang'a County is a major public health problem.

El Ni\xf1o-Southern oscillation and under-5 diarrhea in Botswana

Childhood diarrheal disease causes significant morbidity and mortality in low and middle-income countries, yet our ability to accurately predict diarrhea incidence remains limited. El Niño-Southern Oscillation (ENSO) has been shown to affect diarrhea dynamics in South America and Asia. However, understanding of its effects in sub-Saharan Africa, where the burden of under-5 diarrhea is high, remains inadequate. Here we investigate the connections between ENSO, local environmental conditions, and childhood diarrheal disease in Chobe District, Botswana. Our results demonstrate that La Niña conditions are associated with cooler temperatures, increased rainfall, and higher flooding in the Chobe region during the rainy season. In turn, La Niña conditions lagged 0–5 months are associated with higher than average incidence of under-5 diarrhea in the early rainy season. These findings demonstrate the potential use of ENSO as a long-lead prediction tool for childhood diarrhea in southern Africa.

The Knowledge and Attitude About Diarrhea of Mothers of Students Attending an Elementary School in a Suburban Area in Istanbul

Objective: Diarrhea is one of the main cause of morbidity and mortality among children age under 5 years in Turkey though diarrheal disease control program has been performing and death ratio due to diarrheal disease under 5 years has been decreasing year by year in Turkey. This study is undertaken to evaluate knowledge, attitude and practice of mothers about childhood diarrheal diseases in a suburban area.Methods: This descriptive study was carried out in a primary school in a suburban area of İstanbul. One hundred and forty four mothers of children included accepted in the study with response rate of 85%. A questionnaire form was applied for data collection. Epi-Info programme was used for statistical analysis. In addition to the descriptive statistical methods, for the comparison of qualitative data a chi-square test was used .Results: In our study, the percentage of mothers who could define diarrhea correctly was 40%. Abdominal pain and watery defecation were the main signs which the mothers understand their children have diarrhea. Most of the mothers indicated that microbes as the cause of diarrhea. One of every two mothers stated that they would take their children to the doctor as they notice their child has diarrhea. Among the homemade treatments we asked, Potatoes cooked in boiling water and banana were the most frequent answers. Only one of mothers mentioned about using drugs at home for diarrhea and percentage of hearing about ORS was 21.5%. Eleven percent of mothers mentioned they believed to decrease liquid intake would be an effective practice in the treatment of diarrhea. Education level was very influential about knowledge and attitude about diarrheal disease. Conclusion: This study reveals the importance of continuous health education of mothers as well as the need for raising their status especially schooling in communities. Circulating of correct information is also important as well as educating population.

Ensemble forecast and parameter inference of childhood diarrhea in Chobe District, Botswana

Diarrheal disease is the second largest cause of mortality in children younger than 5, yet our ability to anticipate and prepare for outbreaks remains limited. Here, we develop and test an epidemiological forecast model for childhood diarrheal disease in Chobe District, Botswana. Our prediction system uses a compartmental susceptible-infected-recovered-susceptible (SIRS) model coupled with Bayesian data assimilation to infer relevant epidemiological parameter values and generate retrospective forecasts. Our model inferred two system parameters and accurately simulated weekly observed diarrhea cases from 2007-2017. Accurate retrospective forecasts for diarrhea outbreaks were generated up to six weeks before the predicted peak of the outbreak, and accuracy increased over the progression of the outbreak. Many forecasts generated by our model system were more accurate than predictions made using only historical data trends. Accurate real-time forecasts have the potential to increase local preparedness for coming outbreaks through improved resource allocation and healthcare worker distribution.

Environmental factors affecting childhood diarrheal disease among under-five children in Jamma district, South Wello zone, Northeast Ethiopia

BackgroundGlobally, diarrhea is the leading cause of morbidity and mortality among less than 5 years old children and it contributes to the deaths of approximately one million children every year. In Ethiopia, diarrhea is the second cause of under-five mortality and morbidity. However, in the study area, studies were limited. Therefore, this study has assessed the prevalence of diarrhea and associated factors among < 5 years of age in Jamma district, Northeast Ethiopia.MethodsA community-based cross-sectional study was conducted from August 15 to September 15, 2017, in Jamma district, South Wello zone, northeast Ethiopia. A Systematic random sampling technique was used to select 614 households and a pretested structured questionnaire was used to collect the data. A multivariable logistic regression analysis was used to investigate factors associated with diarrheal disease. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) for variables with P-value < 0.05 was used to show statistically significant association.ResultsIn this study, the prevalence of diarrhea among under-five children was 23.1% (95% CI: (19.4, 26.5). Child’s age 6 to 23 months [AOR: 2.46, 95% CI: (1.49, 4.05)], Living in rural area [AOR: 2.75, 95% CI: (1.33,5.66)], absence of latrine [AOR: 4.80, 95% CI: (2.39,9.60)], absence of handwashing facility [AOR: 2.45, 95% CI: (1.53,3.93], unprotected drinking water source [AOR:2.68, 95% CI: (1.54,4.68)], and Improper waste disposal practices [AOR:3.86, 95% CI: (2.38,6.26)] were associated with diarrhea disease.ConclusionThere was a high prevalence of diarrheal disease among children in the study area. Child age, rural residence, availability of latrine and handwashing facility, source of drinking water, and improper waste disposal were notably associated with childhood diarrheal disease. Therefore, improving handwashing practices and pure water supply, proper waste disposal including the availability of latrines would minimize the burden of diarrheal disease.

Prevalence of diarrheal diseases and associated factors among under-five children in Dale District, Sidama zone, Southern Ethiopia: a cross-sectional study

BackgroundGlobally childhood diarrhoeal diseases continue to be the second leading cause of death, while in Ethiopia it kills half-million under-five children each year. Sanitation, unsafe water and personal hygiene are responsible for 90% of the occurrence. Thus, this study aimed to assess the prevalence and associated factors of diarrheal diseases among under-five children in Dale District, Sidama Zone, Southern Ethiopia.MethodsA community-based cross-sectional study was conducted. A face to face interview using a structured questionnaire and observation checklist was used. A total of 546 households with at least one under-five children were selected using simple random sampling techniques. The data entry and cleaning were performed using Epidemiological information software (EPI Info) 3.5.1 and then exported to Statistical Package for Social Science (SPSS) version 16.0 for analysis. Frequencies and proportions were computed as descriptive analysis. Initially using bivariate analysis a crude association between the independent and dependent variables was investigated. Then, those variables with p-value ≤0.25 were included in multivariable analysis to determine the predictor variables for the outcome variables. Finally, further analyses were carried out using multivariable analysis at a significance level of p-value ≤0.05.ResultsA total of 537 children under the age of 5 years were included. The 2 weeks prevalence of diarrhea among children under the age of 5 years was 13.6, 95% CI (10.7, 16.5%). Educational level [AOR: 3.97, 95% CI (1.60, 8.916)], age of indexed child [AOR: 12.18, 95% CI (1.78, 83.30)], nutritional status [AOR: 6.41, 95% CI (2.47, 16.77.)], hand washing method [AOR, 3.10, 95% CI (1.10, 8.67)], hand washing after latrine [AOR: 2.73, 95% CI (1.05, 6.56)], refuse disposal method [AOR, 3.23, 95% CI (1.37, 7.60)] and housing floor material [AOR: 3.22, 95% CI (1.16, 8.91] were significantly associated with the occurrence of childhood diarrheal diseases.ConclusionChildhood diarrhea remains the commonest health problem in the study area. The findings have important policy implications for childhood diarrhoeal disease intervention programs. Thus, activities focusing on proper handwashing techniques at all appropriate times, proper refuse disposal, improving nutrition and better childcare also highly recommended.

Electrolyte disturbance in rotaviral diarrhea and other acute diarrheal diseases in children under 5 years

Background: Acute diarrheal disease is one of the most common cause of mortality and morbidity in under 5 children. Rotavirus is one of the important cause of diarrhea in under 5. This study was done to know the electrolyte disturbance in under 5 children with diarrhea.Methods: A prospective observational study was conducted in Masonic Medical Centre for Children, Coimbatore on children aged less than 5 years with acute diarrhea with moderate and severe dehydration.Results: Total 220 children are included in study, among them 66(58.9%) had rotavirus infection. Among 220 cases of diarrhea 14.09% (31/220) had hypernatremia, 2.72% (6/220) had hyponatremia, 4.54% (10/220) had hyperkalemia and 9.09% (20/220) had hypokalemia. Among 66 cases of rotavirus diarrhea, 27.27% (18/66) had hypernatremia, 4.5% (3/66) had hyponatremia and 25.75% (17/66) had hypokalemia.Conclusions: Hypernatremia is the most common electrolyte disturbance in acute diarrheal diseases and most frequently seen in rotavirus diarrhea. In most of the situation, there is unavailability of laboratory or time lag in obtaining reports. Hence prediction of electrolyte disturbance and management is more important in diarrheal disease.

Nutritional Management in Child Diarrhea: An Evaluation of Awareness in General Population from Dobrogea Region

Abstract Diet has a major role in the treatment of acute diarrhea in children, along with a minimal drug therapy, but not necessarily using antimicrobials. Children can successfully pas a diarrheal episode with diet and symptomatic treatment. It is important to know how to properly choose foods to introduce in ill children diet. There is a lack of statistical data in our region regarding dietary treatment in child diarrhea. This study was realized by completing a questionnaire regrading nutritional management in children with diarrhea. 110 persons from Dobrogea region completed this questionnaire. We analyzes demographic and clinical issues, people preferences in choosing different foods appropriate to this pathology and minimal knowledge about medication. Our results evidenced that general population knowledges regarding nutritional management of acute diarrheal disease in children and infants are appreciable. Foods like rice, toast, applesauce/baked apple, mint/figs/bilberry leaves teas, vegetables soup, bananas were found among people preferences, proving appropriate information. Antimicrobial drugs misusage is not reported, 83 out of 110 people avoiding them.

Spatial pattern and determinants of diarrhoea morbidity among under-five-aged children in Lagos State, Nigeria

ABSTRACT Diarrhoeal diseases are major causes of morbidity and mortality among under-fived-aged children globally. In Nigeria, 10% of under-five deaths in 2016 were due to diarrhoea. The diseases were responsible for 9% of childhood deaths in Lagos State in 2011. This study examined the spatial pattern and sociodemographic, environmental, hygiene and behavioural factors associated with diarrhoeal morbidity in Lagos State. Data on reported cases of childhood diarrhoeal diseases in government hospitals was analysed using spatial statistical techniques. Data from 2013 Nigerian Demographic Health Survey was used to determine diarrhoeal disease risk factors through multivariate logistic regression analysis. Lagos Island recorded the highest (34.2%) number of cases, followed by Agege (16.6%) and Somolu (13.2%) local government areas (LGAs). The spatial distribution of diarrhoeal cases is random. The prevalence of diarrhoeal diseases during the two-week period before the survey was 7.5%. Factors significantly associated with diarrhoeal disease morbidity were child’s age, mother’s age, religion, paternal education and occupation, mother’s occupation, source of drinking water, floor material, mixed feeding and mothers not wanting the last child. These findings highlight the need to strengthen the provision of safe water supply. Educational programmes that emphasise treatment of drinking water, safe hygiene and sanitation practices should be implemented.

Use of earth observation-derived hydrometeorological variables to model and predict rotavirus infection (MAL-ED): a multisite cohort study

SummaryBackgroundClimate change threatens to undermine recent progress in reducing global deaths from diarrhoeal disease in children. However, the scarcity of evidence about how individual environmental factors affect transmission of specific pathogens makes prediction of trends under different climate scenarios challenging. We aimed to model associations between daily estimates of a suite of hydrometeorological variables and rotavirus infection status ascertained through community-based surveillance.MethodsFor this analysis of multisite cohort data, rotavirus infection status was ascertained through community-based surveillance of infants in the eight-site MAL-ED cohort study, and matched by date with earth observation estimates of nine hydrometeorological variables from the Global Land Data Assimilation System: daily total precipitation volume (mm), daily total surface runoff (mm), surface pressure (mbar), wind speed (m/s), relative humidity (%), soil moisture (%), solar radiation (W/m2), specific humidity (kg/kg), and average daily temperatures (°C). Lag relationships, independent effects, and interactions were characterised by use of modified Poisson models and compared with and without adjustment for seasonality and between-site variation. Final models were created with stepwise selection of main effects and interactions and their validity assessed by excluding each site in turn and calculating Tjur's Coefficients of Determination.FindingsAll nine hydrometeorological variables were significantly associated with rotavirus infection after adjusting for seasonality and between-site variation over multiple consecutive or non-consecutive lags, showing complex, often non-linear associations that differed by symptom status and showed considerable mutual interaction. The final models explained 5·9% to 6·2% of the variability in rotavirus infection in the pooled data and their predictions explained between 0·0% and 14·1% of the variability at individual study sites.InterpretationThese results suggest that the effect of climate on rotavirus transmission was mediated by four independent mechanisms: waterborne dispersal, airborne dispersal, virus survival on soil and surfaces, and host factors. Earth observation data products available at a global scale and at subdaily resolution can be combined with longitudinal surveillance data to test hypotheses about routes and drivers of transmission but showed little potential for making predictions in this setting.FundingBill & Melinda Gates Foundation; Foundation for the National Institutes of Health, National Institutes of Health, Fogarty International Center; Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins School of Medicine; and NASA's Group on Earth Observations Work Programme.

Scale-up Zinc Sulphate Use for Management of Childhood Diarrheal Diseases in Zambia Through Community Health Workers and Women’s Support Groups

Scale-up Zinc Sulphate Use for Management of Childhood Diarrheal Diseases in Zambia Through Community Health Workers and Women’s Support Groups

A study of self-reported handwashing practices of caregivers in relation to acute respiratory infections and gastroenteritis in infants in a peri-urban community in KwaZulu-Natal Province, South Africa

Background. Handwashing is a recognised cost-effective intervention for the prevention of common childhood infections, including pneumonia and diarrhoeal disease. Globally, handwashing practices may be poor and little is known about handwashing practices in South Africa. Objectives. To describe and compare handwashing practises of caregivers whose infants are admitted with acute gastroenteritis and acute lower respiratory tract infection with those of healthy infants who are attending primary healthcare clinics for routine immunisation. Methods. A cross-sectional study of self-reported handwashing practices was conducted among caregivers of infants from the Vulindlela area, Pietermaritzburg. Respondents were interviewed regarding household structure, services and handwashing practices. Results. During the 3-month study period, 137 respondents were interviewed. Of these, 41 (30%) had infants with pneumonia, 41 (30%) with diarrhoea and 55 (40%) had healthy infants. A high rate of handwashing with soap and water (81.8%) was found in this study, with 58.4% of the respondents using running rather than stagnant water. Logistic regression identified some variables associated with higher odds of having a healthy infant, namely: a monthly household income >ZAR2 000 (odds ratio (OR) 4.74; 95% confidence interval (CI) 1.99 - 11.25); washing hands with soap and running water (OR 3.88; 95% CI 1.55 - 9.76); washing hands before eating (OR 7.41; 95% CI 0.79 - 68.76), and washing hands after household chores (OR 9.24; 95% CI 1.85 - 46.25). Conclusion. A higher than anticipated number of participants washed their hands with soap and running water and at critical moments.

PO 8444 CHARACTERISATION OF PATHOGENS CAUSING DIARRHOEA IN CHILDREN UNDER FIVE IN LAMBARÉNÉ, GABON

BackgroundDiarrhoeal disease remains the second leading cause of death in children under five years, being associated with about 525,000 deaths every year. The most common pathogens worldwide are Shigella spp/EIEC, rotavirus, adenovirus 40/41, ST-ETEC and Cryptosporidium spp. Public health interventions rely on estimates of pathogen-specific burden for prioritisation. Sadly, comprehensive data on the aetiology of diarrhoea in children is lacking for Gabon. This study aimed to identify the spectrum of pathogens found in Lambaréné, Gabon and provide baseline data on their prevalence, needed for implementation of effective control measures.MethodsA cross-sectional study was conducted at Albert Schweitzer and Georges Rawiri Regional hospitals in Lambaréné from February 2017 to February 2018. A consecutive sample of children under 5 year old with diarrhoea or a history of diarrhoea within the previous three days were prospectively studied. A single stool sample was collected from each study participant and processed using commercial rapid immunoassays to detect antigens of rotavirus, adenovirus, and Cryptosporidium spp. Multiplex PCR was used for Cryptosporidium spp., Giardia lamblia and Cyclospora cayetanensis detection, and characterisation of E. coli strains.ResultsOut of 188 participants who provided stool samples, one or more pathogens could be detected in 34.6% of the cases. The most prevalent parasites were Giardia lamblia (14.9%), Cryptosporidium spp. (11.7%), and Cyclospora cayetanensis (2.7%). Enteric viruses also were identified in these children: 10.6% and 1.6% of rotavirus and adenovirus, respectively. Multiple pathogens were detected in 5.3% of samples.ConclusionThis analysis of the causes of diarrhoea in children under 5 years of age in our setting showed three main pathogens: Giardia lamblia, Cryptosporidium spp. and rotavirus. Our study confirms major agents of acute diarrhoeal diseases in children, highlights research needs (Cryptosporidium) and supports the introduction of new tools such as the implementation of the rotavirus vaccine in the national immunisation programme.

Enterotoxigenic Escherichia Coli Toxins and Colonization Factors Among Zambian Children Presenting with Moderate to Severe Diarrhea to Selected Health Facilities

Enterotoxigenic Escherichia Coli (ETEC) is an important cause for diarrheal disease in children and travelers globally. Epidemiological data on the distribution of strains of ETEC and associated colonization factors (CFs) is important for evaluation of candidate vaccines. We used conventional PCR and quantitative PCR to screen for toxins and CFs using DNA extracted from stool samples which tested positive for ETEC using the Luminex GPP panel collected from children presenting with moderate to severe diarrhea at selected health facilities in Lusaka. 49/106 (46.2%) were positive for at least one toxin (i.e. LT/STh/STp), ST was 18 (17%) [STh 16(15%) and STp 2 (~2%)], and LT 16(15%). The most frequent CF detected was CS6 with 6/49 (12.2%), followed by CS2, CS3 and CS7 with 2/49 (4.1%) each. CS6 was common across all toxin combinations (LT only, STh only and a combination of LT/STh) while CS2, CS3, CS7 were identified in both LT and LT/STh strains respectively. The mean age of children with detected toxin or CFs was 15.4 months (95% CI: 12.2, 18.7). Our results offer an insight into relevant CFs in ETEC diarrhea in Zambia and that Luminex™ platform is not as specific as ordinary and quantitative PCR for ETEC detection.

Prescription Pattern for Acute Diarrheal Disease in Children Between 6 months to 5 years

Prescription Pattern for Acute Diarrheal Disease in Children Between 6 months to 5 years

Socioeconomic Factors Associated with Diarrhea among Under-Five Children in Manado Coastal Area, Indonesia.

Background:Diarrhea is a condition where individuals experience defecation as much as 3 or more per day with a soft consistency. Diarrhea in children is one of the environmentally-based diseases, and Manado is one of the cities faced with this environmental lead diarrhea problems. The purpose of this study is to analyze the influence of socioeconomic factors on the occurrence of diarrhea among under-five children in the coastal area of Manado city.Materials and Methods:A cross-sectional study design was conducted in August 2017. The numbers of respondents were a total of 120 mothers or caregivers with children under five who suffered from diarrhea in the coastal area of Manado. The respondent candidates were selected from the community health center's records of the diarrhea program and further selected by the inclusion/exclusion criteria. The characteristics of mothers and family income were used as indicators of socioeconomic factors. All of the respondents were questioned about the occurrence of their child's diarrhea that they had experienced in the previous 6 months. A structured and well-designed questionnaire was used to obtain data, which were related to sociodemographic, economic, and diarrhea. Generalized structured component analysis in GeSCA software was applied for data analysis.Results:The findings of this study showed significant influence from socioeconomic factors on diarrhea incidence in under-five children (critical ratio = 2.74). In other words, as socioeconomic factors improve, the incidence of diarrhea decreases (B = −0.246). The characteristics of the mother are the indicator of the highest influence (loading value = 0.846).Conclusions:This study identified that the socioeconomic factors are influencing the diarrhea incidence among children under five in the coastal area of Manado city. Thus, to minimize a childhood diarrheal disease, socioeconomic factors are considered when promoting health and community empowerment among the coastal communities of Manado city.

Multiple Introductions and Antigenic Mismatch with Vaccines May Contribute to Increased Predominance of G12P[8] Rotaviruses in the United States.

Rotavirus is the leading global cause of diarrheal mortality for unvaccinated children under 5 years of age. The outer capsid of rotavirus virions consists of VP7 and VP4 proteins, which determine viral G and P types, respectively, and are primary targets of neutralizing antibodies. Successful vaccination depends upon generating broadly protective immune responses following exposure to rotaviruses presenting a limited number of G- and P-type antigens. Vaccine introduction resulted in decreased rotavirus disease burden but also coincided with the emergence of uncommon G and P genotypes, including G12. To gain insight into the recent predominance of G12P[8] rotaviruses in the United States, we evaluated 142 complete rotavirus genome sequences and metadata from 151 clinical specimens collected in Nashville, TN, from 2011 to 2013 through the New Vaccine Surveillance Network. Circulating G12P[8] strains were found to share many segments with other locally circulating strains but to have distinct constellations. Phylogenetic analyses of G12 sequences and their geographic sources provided evidence for multiple separate introductions of G12 segments into Nashville, TN. Antigenic epitopes of VP7 proteins of G12P[8] strains circulating in Nashville, TN, differ markedly from those of vaccine strains. Fully vaccinated children were found to be infected with G12P[8] strains more frequently than with other rotavirus genotypes. Multiple introductions and significant antigenic mismatch may in part explain the recent predominance of G12P[8] strains in the United States and emphasize the need for continued monitoring of rotavirus vaccine efficacy against emerging rotavirus genotypes.IMPORTANCE Rotavirus is an important cause of childhood diarrheal disease worldwide. Two immunodominant proteins of rotavirus, VP7 and VP4, determine G and P genotypes, respectively. Recently, G12P[8] rotaviruses have become increasingly predominant. By analyzing rotavirus genome sequences from stool specimens obtained in Nashville, TN, from 2011 to 2013 and globally circulating rotaviruses, we found evidence of multiple introductions of G12 genes into the area. Based on sequence polymorphisms, VP7 proteins of these viruses are predicted to present themselves to the immune system very differently than those of vaccine strains. Many of the sick children with G12P[8] rotavirus in their diarrheal stools also were fully vaccinated. Our findings emphasize the need for continued monitoring of circulating rotaviruses and the effectiveness of the vaccines against strains with emerging G and P genotypes.

Watersheds in planetary health research and action

Watersheds in planetary health research and action

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN DIARE PADA ANAK USIA 12-36 BULAN DI DESA CIJORO PASIR WILAYAH KERJA PUSKESMAS RANGKASBITUNG KABUPATEN LEBAK PROVINSI BANTEN TAHUN 2017

Child health problems is one of the main problems in the field of health, until now diarrhoeal disease is still a global health problem, especially in developing countries. From year to year diarrhea remains one of the diseases that cause malnutrition and mortality in children. The incidence of childhood diarrhoeal disease in Cijoro Pasir Village Lebak Regency of Banten Province amounted to 182 (18%) toddlers. The purpose of this study is to determine what factors are associated with the incidence of diarrhea. The type of research is descriptive quantitative research with cross sectional approach. The population in the study was 1010 people and only 94 toddlers were sampled by accidental sampling.Univariate analysis showed that most of the toddlers had diarrhea (53,2%), with low birth weight (55,3%), less nutrition status (51,1%), non-exclusive breastfeeding (54.3%) and incomplete primary immunization (55.3%). Conclusion: There was a relationship between birth weight (p = 0.044), nutritional status (p = 0,000), exclusive breastfeeding (p = 0.026), and primary immunization (p = 0.015) with diarrhea occurrence in toddlers. Toddlers with less nutritional status is the most dominant variable having diarrhea chance with OR = 6,857. Suggestion: To prevent diarrhea occurrence in toddlers, puskesmas could provide the information or giving counseling and education about nutrition status, monitoring and measuring nutrition status and making improvement effort against diarrhea risk factors in toddlers.