Diarrheal Disease Control Research Articles

A survey of fecal virome and bacterial community of the diarrhea-affected cattle in northeast China reveals novel disease-associated ecological risk factors.

Limited information on the virome and bacterial community hampers our ability to discern systemic ecological risk factors that cause cattle diarrhea, which has become a pressing issue in the control of disease. A total of 110 viruses, 1,011 bacterial genera, and 322 complete viral genomes were identified from 70 sequencing samples mixed with 1,120 fecal samples from 58 farms in northeast China. For the diarrheic samples, the identified virome and bacterial community varied in terms of composition, abundance, diversity, and geographic distribution in relation to different disease-associated ecological factors; the abundance of identified viruses and bacteria was significantly correlated with the host factors of clinical status, cattle type, and age, and with environmental factors such as aquaculture model and geographical location (P < 0.05); a significant interaction occurred between viruses and viruses, bacteria and bacteria, as well as between bacteria and viruses (P < 0.05). The abundance of SMB53, Butyrivibrio, Facklamia, Trichococcus, and Turicibacter was significantly correlated with the health status of cattle (P < 0.05). The proportion of BRV, BCoV, BKV, BToV, BoNoV, BoNeV, BoAstV, BEV, BoPV, and BVDV in 1,120 fecal samples varied from 1.61% to 12.05%. A series of significant correlations were observed between the prevalence of individual viruses and the disease-associated ecological factors. A genome-based phylogenetic analysis revealed high variability of 10 bovine enteric viruses. The bovine hungarovirus was initially identified in both dairy and beef cattle in China. This study elucidates the fecal virome and bacterial community signatures of cattle affected by diarrhea, and reveals novel disease-associated ecological risk factors, including cattle type, cattle age, aquaculture model, and geographical location.IMPORTANCEThe lack of data on the virome and bacterial community restricts our capability to recognize ecological risk factors for bovine diarrhea disease, thereby hindering our overall comprehension of the disease's cause. In this study, we found that, for the diarrheal samples, the identified virome and bacterial community varied in terms of composition, abundance, diversity, configuration, and geographic distribution in relation to different disease-associated ecological factors. A series of significant correlations were observed between the prevalence of individual viruses and the disease-associated ecological factors. Our study aims to uncover novel ecological risk factors of bovine diarrheal disease by examining the pathogenic microorganism-host-environment disease ecology, thereby providing a new perspective on the control of bovine diarrheal diseases.

Revisiting transformative WASH: measuring impact

Revisiting transformative WASH: measuring impact

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.

Comparative analysis of fecal microbiota composition diversity in Tibetan piglets suffering from diarrheagenic Escherichia coli (DEC)

This study was ascertained to investigate the adverse effects of pathogenic E. coli on gut microbiota of Tibetan piglets with history of yellow and white dysentery. For this purpose, a total of 18 fecal samples were collected from infected and healthy Tibetan piglets for 16S rRNA gene amplification and sequencing of V3–V4 region. Results showed that Firmicutes, Bacteroidia Fusobacteriota, Proteobacteria and Actinobacteriota were the predominant bacteria in Tibetan piglets at the level of phylum classification. Results on classification at family level showed that Lactobacillus, Bacteroidota, Fusobacteriota and Enterobacteriaceae were the dominant bacteria. Results on classification of bacteria at phylum level compared with normal piglets indicated that Bacteroidota, Actinobacteriota, Euryarchaota and Spirochaetota in fecal microbial community in Tibetan piglets showing yellow dysenteric and diarrhea group were significantly decreased (P ≤ 0.05). Compared with the feces of healthy Tibetan piglets, the abundance of Escherichia-Shigella, Lactobacillus and Enterococcus increased significantly in feces of Tibetan piglets having yellow dysentery and white dysentery. Moreover, results exhibited that the Proteobacteria and Fusobacteriota were significantly increased (P ≤ 0.05) suggesting dominant microbial community. Results revealed that E. coli induced different pathological alterations in intestine including damage to intestinal epithelial cells, infiltration of inflammatory cells, presence of red blood cells in spaces of tissues, hemorrhages and necrosis of intestinal villi in piglets with history of yellow dysentery. This study for the first time reported the composition, characteristics, and differences of the fecal microflora diversity of Tibetan piglets with yellow and white dysentery in Qinghai-Tibet Plateau, which can provide a suitable support for effective control of diarrhoeal disease in these animals.

Everything is not on track in management of diarrhoea in under-five children: Evidence from rural area of India.

Context:Diarrhea is one of the leading causes of death and morbidity in under-five children. Effective management can significantly influence survival of children with diarrhea.Objectives:This study was carried out to assess extent of diarrhea, its source of treatment, and type of therapy.Settings and Design:This snapshot study was conducted in rural setting of India.Methods and Material:This study was conducted on 217 under-five children selected through multistage sampling procedure.Statistical analysis used:Statistical association of diarrhea with age and gender of children was established by computing Chi-square.Results:Period prevalence (Recall period 2 weeks of visit) of diarrhea in rural under-five children was 35.9% (95%C.I. 29.3–42.2%). Highest prevalence in age group 0–12 months (47.8%) and lowest in 49–59 months (18.2%). Number of episode per child is 1.08. Diarrhea was watery in 69.4%. Quacks were treatment provider for 36.4% cases. In 17.6% episodes, no treatment was taken. Only 9.4% episodes were treated in government facilities. For the treatment of diarrhea, antibiotic was used in 71.8% cases, ORS use was 33.3% cases, and zinc was used 21.8% of diarrhea episodes.Conclusions:Diarrhea is a significant problem in under-five children from a rural area of India. In spite of existence of National Program for Control of Diarrheal Diseases (NPCDD) since four decades, management of diarrhea is not on track. Focusing on primary care provision to under-five children can help in bringing the management of diarrhea on track.

The cholera endemic in the Democratique republic of Congo: The last decades

Background: Between 2010 and 2017, the DRC reported 25% of all cholera cases in Africa. Despite the multisectoral plan for cholera implemented since 2008, the country faced a major epidemic in 2017, being the second most extended one after the Goma-epidemic following Rwandan genocide. This study aim describe spatio-temporally the epidemics from the last 20 years and redefine the National Program for Cholera Elimination and Prevention of other Diarrheal Diseases. Methods and materials: This is a descriptive study of cholera epidemics in the DRC from week 1, 2000 to week 41, 2019 based on cholera surveillance databases of the Ministry of Health coordinating data from the different cholera treatment facilities. Using time-series and mapping the spatio-temporal dynamics of the epidemics were studied. Various strategies, their limits and implementations, put in place by the Ministry of Health, were comparatively analyzed while social-community interactions were promoted Results: From week 1, 2000 to week 41, 2019 a total of 481012 cases and 11897 deaths were reported (Case fatality rate 2.5%). The 2017epidemy recorded, 54779 cases and 1157 deaths (case fatality rate 2%). In 2017, only 772 stool samples were taken of which 19% returned positive for Vibrio cholerae O1 Ogawa. During this epidemic 24 of the 26 provinces of the DRC were affected by cholera. Given the impactful situation in 2017, it was decided to bring the Diarrheal Diseases Control Program under the National Program for the Elimination of Cholera and the Control of Other Diarrheal Diseases (PNECHOL- MD), for a better coordination of activities. The emergency Water-Sanitation-Hygiene (WASH)-strategy developed by the PNECHOL-MD included massive community involvement combined with good case management in the treatment centers which with immunization helped to control this epidemic. The laboratory and microbiology aspects however should be improved. Conclusion: Specifically the extended-2017 outbreak showed the necessity of integrating the different analytical levels and actors in order to effectively master the epidemiology and infectiology. The input of social and human behavioural aspects seems essential while new and/or emerging microbiological approaches like phages- and vaccine- research are warranted especially in the light of increasing antibiotic resistances

Control of Diarrhoeal Diseases in Children in Kericho West Sub-County, Kenya

Acute diarrheal disease among children aged less than five years remains a significant cause of morbidity and mortality worldwide. Severe infectious diarrhoea in children occurs most frequently under circumstances of poor environmental sanitation and hygiene, inadequate water supplies and poverty. In Kenya, the control of diarrhoea disease including the promotion of breastfeeding, oral rehydration therapy and specific health education is a part of national strategies aimed to improve the quality of life and reduce the burdens caused by diseases. In Kericho West Sub-County, diseases associated with contaminated water, sanitation and poor hygiene tend to affect more in rural households. Nearly half of the children under five years suffer from related diarrhoeal diseases, thereby causing major concern to the entire local population. Therefore, this study aimed to determine the factors that lead to diarrhoeal diseases, to investigate the hygienic condition and source of water supply in the area, to examine the practices of the breastfeeding mothers and to determine the measures the county government has put in place to improve the health situation of the children. The study was grounded on two theories proposed by self-efficacy theory by Bandura. The study was carried out using a structured questionnaire as a quantitative tool while the interview guide was the qualitative tool for data collection. The location of the study was in Kericho West sub-county. The study concluded that there was a relationship between childhood diarrhoea, water, sanitation and hygiene in the study area. The study also found that there was a substantial positive association between breastfeeding and diarrhoea in children aged less than five years. From the findings, 83% used water with soap, while 41.3% obtained food from street vendors. The study recommends that the government facilities and private facilities should start sensitizing the Kericho West sub-county residents on the importance of maintaining hygiene through the use of clean and treated water as well as washing their utensils with hot water and soap. The government health care workers at the government facilities should counsel all the mothers and educate them on all the waterborne diseases as this would be the best option to control the communicable diseases in the County.

Knowledge, Attitudes and Perception of Caretakers towards Control and Preventive Practices of Malnutrition and Diarrhoeal Diseases in Under-Five Children in Pemba Districts of Zambia

Knowledge, Attitudes and Perception of Caretakers towards Control and Preventive Practices of Malnutrition and Diarrhoeal Diseases in Under-Five Children in Pemba Districts of Zambia

Antibiotic resistance and virulence patterns of pathogenic Escherichia coli strains associated with acute gastroenteritis among children in Qatar

BackgroundThe treatment of Enterobacteriaceae family including diarrheagenic E. coli (DEC) has been increasingly complicated due to the emergence of resistant strains. Here we report on the phenotypic resistance profiles and ESBL genotype and virulence profiles of Enteroaggregative E. coli (EAEC) and Enteropathogenic E. coli (EPEC) isolated from children hospitalized with acute gastroenteritis in Qatar (AGE).ResultsE. coli were isolated and characterized from 76 diarrheagenic stool positive samples, collected from hospitalized children less than 10 years old. Isolates were tested for antibiotic susceptibility against eighteen clinically relevant antibiotics using E-test method. Conventional PCR was performed to detect genes encoding ESBL and virulence factors. Chi-square test was performed to compare the individual antibiotic resistance between EPEC and EAEC.A significant percentage (73.7%) of isolates were resistant to at least one antibiotic. Overall, high resistance (70%) was reported to the first-line antibiotics such as ampicillin, tetracycline (46.4%), and sulfamethoxazole-trimethoprim (42.9%). Further, 39.5% of the isolates were multidrug resistant (MDR), with 22.4% being ESBL producers. On the other hand, all isolates were susceptible to carbapenem, fosfomycin, amikacin and colistin. The incidences of resistance to the 18 antibiotics between EPEC and EAEC were not significantly different by Pearson chi -square test (P > 0.05). Genetic analysis revealed that 88.23% of ESBL production was blaCTX-M-G1 (blaCTX-M-15, blaCTX-M-3) - encoded. Several different combinations of virulence markers were observed, however, there was no specific trend among the isolates apart from absence of the bundle-forming pilus (bfpA) gene, which encodes the type IV fimbriae in EPEC adherence factor (EAF) plasmid (pEAF), among all EPEC (atypical). 15% of the EAEC strains were positive for a combination of astA, aap & capU, while 10% were positive for three different combinations. The aap, aatA, capU and aggR virulence genes showed the highest frequency of 65, 60, 55 and 55% respectively. Others genes, east, astA, and aai, showed frequencies of 35, 30 and 20% respectively.ConclusionsAtypical EPEC and EAEC were the primary etiological agents of diarrhea in children among DEC pathotypes. Our results indicated high rate of antimicrobial resistance pattern of DEC strains, which necessities the development of regulatory programs and reporting systems of antimicrobial resistance in DEC and other AGE-associated bacteria to insure effective control of diarrheal diseases. Results from this study demand a further research on identifying the phenotypic and genotypic profiles of more DEC pathotypes in various clinical samples.

Barriers and Enabling Factors Associated with the Implementation of Household Solar Water Disinfection: A Qualitative Study in Northwest Ethiopia.

Household water treatment including solar disinfection (SODIS) is recognized worldwide as an important intervention for prevention and control of diarrheal and other waterborne diseases. However, in Ethiopia's countryside, SODIS is not being practiced. Therefore, the objective of this qualitative study conducted in villages of Dabat district in northwest Ethiopia was to explore barriers to and enabling factors for consistent and wider implementation of SODIS. This phenomenological study design included four focus group discussions with 25 parents of children younger than 5 years and interviews with four key informants to elicit their experiences and opinions. ATLAS.ti 8.0 software (GmbH, Berlin, Germany) was used for data organization, and the content was analyzed thematically. Enabling factors were categorized into four themes, such as supportive values for SODIS (positive attitude, advantage of SODIS, and cultural acceptance of SODIS), consistent use of SODIS (community's interest, health education, availability of bright sunlight, and simplicity of the method), participation of family and community in daily implementation of the SODIS process (controlling theft of bottles and recognizing the importance of SODIS technology), and willingness to pay for new polyethylene terephthalate (PET) bottles. On the other hand, barriers were grouped into three themes such as sociocultural (poor knowledge, hesitation to leave SODIS bottles unguarded outdoor, less attention, and unplanned social events), environmental (cloud, shadow over SODIS bottles, turbidity and leeches in source water, and geographical settings), and behavioral (mishandling of SODIS bottles and drinking water). The analysis of the data revealed that all the participants had positive attitude toward the implementation of SODIS, and it was culturally accepted. They identified the barriers to and enabling factors for the implementation of SODIS. Promoting enabling factors and mitigating barriers are substantially important for consistent implementation of SODIS as a long-term interventional measure widely in rural Ethiopia for the achievement of the goal of safe drinking water for all.

Diarrheal disease and associated behavioural factors among food handlers in Addis Ababa, Ethiopia.

Introduction: Diarrheal diseases are threat everywhere, but its frequency and impact are more severe in developing countries. Diarrhea occurs world-wide and causes 4% of all deaths and 5% of health loss to disability. In 2016, it was the eighth leading cause of mortality. Moreover, data from the World Health Organization indicated that diarrheal diseases are causes for an estimated 2 million deaths annually. Therefore, this study aimed to assess diarrheal diseases and associated behavioural factors. Method: An institution based cross-sectional study was conducted. A stratified random sampling method was employed to select 1050 study participants. Participants were interviewed using structured questionnaire. To analysis the data, binary logistic regression and multivariable logistic regression analysis was conducted. Results: The two weeks prevalence of diarrhea was found to be 3.4%. Further, 1.6%, 10.5%, 10.7% and 9% of the food handlers had acute watery diarrhea, cough, an infection of runny nose and incidence of any fever respectively. Regular hand washing after toilet (AOR = 0.13 with 95% CI: 0.024, 0.72), using toilet while wearing protective clothes/gown (AOR = 5.39 with 95% CI; 1.59, 18.32), habit of eating raw beef and raw vegetables (AOR = 6.27 with 95% CI: 1.89–20.78), type of toilet (AOR = 4.07 with 95% CI: 0.29–6.67 were associated significantly with diarrhea. Conclusion: This assessment proved to be an essential activity for reduction of community diarrheal diseases, as a significant number of food handlers had diarrhea. Good sanitation, hygiene practice and a healthy lifestyle behavior can prevent diarrhea. A strong political commitment with appropriate budgetary allocation is essential for the control of diarrheal diseases.

Water, sanitation and hygiene risk factors associated with diarrhoea morbidity in a rural community of Enugu, South East Nigeria.

Introductiondiarrhoea remains a public health problem globally with majority of diarrhoea morbidity and mortality occurring in low resource settings. This study assessed the prevalence of diarrhoea and factors associated with diarrhoea in a rural community in Enugu, South East Nigeria.Methodsa community-based cross-sectional survey was conducted between May and June, 2017. Information on socio-demographic characteristics, water, sanitation, hand washing practices and diarrhoea history was obtained from 534 community residents using a structured interviewer administered questionnaire. Data were analyzed using descriptive statistics, Chi-square and logistic regression tests at 5% level of significance.Resultsprevalence of diarrhoea in the two weeks preceding the study was 7.47% and 10.77% among all ages and children younger than five years respectively. Of 469 residents aged five years and above, 206 (43.92%) accessed source of drinking water within 30 minutes round trip walking distance from their households, 275 (58.64%) practiced open defecation while 456 (97.23%) and 455 (97.01%) reported washing hands with soap or ash and water before eating and after using the toilet respectively. Two or more households sharing a toilet facility [AOR = 4.78 (95% CI 2.03-11.24)] was a risk factor for diarrhoea while washing hands with soap or ash and water before eating [AOR = 0.23 (95% CI 0.06-0.90)] and after using the toilet [0.16 (95% CI 0.04-0.55)] protected against diarrhoea.Conclusionincreasing access to improved sanitary sewage disposal methods and promoting hand washing with soap and water at critical moments would improve diarrhoeal disease control.

Evolution of the World Health Organization's programmatic actions to control diarrheal diseases.

The Program for the Control of Diarrheal Diseases (CDD) of the World Health Organization (WHO) was created in 1978, the year the Health for All Strategy was launched at the Alma Ata International Conference on Primary Health Care. CDD quickly became one of the pillars of this strategy, with its primary goal of reducing diarrhea-associated mortality among infants and young children in developing countries. WHO expanded the previous cholera-focused unit into one that addressed all diarrheal diseases, and uniquely combined support to research and to national CDD Programs. We describe the history of the Program, summarize the results of the research it supported, and illustrate the outcome of the Program’s control efforts at country and global levels. We then relate the subsequent evolution of the Program to an approach that was more technically broad and programmatically narrow and describe how this affected diarrheal diseases-related activities globally and in countries.

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.

Assessment of laboratory diagnostic and surveillance system for enteric infections in Azerbaijan

Purpose: Our study sought to gain a better understanding of the etiology of infections that fall within the generalized diagnosis of enteric infections with unassigned etiological agent. We hypothesized that meticulous assessment of patient diagnostic and surveillance data from enteric infections in Azerbaijan would increase our knowledge of the enteric disease situation in the country. In consequence, our ability to assign causative agents to enteric infections would be enhanced and gaps in public health detection and reporting requirements could be identified. Methods & Materials: Given the high number of AEI cases with unknown etiology in Azerbaijan, AEI patient data from 2014 to 2016 were analyzed using the Electronic Integrated Disease Surveillance System (EIDSS) and patient information from annual reports from the Bacteriology Laboratory at the Republican Center of Hygiene and Epidemiology. Results: The analysis revealed that yersinosis (0.3% of the cases), shigellosis (0.6%), and salmonellosis (5.7%) were the most common AEI cases. Opportunistic bacterial infections accounted for remaining cases. Between 2014 and 2016, notification of enteric infections improved with every year (i.e., 2014: 67.4% of timely notifications; 2015: 80.4%; 2016: 87.3%). EIDSS entry deficiencies included the lack of antibiotic treatment information in 57.4% of the cases, and an overwhelming incidence of AEI diagnosis based on clinical-epidemiological data (78.6%) and not confirmatory laboratory assays, indicating that treatment received was not etiologically substantiated. Absence of point-of-care, pathogen detection assays covering more agents, especially viral agents, might in part explain the high rate of clinical diagnosis of AEIs as "acute enteric infections of unknown etiology". In fact, in Azerbaijan, only rotaviruses are currently tested when viral enteric infections are suspected. Conclusion: Better communication among health system databases with established minimum data entry requirements, including treatment and disease chronology information, capability for multiple pathogen testing and improvement in the quality of EIDSS entries to reconcile electronic and paper forms of notification are needed. Use of rapid immunological or molecular diagnostic methods, or test strips using immunochromatographic technology, rather than traditional long-term culture assays, should expedite pathogen identification. Altogether, such efforts will improve diagnosis, treatment and spread control of diarrheal diseases in the country.

Risk Factors of Infantile Diarrhea (A Case-Control Study)

From March thru April 1990 an unmatched case-control study had been conducted at the pediatric out-patient Clinic of Dr. Pirngadi Hospital Medan to assess risk factors of infantile diarrhea. The study population were infants, aged younger than 21 months. The mothers of the infants were interviewed, using structured questionnaires.&#x0D; Sample size, calculated by means of formula, with 95 % level of confidence, 90 % power of study, 50% estimated proportion of exposure in the control-group and 2.0 estimated odds ratio, was 121.&#x0D; All infants with diarrhea were included in the case-group until a total number of 124 infants were reached. One control, an infant without diarrhea, was taken for each case from the nearest sequence of attendance after the case. A total of 20 risk factors were tested. Exposure was indicated from the last day before illness.&#x0D; Computerized statistical analysis was performed to calculate odds ratio, 95 % confidence interval and two tailed significance testing for qualitative dichotomic data by means of Chi square test.&#x0D; A total of nine factors were confirmed as risk factors of infantile diarrhea i.e mothers age than 20 years, working mother, not cleaning nipple before suckling the baby bottle feeding, having only one nursing botlle/teat, not ready for use nursing bottle/teat, giving left over supplementary food without reheating, no band-washing before giving supplementary food and malnutrition.&#x0D; The result of this study can be emphasized in health education, especially in diarrheal disease control of infancy; Further well-designed studies are needed.

Prevalence, patterns, and predictors of diarrhea: a spatial-temporal comprehensive evaluation in India

BackgroundSpatial analysis has been vital in mapping the spread of diseases and assisting in policy making. Targeting diarrhea transmission hotspots is one of the potential strategies for reducing diarrhea cases. This study aimed to examine the spatial-temporal variations and to identify the modifiable determinants of diarrhea while controlling for the spatial dependence in the data.MethodsAn ecological study on diarrhea data from DLHS-3 and NFHS- 4 in India. Moran’s I and LISA were used to detect the spatial clustering of diarrhea cases and to test for clustering in the data. Spatial regression was used to identify the modifiable factors associated with the prevalence of diarrhea. The study comprised of the prevalence of diarrhea among the children below the age of five years (U-5 s) across different states in India. The determinants of diarrhea were obtained using spatial lag models. The software used were GeoDa 1.6.6 and QGIS 2.0.ResultsThe presence of spatial autocorrelation in DLHS-3 and NFHS-4 (Moron’s I = 0.577 and 0.369 respectively) enforces the usage of geographical properties while modeling the diarrhea data. The geographic clustering of high-prevalence districts was observed in the state of UP consistently. The spatial pattern of the percentage of children with diarrhea was persistently associated with the household with a sanitation facility (%) (p = 0.023 and p = 0.011). Compared to the diarrhea cases in the period 2007–2008, no much reduction was observed in the period 2015–2016. The prevalence of diarrhea and percentage of household with sanitation were ranging between 0.1–33.8% and 1.3–96.1% in the period 2007–2008 and 0.6–29.1% and 10.4–92.0% in the period 2015–2016 respectively. The least and highest prevalence of diarrhea being consistently from Assam and UP respectively.ConclusionDespite improvements in controlling spread of diarrheal disease, the burden remains high. Focus on widespread diarrheal disease control strategy by addressing the social determinants of health like basic sanitation is crucial to reduce the burden of diarrhea among U-5 s in India. The identification of hotspots will aid in the planning of control strategies for goal setting in the targeted regions.

A review of rotavirus diarrhea in Pakistan: how much do we know?

Rotavirus diarrhea has a worldwide distribution, infecting almost all children by the age of 3-5 years. A comparable etiological 2-year survey carried out by the W.H.O Diarrheal Disease control (CDD) Program in 1991, in a multicenter study in 5 developing countries including Pakistan revealed that Rotavirus was found to be the most frequently detected pathogen in diarrheal episodes, during the first year of life, with the highest incidence (20%) occurring among 6-11 months old. Two other studies done in Pakistan, in under five children done in Lahore (between 1985 and 1991) and Rawalpindi (between May 1983 and April 1984) showed that Rotavirus was the second most common Diarrhea causing enteric pathogen following E.Coli Rotaviruses are shed in high concentrations 2 days before and as many as 10 days after onset of symptoms in immunocompetent hosts, thus being an important source of viral transmission. A multicenter study in 5 developing countries including Pakistan conducted by WHO CDD program revealed that only 1.8 % of cases presented with severe dehydration and these were mostly due to Rotavirus, V. Cholerae and ETEC13. A study conducted in local hospitals in Pakistan during the period of October 1985-April 1986 compared the different diagnostic modalities for the detection of rotavirus in the faeces of children with acute diarrhea. The study all methods detected Rotavirus to varying degrees but ELISA was found to be the most sensitive method with 72.4% stools being positive. PREVENTIVE STRATEGIES: A study was conducted in Lahore (Pakistan) among 72 infants 6 weeks old in 1991 to assess safety and efficacy of RRV vaccine. It was found that of all infants given RRV with OPV, 50% had a two to four-fold rise in neutralization titers against rotavirus. RRV was found to be safe and not associated with adverse reactions in the 6 weeks old infants. With regards to Pakistan, there is a great need for defining rotavirus associated disease burden and strain prevalence. We also need to conduct Rotavirus vaccine trials to assess its efficacy and safety in our setting.

Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries.

.Past research has focused on typhoid fever surveillance with little attention to implementation methods or effectiveness of control interventions. This study purposefully sampled key informants working in public health in Chile, India, Pakistan, Bangladesh, Thailand, Vietnam, South Africa, and Nigeria to 1) scope typhoid-relevant interventions implemented between 1990 and 2015 and 2) explore contextual factors perceived to be associated with their implementation, based on the Consolidated Framework for Implementation Research (CFIR). We used a mixed methods design and collected quantitative data (CFIR questionnaire) and qualitative data (interviews with 34 public health experts). Interview data were analyzed using a deductive qualitative content analysis and summary descriptive statistics are provided for the CFIR data. Despite relatively few typhoid-specific interventions reportedly implemented in these countries, interventions for diarrheal disease control and regulations for food safety and food handlers were common. Most countries implemented agricultural and sewage treatment practices, yet few addressed the control of antibiotic medication. Several contextual factors were perceived to have influenced the implementation of typhoid interventions, either as enablers (e.g., economic development) or barriers (e.g., limited resources and habitual behaviors). Consolidated Framework for Implementation Research factors rated as important in the implementation of typhoid interventions were remarkably consistent across countries. The findings provide a snapshot of typhoid-relevant interventions implemented over 25 years and highlight factors associated with implementation success from the perspective of a sample of key informants. These findings can inform systematic investigations of the implementation of typhoid control interventions and contribute to a better understanding of the direct effects of implementation efforts.

Socio-environmental factors and diarrheal diseases in under five-year old children in the state of Tocantins, Brazil.

BackgroundDiarrhea is a waterborne disease that affects children, especially those under 5 years of age. The objective of this study was to identify the spatial patterns of distribution of diarrheal disease in under 5-year-old children in the State of Tocantins, Brazil, from 2008 to 2013.MethodsGeoprocessing tools were used to carry out an epidemiological study, to prepare thematic maps in the TerraView 4.2.2 software based on secondary data. General indicators of the disease, presence of spatial dependence through the Global Moran’s Index (I) and the Spatial Association Index (LISA) were described.ResultsThere were 3,015 cases of under 5-year-old children hospitalized for diarrhea, with an average annual rate (AAR) of 4.10/1,000 inhabitants (inhab.). Among the main characteristics were: increasing rates in under 1-year-old children (6.16 to 9.66/1,000 inhabitants); children aged 1 to 4 full years (63%); males (55%); 8 deaths of under one-year-old children (75%); county of Araguaína (67%); incidence in the county of Nazaré (63.97/1,000 inhab.); prevalence and incidence in the Araguaína microregion (45%, AAR 9.38/1,000 inhab.). The presence of a cluster with spatial autocorrelation was found in the Araguaína microregion, which was statistically significant (I = 0.11, p-value < 0.03), with priority of intervention (Moran Map).ConclusionsThere was an increase in the number of hospitalizations for diarrhea in under 5–year-old children in the state of Tocantins. The spatial analysis identified clusters of priority areas for measures of maintenance and control of diarrheal diseases.