Diarrheal Disease In Children Research Articles

Intervention studies for improving global health and health care: An important arena for epidemiologists

Marginalised populations in many low- and middle-income countries experience an increasing burden of disease, in sub-Saharan Africa to a large extent due to faltering health systems and serious HIV epidemics. Also other poverty related diseases (PRDs) are prevalent, especially respiratory and diarrhoeal diseases in children, malnutrition, maternal and perinatal health problems, tuberculosis and malaria. Daily, nearly 30,000 children under the age of 5 die, most from preventable causes, and 8,000 people die from HIV infections. In spite of the availability of powerful preventive and therapeutic tools for combating these PRDs, their implementation, especially in terms of equitable delivery, leaves much to be desired. The research community must address this tragic gap between knowledge and implementation. Epidemiologists have a very important role to play in conducting studies on diseases that account for the largest share of the global disease burden. A shift of focus of epidemiologic research towards intervention studies addressing health problems of major public health importance for disadvantaged population groups is needed. There is a need to generate an evidence-base for interventions that can be implemented on a large scale; this can result in increased funding of health promotion programs as well as enable rational prioritization and integration between different health interventions. This will require close and synergetic teamwork between epidemiologists and other professions across disciplines and sectors. In this way epidemiologists can contribute significantly to improve health and optimise health care delivery for marginalized populations.

A Prospective Multicentric Observational Study to Evolve the Usefulness of the Predefined Homoeopathic Medicines in the Management of Acute Diarrheal Disease in Children

Background & objectives: Acute diarrheal disease is one of the major causes of morbidity and mortality in developing countries. No data regarding the pediatric population suffering from acute diarrhea seeking homoeopathic treatment in India are available. Therefore, an observational study on acute diarrheal diseases in children was undertaken with 14 predefined trial homoeopathic medicines to arrive at a group of useful homeopathic medicines for the treatment of acute childhood diarrhea. Methods: A prospective, multi-centre observational study was conducted by Central Council for Research in Homeopathy at its various Institutes and Units throughout India during Oct. 2005- Sept. 2008. A total of three hundred twenty seven children in the age-group, 6 months to 12 years, were included. Trial medicines selected on the principles of Homeopathy were prescribed and the diarrhea index score was assessed before and after treatment using SPSS (ver. 16). Results: The difference in the mean number of stools and diarrhea index score was found to be statistically significant (p=0.000, <0.05) after the prescription of trial homoeopathic medicines in 321 children. The diarrhea index score got either worsened or remained unchanged from the baseline score in 6 (1.83%) children. Of the 14 medicines half of them viz.,Podophyllum peltatum (n=158), Chamomilla (n=49), Aethusa cynapium (n=25), Mercurius solubilis (n=23), Calcarea carbonica (n=21), Sulphur (n=18), and Phosphorus (n=17) were found to be most useful among the 14 predefined trial medicines. Conclusion: This was an observational study with positive results leads to further validation by suitable Randomized Control Trial(s).

Caretaker's perceptions, attitudes and practices regarding childhood febrile illness and diarrhoeal diseases among riparian communities of Lake Victoria, Tanzania

Understanding community perceptions and attitudes towards childhood illness is important in developing appropriate interventions. A cross sectional survey was therefore, conducted in a riparian community of Lake Victoria basin in Tanzania to determine caretakers' perception, attitudes and practices on childhood malaria and diarrhoeal diseases. Among 336 caretakers interviewed, 61.1% (205) reported febrile illness in children within three months and 26.0% reported a diarrhoeal episode among children within two weeks before the survey. The majority of the respondents reported high fever (98.7%) and prostration (53.7%) as major symptoms of severe malaria. Convulsions were associated with high fever by only 13.7% of the respondents. Forty percent of the respondents attributed convulsions in children to either fever or malaria, and 24.4% correctly mentioned high fever or malaria. A health facility was the first point of care for childhood malaria for the majority (73%) of the respondents. In diarrhoeal diseases, prostration-weakness (67.7%) and dysentery (20.4%) were commonly reported among the respondents. Typical symptoms of severe dehydration (sunken eyes, loss of skin turgor, dry tears) were poorly recognised as characteristics of severe diarrhoeal diseases. Over 85% of the respondents practiced appropriate dietary measures or increased fluid intake for a child who had diarrhoea. Use of anti-diarrhoea (40.8%) and antibiotic medications (34.8%) were common in the treatment of diarrhoeal diseases. It is important that health education emphasizing recognitions of danger signs/symptoms of malaria and diarrhoeal diseases and their management is strengthened among riparian communities in Lake Victoria basin.

Phylogenetic analysis of rotaviruses with predominant G3 and emerging G9 genotypes from adults and children in Wuhan, China

Prevalence and phylogenetic relatedness of rotaviruses causing diarrheal diseases in children and adults were analyzed in Wuhan, China. During a period between June 2006 and February 2008, group A rotavirus was identified in 24.9% (280/1126) and 7.6% (83/1088) of specimens taken from children and adults, respectively. G3P[8] was the most frequent genotype in both children (66.3%) and adults (62.7%), followed by G1P[8] (20.3% and 26.2%, respectively). G9 was detected in specimens from six children (2.0%) and seven adults (5.6%). The VP7 genes of G3P[8] rotaviruses from children and adults showed extremely high sequence identities to each other (98.9-100%) and also to those of G3 viruses isolated in Wuhan in 2003-2004. In the phylogenetic analysis of the VP7 gene, the G3P[8] rotaviruses in Wuhan were clustered into a single lineage with some G3 viruses, which had been referred to as "the new variant G3" rotaviruses, reported recently in East Asia and Southeast Asia. Similar to G3P[8] rotaviruses, extremely high sequence identities between children and adults were observed for VP7 genes of G1 and G9 rotaviruses. The G9 viruses were clustered in the lineage of globally spreading strains, while G1 viruses were genetically close to those reported previously in China and Japan. These findings indicated the persistence of the variant G3 rotaviruses and spread of G9 rotaviruses derived from the global G9 lineage in Wuhan, and suggested that the rotaviruses were circulating among children and adults, irrelevant to the G types.

Gene expression profiling in hepatic tissue of newly weaned pigs fed pharmacological zinc and phytase supplemented diets

BackgroundZinc (Zn) is an essential trace element. However, Zn bioavailability from commonly consumed plants may be reduced due to phytic acid. Zn supplementation has been used to treat diarrheal disease in children, and in the U.S. swine industry at pharmacological levels to promote growth and fecal consistency, but underlying mechanisms explaining these beneficial effects remain unknown. Moreover, adding supplemental phytase improves Zn bioavailability. Thus, we hypothesized that benefits of pharmacological Zn supplementation result from changes in gene expression that could be further affected by supplemental phytase. The goal of this study was to investigate the effects of feeding newly weaned pigs dietary Zn (150, 1,000, or 2,000 mg Zn/kg) as Zn oxide with or without phytase [500 phytase units (FTU)/kg] for 14 d on hepatic gene expression. Liver RNA from pigs fed 150, 1,000, or 2,000 mg Zn/kg, or 1,000 mg Zn/kg with phytase (n = 4 per treatment) was reverse transcribed and examined using the differential display reverse transcription polymerase chain reaction technique. Liver RNA from pigs fed 150 or 2,000 mg Zn/kg (n = 4 per treatment) was also evaluated using a 70-mer oligonucleotide microarray.ResultsExpressed sequence tags for 61 putatively differentially expressed transcripts were cloned and sequenced. In addition, interrogation of a 13,297 element oligonucleotide microarray revealed 650 annotated transcripts (FDR ≤ 0.05) affected by pharmacological Zn supplementation. Seven transcripts exhibiting differential expression in pigs fed pharmacological Zn with sequence similarities to genes encoding GLO1, PRDX4, ACY1, ORM1, CPB2, GSTM4, and HSP70.2 were selected for confirmation. Relative hepatic GLO1 (P < 0.0007), PRDX4 (P < 0.009) and ACY1 (P < 0.01) mRNA abundances were confirmed to be greater in pigs fed 1,000 (n = 8) and 2,000 (n = 8) mg Zn/kg than in pigs fed 150 (n = 7) mg Zn/kg. Relative hepatic HSP70.2 (P < 0.002) mRNA abundance was confirmed to be lower in pigs fed 2,000 mg Zn/kg than in pigs fed 150 or 1,000 mg Zn/kg.ConclusionResults suggest that feeding pharmacological Zn (1,000 or 2,000 mg Zn/kg) affects genes involved in reducing oxidative stress and in amino acid metabolism, which are essential for cell detoxification and proper cell function.

Estimates of the economic burden of rotavirus‐associated and all‐cause diarrhoea in Vellore, India

To determine the cost of rotavirus and all-cause diarrhoea in Vellore, India. Parents of children <5 years of age accessing clinics, emergency rooms, or hospitals for acute diarrhoea completed a questionnaire detailing healthcare utilisation, medical and non-medical expenditures, and lost income. Faecal samples were screened for rotavirus and medical records were examined. Costs were estimated for inpatient and outpatient resource consumption, stratified by facility. Total societal costs of a hospitalised diarrhoeal episode were Rs 3278.50 (US$ 80.80) at a large referral hospital and Rs 1648.60 (US$ 40.60) at a smaller community hospital. Costs for rotavirus positive or negative gastroenteritis were similar. Median household expenditures per diarrhoeal episode at the referral and the community hospitals equalled 5.8% and 2.2% of the annual household income, respectively. Diarrhoeal disease in children constitutes a considerable economic burden. An appropriately priced and effective rotavirus vaccine may provide significant economic savings for the Indian household and healthcare system.

Food Hygiene and Global Health

Food Hygiene and Global Health

Childhood pneumonia and diarrhoea: setting our priorities right

Childhood pneumonia and diarrhoeal disease cause almost half of all child deaths globally. Effective interventions against these conditions are available and could prevent about two-thirds of these deaths. We argue that part of the reason for the lack of success in delivering these interventions is the lack of attention to implementation challenges. We present a novel research priority setting model that shifts the emphasis from generation of new knowledge and publication to potential public-health outcomes, and propose a framework by which this new model can be put into operation. We believe that only in this way will proper attention be given to delivery of proven interventions to reduce the high childhood mortality caused by pneumonia and diarrhoea.

Directing the Mucosal Immune Response

The mucosal lining of the intestine is stuffed with antibody-secreting B cells, which produce vast quantities of immunoglobulin A (IgA), a specialized form of antibody equipped specifically for secretion across the gut wall, where it protects against enteric pathogens. The cues that make a mucosal B cell produce IgA, rather than any of the other forms of antibody, are unclear. Mora et al . now show that another immune cell, the dendritic cell, imparts this information within lymphoid tissue associated with the gut. Once activated by the gut dendritic cells, B cells become "imprinted" to enter the circulation and then home back to the mucosal lining to begin IgA production. Induction depended on the vitamin A metabolite retinoic acid, which may explain why vitamin A deficiency exacerbates childhood diarrheal disease in the developing world. J. R. Mora, M. Iwata, B. Eksteen, S.-Y. Song, T. Junt, B. Senman, K. L. Otipoby, A. Yokota, H. Takeuchi, P. Ricciardi-Castagnoli, K. Rajewsky, D. H. Adams, U. H. von Andrian, Generation of gut-homing IgA-secreting B cells by intestinal dendritic cells. Science 314 , 1157-1160 (2006). [Abstract] [Full Text]

Seasonality of Cardiovascular, Respiratory, and Diarrheal Emergency Hospital Admissions in 3 Australian Cities

Background This study investigates whether overall emergency admissions, especially respiratory, cardiovascular (CVD) and diarrheal disease admissions, show distinct seasonal patterns. It also examines the proportion of all hospital admissions that are classified as “emergency’ for respiratory and CVD in the elderly (≥65 years) and for respiratory and diarrheal disease in children (<5 years).

A Randomized Controlled Trial of the Effect of Selected Arsenic Mitigation Water Supply Interventions on Childhood Diarrheal Disease in Bangladesh

A Randomized Controlled Trial of the Effect of Selected Arsenic Mitigation Water Supply Interventions on Childhood Diarrheal Disease in Bangladesh

Childhood Diarrhoea in a District in Northeast Thailand: Incidence and Treatment Choices

Diarrhoeal disease is a major public health problem in Thailand. We collected information on childhood diarrhoea from a district in northeast Thailand, using various approaches which focus on both consumers and providers. The overall incidence of diarrhoea in the study area was 2.1 episodes per child per 12 months, with children under two years of age having a higher rate at 3.0 episodes per child per 12 months. Many episodes were not recognized as diarrhoeal episodes by caregivers, and treatment was sought in just over half of all episodes. Although children received an average of 2.4 items of medicine per episode, there was relatively low use of oral rehydration solutions. This study highlights the importance of assessing local beliefs when collecting data on diarrhoeal diseases in children, and the importance of continuing efforts to improve public health education on the management of diarrhoeal diseases.

Redundant Role of Chemokines CCL25/TECK and CCL28/MEC in IgA+ Plasmablast Recruitment to the Intestinal Lamina Propria After Rotavirus Infection

Rotaviruses (RV) are the most important cause of severe childhood diarrheal disease. In suckling mice, infection with RV results in an increase in total and virus-specific IgA(+) plasmablasts in the small intestinal lamina propria (LP) soon after infection, providing a unique opportunity to study the mechanism of IgA(+) cell recruitment into the small intestine. In this study, we show that the increase in total and RV-specific IgA(+) plasmablasts in the LP after RV infection can be blocked by the combined administration of Abs against chemokines CCL25 and CCL28, but not by the administration of either Ab alone. RV infection in CCR9 knockout mice still induced a significant accumulation of IgA(+) plasmablasts in the LP, which was blocked by the addition of anti-CCL28 Ab, confirming the synergistic role of CCL25 and CCL28. The absence of IgA(+) plasmablast accumulation in LP following combined anti-chemokine treatment was not due to changes in proliferation or apoptosis in these cells. We also found that coadministration of anti-CCL25 and anti-CCL28 Abs with the addition of anti-alpha(4) Ab did not further inhibit IgA(+) cell accumulation in the LP and that the CCL25 receptor, CCR9, was coexpressed with the intestinal homing receptor alpha(4)beta(7) on IgA(+) plasmablasts. Finally, we showed that RV infection was associated with an increase in both CCL25 and CCL28 in the small intestine. Hence, our findings indicate that alpha(4)beta(7) along with either CCR9 or CCR10 are sufficient for mediating the intestinal migration of IgA(+) plasmablasts during RV infection.

Probiotics for Children: Use in Diarrhea

The use of probiotics in diarrheal diseases of children is increasing. Probiotics, mostly lactic acid bacteria such as Lactobacilli and Bifidobacteria, but also the yeast Saccharomyces boulardii, have been tried in many double-blinded, randomized, placebo-controlled studies, and several well-conducted meta-analyses are now available. There is some evidence of efficacy in the prevention of community-acquired and nosocomial diarrhea. More solid evidence of efficacy is found in the treatment of sporadic, infectious diarrhea, where several probiotics, and especially Lactobacillus GG, have been found capable of reducing by approximately 1 day the duration of diarrhea, shorten the initial phase of watery stools, and reducing hospital stay in developed countries. The effect is best documented in viral diarrheas. Although there are valid conceptual premises for probiotics to be helpful in inflammatory bowel diseases, only 1 trial has been published in children, showing Lactobacillus GG not to be superior to placebo in maintaining remission of Crohn disease. All considered, more research is needed for a better understanding of the role of probiotics in gastrointestinal diseases of children, addressing issues such as pharmacokinetics, mechanism of action, and role of specific probiotics, alone or in combination, in different disorders.

A double-blind, randomized, clinical trial of the effect of vitamin A and zinc supplementation on diarrheal disease and respiratory tract infections in children in Mexico City, Mexico

The efficacy of micronutrient supplementation in improving childhood health and survival in developing countries may be specific to the micronutrient used and health outcome measured. We evaluated the effect of vitamin A and zinc supplementation on overall rates of childhood diarrheal disease and respiratory tract infections and rates stratified by household and personal characteristics. A double-blind, randomized, placebo-controlled trial was carried out in which 736 children aged 6-15 mo living in a periurban area of Mexico City were assigned to receive vitamin A every 2 mo, zinc daily, vitamin A and zinc together, or placebo. Children were followed for 12 mo to determine overall counts of diarrheal episodes and respiratory tract infections. Vitamin A supplementation was associated with a 27% increase in diarrheal disease [risk ratio (RR): 1.27; 95% CI: 1.10, 1.45; P < 0.001] and a 23% increase in cough with fever (RR: 1.23; 95% CI: 1.02, 1.47; P = 0.02), whereas zinc had no effect on these outcomes. Vitamin A supplementation decreased diarrhea in children from households with dirt floors but increased diarrhea in children from households with nondirt floors, piped water, and indoor bathrooms. Zinc supplementation decreased diarrhea in children from households with dirt floors and whose mothers were more educated. Vitamin A supplementation increased cough with fever in children from less-crowded households that lacked indoor bathrooms and in children of less-educated mothers. Vitamin A increases diarrheal disease and respiratory tract infections in young children in periurban areas of Mexico City. Vitamin A and zinc have more heterogeneous effects in different subgroups of children.

Current epidemiological status of enterohaemorrhagic Escherichia coli O157:H7 in Africa

Enterohaemorrhagic E。关口 i (EHEC ) 从人的痢疾的疾病，出血性的大肠炎(HC ) ，和溶血的尿毒症的症候群(HUS ) 被孤立。在 20 年以后自从对 E 的第一描述。关口 i O157：在美国的 H7， EHEC 成为了世界范围的一个重要公共健康问题。给 E 的最近的爆发的大小和严厉。关口 i O157：H7 感染，有迫切需要减少这病原体引起的人的危险。牛被看作 E 的主要水库。关口 i O157 : H7 因为从牛过时的人或物的煮得太生的肉产品的消费经常与许多人的感染联系了。属于 serogroup EHEC O157 的 EHEC 紧张最经常与人的疾病被联系。他们有 flagellar (H7 ) 抗原或 arenon 能动(H-) 。然而，从人，动物和食物来源的另外的 serotypes 的 EHEC 紧张被报导了。EHEC 紧张生产一个或二主要 shiga 毒素(ST1 和 ST2 ) 。ST1 与 Shigella dysenteriae 类型 1 生产的 shiga 毒素几乎相同，而 ST2 是 antigenicallydistinct。通常在英国孤立的 O157 EHEC 的紧张仅仅生产 ST2。详细描述两毒素的紧张经常被发现更少，并且 ST1 制片人是相对稀罕的。词法上， E.coli O157 : H7 与另外的 E.coli serotypes 难区分。文化上 E。关口 i O157 : H7distinctly 别在 24 小时孵化以后使山梨糖醇和 gulucuronide 发酵。

Entamoeba histolytica infection in children and protection from subsequent amebiasis.

The contribution of amebiasis to the burden of diarrheal disease in children and the degree to which immunity is acquired from natural infection were assessed in a 4-year prospective observational study of 289 preschool children in an urban slum in Dhaka, Bangladesh. Entamoeba histolytica infection was detected at least once in 80%, and repeat infection in 53%, of the children who completed 4 years of observation. Annually there were 0.09 episodes/child of E. histolytica-associated diarrhea and 0.03 episodes/child of E. histolytica-associated dysentery. Fecal immunoglobulin A (IgA) anti-parasite Gal/GalNAc lectin carbohydrate recognition domain (anti-CRD) was detected in 91% (183/202) of the children at least once and was associated with a lower incidence of infection and disease. We concluded that amebiasis was a substantial burden on the overall health of the cohort children. Protection from amebiasis was associated with a stool anti-CRD IgA response. The challenge of producing an effective vaccine will be to improve upon naturally acquired immunity, which does not provide absolute protection from reinfection.

CLIMATIC FACTORS ASSOCIATED WITH HOSPITALISATIONS AND EMERGENCY ROOM PRESENTATIONS FOR DIARRHOEA IN CHILDREN

ISEE-143 Aim: The objective of this study was to investigate the seasonal pattern of admissions and emergency room (ER) presentations for diarrhoeal disease in children, and their association with climatic factors such as temperature and humidity. Methods: Monthly hospital admissions (July 1992 to June 2003) and ER presentations (July 1998 to June 2003) for diarrhoea in children (< 5 years) were aggregated in Canberra, Australia. Log-linear models describing monthly hospitalisations for diarrhoea, in terms of calendar time and the current and previous month’s average temperatures and dew point average (a measure of humidity), were fitted for hospitalisations and ER presentations. A negative binomial chance model was used to accommodate over-dispersion in the counts. The admissions and ER presentations for the previous month were also included in the models. Results: Diarrhoeal admissions comprised 4.3% of admissions and 5.3% of ER presentations. The rates of hospital admissions and ER presentations for diarrhoea fluctuated over the study period. Children younger than two years of age comprised 64% and 62% of all children’s (<5 years) diarrhoeal admissions and ER presentations, respectively. Admissions and ER presentations peaked in winter and spring and were lowest in summer. The most pronounced seasonal patterns were observed among children younger than two years of age. The difference between summer and spring admissions and ER presentations were 153% and 146% respectively. An increase in temperature of the previous month was significantly associated with a decrease in diarrhoeal admissions, while a decrease in temperature of the current month and humidity of the previous month were associated with a decrease in ER presentations. These factors were significant even when adjusted for season in the model. There was a significant interaction between temperature and season for hospitalisations and ER presentations. This analysis will be extended to two other cities in Australia. Conclusion: This study demonstrates an association between climatic factors and diarrhoeal admissions and ER presentations. The lag of one month suggests that temperature may be influential, earlier, for hospitalisations. The winter and spring peaks observed for children less than two years of age presenting to the ER and being admitted to hospital suggest rotavirus as the possible aetiology for a large proportion of these cases. There may be differences in the aetiology of some ER presentations compared to hospital admissions. Climatic factors such as humidity in the previous month, for example, may be associated with some of the ER presentations observed. Understanding the links between climatic factors and diarrhoeal disease in children and given the predictable nature of excess diarrhoeal admissions and ER presentations in winter and spring, demands on health service needs could be forecasted. This would facilitate the appropriate real-location of hospital resources in terms of staff and hospital beds to prepare for seasonal fluctuations in cases. This study will be presented at the Symposium on “Climate, weather and enteric disease”.

Role of Dietary Zinc as a Nutritional Immunomodulator

Zinc is ubiquitous in all living cells. Structural and catalytic properties of cellular enzymes are zinc dependent. Zinc deficiency leads to a variety of pathological abnormalities with immune impairment. It is an established fact that nutritional status contributes to overall immune response of individuals. Outcome of zinc deficiency on immune system is so drastic that it is difficult to conceive at the first instance. Zinc supplementation has been advocated to prevent diarrheal disease in children with poor nutritional status. The bioavailability of zinc depends upon its sources. Moreover it varies between monogastrics and ruminants. Controversy still prevails between inorganic and organic sources of zinc with respect to their superiority in bioavailability. Zinc exerts immunostimulatory effects in various laboratory and farm animals. Animals having congenital zinc deficiency diseases like A46 lethal trait usually die due to impairment of the immune system unless treated with zinc. The immune mechanism of zinc and its effect on animals and man are discussed. Zinc has been considered as extremely safe at higher therapeutic doses, but does not provide any beneficial effect but rather may cause immunosuppression. More recently, zinc has been prescribed for immunodeficient hosts, to modulate the immune system so that to a certain extent it can combat against opportunistic pathogens. (Asian-Aust. J. Anim. Sci. 2005. Vol 18, No. 3 : 439-452)

EnterotoxigenicBacteroides fragilis–Associated Diarrhea in Children 0–2 Years of Age in Rural Bangladesh

The burden of enterotoxigenic Bacteroides fragilis (ETBF)-related diarrhea was determined in a birth cohort of 252 children in rural Bangladesh. Isolation rates of ETBF in stool and risk factors for acquisition of ETBF and disease were established. Of 382 B. fragilis-positive specimens, 14.4% of the strains found in them produced enterotoxin, as determined by a tissue-culture assay. The overall isolation rate of ETBF was 2.3% (40/1750) from diarrheal specimens and 0.3% (15/5679) from nondiarrheal specimens collected throughout the 2 years of the study (P < .001). ETBF was isolated from 20.3% (40/197) of the B. fragilis-positive diarrheal specimens and from 8.1% (15/185) of the B. fragilis-positive nondiarrheal specimens (P < .001) and was significantly associated with acute diarrheal disease in children > or = 1 year of age (P = .0001). The diarrheal illness was mild in nature. In conditional multivariate analyses that examined environmental and host risk factors, the presence of livestock in the household area was linked to the acquisition of ETBF (chickens, P < .05; cows, P = .06). ETBF was found to be a small but significant contributor to diarrheal disease in this rural community. Improved management of livestock may be useful for the prevention of ETBF infection.