Diarrheal Morbidity Research Articles

Temporal trends of diarrheal diseases and associated treatment responses among children aged under five: Insight from the multiple Indicator Cluster surveys from 2006 to 2019

BackgroundDespite significant progress in its health sector, Bangladesh has a high burden of diarrheal mortality and morbidity in the South Asian region. Given recent major social and economic transitions in Bangladesh, it is important to examine how patterns of diarrhea and its treatment have evolved over the past few decades. The current study aims to assess the temporal changes in the frequency of diarrhea and identify the factors that influence whether affected children receive proper treatment. MethodsThe current study utilized data from three Bangladesh Multiple Indicator Cluster Surveys (MICS), 2006, 2012–13, and 2019, respectively. Binary logistic regressions were conducted, and the reported results included odds ratios (OR) and 95% confidence intervals (CIs). A p-value of <0.05 was considered statistically significant (α = 0.05). ResultsThe prevalence of diarrhea in Bangladesh declined from 7.05% in 2006 to 3.91% in 2012–13, but then increased to 8.78% in 2019. The proportion of children with diarrhea who received oral rehydration therapy (ORT) was 68.91%, 77.35%, and 70.59% respectively. Binary logistic regression indicated that older children (OR:0.54; CI:0.51–0.58), females (OR:0.92; CI:0.86–0.98), children from upper quintile families, and children from mothers having primary education (OR:0.9; CI:0.83–0.98) were less likely to suffer from diarrhea. However, the odds of receiving proper treatment with ORT were higher among older children (OR:1.45; CI:1.26–1.68), children from the rich and richest quintiles (OR:1.85; CI:1.47–2.32 and OR:1.7; CI:1.32–2.2 respectively). Also, it was the same for children from mothers with primary (OR:1.19; CI:1.01–1.41) and secondary or above education (OR:1.32; CI:1.12–1.56). ConclusionA targeted approach is needed to reduce diarrhea and promote the use of ORT. Maternal education can be an important intervention, and steps should be taken to reduce poverty. Future policies should consider strategies focusing on socioeconomic and environmental factors.

Landscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children

ObjectiveDiarrhoea remains a leading cause of morbidity and death among under-5 children in Kenya, despite multipronged policy and programme initiatives to increase access to treatment. This study interrogates the comprehensiveness...

Multilevel modeling analysis of bottle feeding and its determinants among children 0-23 months in East Africa: evidence from recent DHS data (2015-2022).

Despite breastfeeding recommendations, the prevalence and length of breast milk feeding in developing nations is rapidly decreasing, with bottle feeding taking its place. This reduces the effectiveness of breastfeeding and is associated with diarrheal disease mortality and morbidity. The purpose of this study was to determine the prevalence, distribution, and determinants of bottle feeding among under-two-year-old children in the region. The ten East African countries' Demographic and Health Surveys (DHS) recent data from 2015 to 2022 was used. The data were weighted using sample weights for probability sampling and nonresponse. The study used 43,150 weighted children. A multi-level logistic regression model was used, and P - values of ≤ 0.2 and < 0.05 were used to declare candidate variables in the binary, and multivariable to declare significant variables, respectively. The prevalence of bottle feeding among children under-two-years-old in East Africa was 10.08% (95% CI 9.79, 10.36), ranging from 4.04% (95% CI 3.56, 4.53) in Tanzania to 33.40% (95% CI 32.72, 34.08) in Kenya. High antenatal care communities (AOR 1.22; 95% CI 1.11, 1.35), mothers aged 25-34 years (AOR 1.17; 95% CI 1.06, 1.28), high wealth index communities (AOR 1.12; 95% CI 1.02,1.25), women who had at least one types mass media exposure (AOR 1.64; 95% CI 1.53, 1.77), women from communities with high level mass media exposure (AOR 1.36; 95% CI 1.23, 1.52), given first birth after teenage years (AOR 1.17; 95% CI 1.09, 1.26), having more than one health visit in the year (AOR 1.37; 95% CI 1.27,1.47), multiple children (AOR 1.46; 95% CI 1.22, 1.75) were associated with higher rates of bottle feeding. Whereas a primary education (AOR 0.51; 95% CI 0.47, 0.54), having 3-5 living children (AOR 0.86; 95% CI 0.79, 0.95), a rural setting (AOR 0.53; 95% CI 0.49, 0.58), and a long distance from health facilities (AOR 0.84; 95% CI, 0.78, 0.91) were associated with lower rates of bottle feeding. The overall prevalence of bottle feeding was moderate in East African countries. Improving the availability and accessibility of health facilities to mothers, utilizing maternal healthcare, and media exposure will contribute to a significant decrease in the inappropriate bottle feeding of children in East Africa.

Epidemiology of enterotoxigenic Escherichia coli and impact on the growth of children in the first two years of life in Lima, Peru.

Enterotoxigenic E. coli (ETEC) is a leading cause of diarrheal morbidity and mortality in children, although the data on disease burden, epidemiology, and impact on health at the community level are limited. In a longitudinal birth cohort study of 345 children followed until 24 months of age in Lima, Peru, we measured ETEC burden in diarrheal and non-diarrheal samples using quantitative PCR (LT, STh, and STp toxin genes), studied epidemiology and measured anthropometry in children. About 70% of children suffered from one or more ETEC diarrhea episodes. Overall, the ETEC incidence rate (IR) was 73 per 100 child-years. ETEC infections began early after birth causing 10% (8.9-11.1) ETEC-attributable diarrheal burden at the population level (PAF) in neonates and most of the infections (58%) were attributed to ST-ETEC [PAF 7.9% (1.9-13.5)] and LT + ST-ETEC (29%) of which all the episodes were associated with diarrhea. ETEC infections increased with age, peaking at 17% PAF (4.6-27.7%; p = 0.026) at 21 to 24 months. ST-ETEC was the most prevalent type (IR 32.1) with frequent serial infections in a child. The common colonization factors in ETEC diarrhea cases were CFA/I, CS12, CS21, CS3, and CS6, while in asymptomatic ETEC cases were CS12, CS6 and CS21. Only few (5.7%) children had repeated infections with the same combination of ETEC toxin(s) and CFs, suggested genotype-specific immunity from each infection. For an average ETEC diarrhea episode of 5 days, reductions of 0.060 weight-for-length z-score (0.007 to 0.114; p = 0.027) and 0.061 weight-for-age z-score (0.015 to 0.108; p = 0.009) were noted in the following 30 days. This study showed that ETEC is a significant pathogen in Peruvian children who experience serial infections with multiple age-specific pathotypes, resulting in transitory growth impairment.

Prevalence and determinants of diarrhea morbidity among under five children of west Shoa Zone, Oromia Region, Ethiopia

BackgroundDiarrhea is the leading cause of morbidity and mortality among under-five children, including Ethiopia. This study aimed to assess the prevalence and determinants of diarrhea morbidity among under-five children in the west Shewa zone. MethodsThe community-based cross-sectional study was conducted using an interviewer-administered questionnaire. The study was conducted among 1004 study participants with under five children. The relation of covariates and diarrheal disease was checked using logistic regression at 95 %CI, where variables with p < 0.05 were statistically significant. ResultsThe finding revealed that the two-week prevalence of diarrhea in the west Shewa zone was 18.7 %. Children living in Ambo [AOR = 0.492, 95 %CI (0.255, 0.948)], Dendi [AOR = 0.413, 95 %CI (0.222, 0.769)], Toke kutaye [AOR = 0.462, 95 %CI (0.240, 0.889)], Bako Tibe [AOR = 0.522, 95 %CI (0.275, 0.993)] were less likely affected by diarrhea. Feeding by cup and spoon [AOR = 0.656, 95 %CI (0.433, 0.995)] and feeding by bottle [AOR = 0.577, 95 %CI (0.362, 0.922)] were less likely affected by diarrhea. Using untreated water [AOR = 1.795, 95 %CI (1.184, 2.721)], complementary feeding before six months [AOR = 1.798, 95 %CI (1.261, 2.565)], improper waste disposal [AOR = 2.041, 95 %CI (1.394, 2.989)], unvaccinated for rotavirus [AOR = 1.990, 95 %CI (1.162, 3.410)] were more likely develop diarrhea. ConclusionOur study identified that one in five under-five children was affected by diarrheal morbidity. It was determined by the woreda of respondents, drinking water, child feeding method, complementary feeding initiation time, waste disposal, and rotavirus vaccination. All concerned bodies should intervene based on the cause of the disease.

Reassessing potential economic value and health impact of effective Shigella vaccines.

The gram-negative bacterium Shigella is a leading cause of diarrheal morbidity and mortality in children in low- and middle-income countries. Several promising vaccine candidates are in late stages of clinical development against this increasingly antibiotic-resistant pathogen. However, considering the increasingly crowded and costly paediatric immunization schedule, and likely advent of other important new vaccines, it is unclear whether introduction of a Shigella vaccine would represent a high priority for international agencies or health ministries in low- and middle-income countries. To determine whether there is a compelling public health value proposition for a Shigella vaccine, we used the World Health Organization's Full Value of Vaccine Assessment analytic framework and formulated five broad scientific, policy, economic and commercial-related propositions regarding the development of a Shigella vaccine. We also explored the current regulatory, clinical, policy and commercial challenges to a Shigella-containing combination vaccine development and adoption. Through a series of literature reviews, expert consultations, social science field studies and model-based analyses, we addressed each of these propositions. As described in a series of separate publications that are synthesized here, we concluded that the economic and public health value of a Shigella vaccine may be greater than previously recognized, particularly if it is found to also be effective against less severe forms of diarrheal disease and childhood stunting. The decision by pharmaceutical companies to develop a standalone vaccine or a multipathogen combination will be a key factor in determining its relative prioritization by various stakeholders in low- and middle-income countries.

Reduction in diarrhea cases following implementation of COVID-19 hand hygiene interventions in Ghana: A causal impact analysis.

The human hand has constant contact with the environment, hence requires regular hand hygiene. Hand hygiene has gained recognition because of the COVID-19 pandemic and is a largely effective, affordable preventive measure against infectious diseases. This study used both national and sub-national analyses to evaluate the effect of COVID-19 handwashing guidelines on instances of diarrhea in Ghana. Data on diarrhea cases spanning February 2018 and March 2022 were retrieved from the District Health Information Management System (DHIMS 2) using a data extraction guide. The data were summarized using descriptive statistics. The difference in diarrhea cases between the pre-COVID-19 and COVID-19 periods was measured using a two-sample t-test across Ghana's 16 administrative areas. Causal Impact package in R statistical software was employed to determine the impact of the introduction of COVID-19 hand hygiene protocols on diarrheal disease. A total of 5,645,533 diarrheal cases reported between February 2018 and March 2022 through the routine MIS (DHIMS2) were examined. Fifty-three percent of the cases occurred before the introduction of the hand hygiene protocol. Descriptive statistics indicated a statistically significant decrease in average diarrheal cases during the hand hygiene implementation era (13,463 cases reduction, p<0.001). Sub-national analyses revealed significant reductions in various regions: Greater Accra, Ashanti, Ahafo, Central, Eastern, Northern, Upper East, Upper West, and Volta (p<0.05). Causal impact analysis confirmed 11.0% nationwide reduction in diarrheal cases attributed to the COVID-19 hand hygiene protocols (p<0.001). This study underscores the effectiveness of COVID-19 hand hygiene protocols in reducing diarrheal morbidity in Ghana, with varying regional impacts. These findings advocate for the sustenance of investments and commitments made at the COVID hand hygiene protocols, particularly in this era where the pandemic appears controlled.

Preservation and Handling Practices of Household Drinking Water in Ahmedabad city with special reference to Bacterial Contamination and Diarrheal Episode in Children: A Cross Sectional Study

Background: Safe drinking water is essential for healthy human life. Presence of coliform organism, E. coli in particular, has been found to be the most specific bacteriological indicator of faecal contamination. Studying their preservation and handling practices of household drinking water, its contamination and diarrheal episodes in children is very necessary for hygiene promotion intervention. Methods: This cross-sectional study was conducted at urban field practice area of community medicine department B.J.M.C, Ahmedabad in year 2020-2021. Total 168 Drinking water samples were collected from each household and tested at microbiology department. Information regarding household characteristics, preservation and handling practices of drinking water were gathered from mother using pre-tested and pre-designed proforma. Data were entered in Microsoft excel and analysed using Epi-info Software. Result: Out of 168 households studied, 165(98.2%) households used matka / earthen pot and 161(95.8%) used narrow necked covered container to preserve drinking water. Only in 10 (5.8%) households’ water was filtered with folded cotton cloth at the time of collection. 101 (60%) water containers did have tap while 67 (39.8%) didn’t have it. 4/168 (2.3%) samples were bacteriologically not acceptable for drinking purpose. Conclusion: Narrow necked coveredmatka (earthen pot) was the most commonly used container to preserve drinking water. Though prevalence of bacterial contamination and ADD episodes in under five child were low due to pre-treated piped water supply, diarrhoeal morbidity is more in household where broad necked, non tapped containers used. Education of mother has positive impact on preservation and handling practices of drinking water. Keywords: Preservation, Handling, Drinking water, Coliform, Diarrheal episode, Under 5 children

The genomic epidemiology of shigellosis in South Africa

Shigellosis, a leading cause of diarrhoeal mortality and morbidity globally, predominantly affects children under five years of age living in low- and middle-income countries. While whole genome sequence analysis (WGSA) has been effectively used to further our understanding of shigellosis epidemiology, antimicrobial resistance, and transmission, it has been under-utilised in sub-Saharan Africa. In this study, we applied WGSA to large sub-sample of surveillance isolates from South Africa, collected from 2011 to 2015, focussing on Shigella flexneri 2a and Shigella sonnei. We find each serotype is epidemiologically distinct. The four identified S. flexneri 2a clusters having distinct geographical distributions, and antimicrobial resistance (AMR) and virulence profiles, while the four sub-Clades of S. sonnei varied in virulence plasmid retention. Our results support serotype specific lifestyles as a driver for epidemiological differences, show AMR is not required for epidemiological success in S. flexneri, and that the HIV epidemic may have promoted Shigella population expansion.

Absence of proline-peptide transporter YjiY in Salmonella Typhimurium leads to secretion of factors which inhibits intra-species biofilm formation

Salmonella is a genus of widely spread Gram negative, facultative anaerobic bacteria, which is known to cause ¼th of diarrheal morbidity and mortality globally. It causes typhoid fever and gastroenteritis by gaining access to the host gut through contaminated food and water. Salmonella utilizes its biofilm lifestyle to strongly resist antibiotics and persist in the host. Although biofilm removal or dispersal has been studied widely, the inhibition of the initiation of Salmonella Typhimurium (STM WT) biofilm remains elusive. This study demonstrates the anti-biofilm property of the cell-free supernatant obtained from a carbon-starvation induced proline peptide transporter mutant (STM ΔyjiY) strain. The STM ΔyjiY culture supernatant primarily inhibits biofilm initiation by regulating biofilm-associated transcriptional network that is reversed upon complementation (STM ΔyjiY:yjiY). We demonstrate that abundance of FlgM correlates with the absence of flagella in the STM ΔyjiY supernatant treated WT cells. NusG works synergistically with the global transcriptional regulator H-NS. Relatively low abundances of flavoredoxin, glutaredoxin, and thiol peroxidase might lead to accumulation of ROS within the biofilm, and subsequent toxicity in STM ΔyjiY supernatant. This work further suggests that targeting these oxidative stress relieving proteins might be a good choice to reduce Salmonella biofilm.

Identification of Fungus-Derived Natural Products as New Antigiardial Scaffolds.

There is an unmet need for effective therapies for treating diseases associated with the intestinal parasite Giardia lamblia. In this study, a library of chemically validated purified natural products and fungal extracts was screened for chemical scaffolds that can inhibit the growth of G. lamblia. The phenotypic screen led to the identification of several previously unreported classes of natural product inhibitors that block the growth of G. lamblia. Hits from phenotypic screens of these naturally derived compounds are likely to possess a variety of mechanisms of action not associated with clinically used nitroimidazole and thiazolide compounds. They may therefore be effective against current drug-resistant parasite strains. IMPORTANCE There is a direct link between widespread prevalence of clinical giardiasis and poverty. This may be one of the reasons why giardiasis is a significant contributor to diarrheal morbidity, stunting, and death of children in resource-limited communities around the world. FDA-approved treatments for giardiasis include metronidazole, related nitroimidazole drugs, and albendazole. However, a substantial number of clinical infections are resistant to these treatments. The depth of the challenge is partly exacerbated by a lack of investment in the discovery and development of novel agents for treatment of giardiasis. Applicable interventions must include new drug development strategies that will result in the identification of effective therapeutics, particularly those that are inexpensive and can be quickly advanced to clinical uses, such as products from nature. This study identified novel chemical scaffolds from fungi that can form the basis of future medicinal chemistry optimization of novel antigiardial agents.

Prospective Cohort Study of Cryptosporidium Infection and Shedding in Infants and Their Households.

Cryptosporidium spp. are responsible for significant diarrheal morbidity and mortality in under-5 children. There is no vaccine; thus, a focus on prevention is paramount. Prior studies suggest that person-to-person spread may be an important pathway for transmission to young children. Here we describe a longitudinal cohort study of 100 families with infants to determine rates of cryptosporidiosis within households during the coronavirus disease 2019 (COVID-19) pandemic. Families living in Mirpur, Bangladesh, with 1 infant aged 6-8 months were enrolled and followed with weekly illness survey and stool testing for Cryptosporidium for 8 months. From December 2020 to August 2021, 100 families were enrolled. Forty-four percent of index children and 35% of siblings had at least 1 Cryptosporidium infection. Shedding of Cryptosporidium occurred for a mean (standard deviation) of 19 (8.3) days in index infants, 16.1 (11.6) days in children 1-5 years, and 16.2 (12.8) days in adults. A longer duration of Cryptosporidium shedding was associated with growth faltering in infants. There was a spike in Cryptosporidium cases in May 2021, which coincided with a spike in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in the region. In this intensive, longitudinal study of Cryptosporidium infection in families we found high rates of cryptosporidiosis in infants and children, and prolonged parasite shedding, especially among malnourished children. These data support that transmission within the household is an important route of exposure for young infants and that treatment of nondiarrheal infection to interrupt person-to-person transmission within the home may be essential for preventing cryptosporidiosis in infants.

Transition in availability of improved sanitation facilities and its effect on diarrhoeal disease in India: evidence from longitudinal data.

Poor sanitation, such as open defecation, is a major public health concern in India, causing diarrhoea and other infectious diseases. So far, few studies have linked poor sanitation with diarrhoea using longitudinal data. In this context, this study assesses the transition in availability of household sanitation facilities and its effect on diarrhoeal morbidity. We used two waves of longitudinal data from the India Human Development Survey, conducted in 2004-2005 and 2011-2012, and based on 34131 followed-up households using a two-stage stratified random sampling method. In the first stage, multinomial logistic regression was used to assess socio-economic factors contributing to the transition in the availability of household sanitation facilities. In the second stage, multivariate linear regression was performed to examine the effect of the change in the availability of household sanitation facilities on the prevalence of diarrhoeal morbidity. All the analysis in this study was carried out by using Stata version 13 software. The findings reveal that the practice of open defecation was continued to be higher among lower socio-economic households than better-off socio-economic households in both 2004-2005 and 2011-2012. The proportion of household members who fell sick due to diarrhoea morbidity has decreased significantly (β=-0.06, p<0.04) among households that switched from open defecation in 2004-2005 to improved sanitation facilities in 2011-12, compared to households that continued to practice open defecation in both periods (2004-2005 and 2011-2012). The share of household members who fell sick due to diarrhoeal morbidity was significantly lower (β=-0.09, p<0.001) among the households who adopted improved toilet facilities in both periods (2004-2005 and 2011-2012) as compared with the households who continued to defecate openly in both periods, net of other covariates. Our findings show that there is a need to strengthen existing policies focusing on lower socio-economic groups to improve sanitation and eliminate its related diseases. In particular, the ongoing 'Clean India Mission' should play a critical role in promoting sanitation for all.

Predictors of diarrhea among children under 24 months in Nepal: A multilevel analysis of multiple indicator cluster survey 2019.

Diarrhea has remained an unmet challenge in global child health. Its severity may be worse than reported in resource-limited settings. Understanding changing epidemiology is critical to combat diarrheal morbidity. Therefore, this study aimed to understand factors associated with diarrhea among under two years children in Nepal. A total of 2,348 samples from Multiple Indicator Cluster Survey 2019 were used to estimate the significant child, maternal, household and external environmental predictors of diarrhea using multilevel analysis. The prevalence of diarrhea was 11.9% (95% CI: 10.2%-13.6%). Children residing in Koshi Province [AOR (Adjusted Odds Ratio): 2.23, 95% CI: 1.22-4.08], Karnali Province (AOR: 2.28, 95% CI: 1.11-4.70), and Sudurpaschim Province (AOR: 4.49, 95% CI: 2.39-8.42) were at higher risk of diarrhea. Children aged 7-23 months (AOR: 1.56, 95% CI: 1.10-2.20), children with ARI symptoms (AOR: 4.14, 95% CI: 2.21-7.72) and children whose mothers had no access to prenatal care (AOR: 1.87, 95% CI: 1.01-3.45) had a higher risk of diarrhea. Children from below the richest household wealth group (AOR: 1.76, 95% CI: 1.01-3.08) and those from households practicing open defecation, with unimproved or limited sanitation facilities (AOR: 1.52, 95% CI: 1.09-2.11) were more likely to have diarrhea. The findings underscore the need for public health policy-makers to improve sanitation facilities, especially focusing on poor households from Karnali and Sudurpaschim Provinces practicing open defecation to protect the children from the life risk of diarrhea in Nepal.

The Relationship between the WES Interventions and the Incidence of Diarrhoea

Access to clean drinking water and sanitation facilities have a direct positive impact on health through prevention of water-borne diseases, especially diarrhoeal morbidity of children. Lack of WES (Water and Environmental Sanitation) services and poor hygiene practices in Pakistan contribute significantly to the prevalence of diarrhoea, a major cause of infant death and children less than five years of age. The estimates show that about 30 percent of total deaths among children are attributed to diarrhoeal disease [Gallup (2001); UNICEF (2000)], and 4.1 years in life expectancy can be added if water borne diseases are eliminated [Ali and Haq (2003)]. Hence, reduction of diarrhoeal morbidity stands out as an important policy goal, which can ultimately lead to reduction in infant/child mortality. In this paper, we shall examine the relationship of WES interventions with that of the incidence of diarrhoea among children under age 10.

Bacteroides thetaiotaomicron Outer Membrane Vesicles Modulate Virulence of Shigella flexneri.

ABSTRACTThe role of the gut microbiota in the pathogenesis of Shigella flexneri remains largely unknown. To understand the impact of the gut microbiota on S. flexneri virulence, we examined the effect of interspecies interactions with Bacteroides thetaiotaomicron, a prominent member of the gut microbiota, on S. flexneri invasion. When grown in B. thetaiotaomicron-conditioned medium, S. flexneri showed reduced invasion of human epithelial cells. This decrease in invasiveness of S. flexneri resulted from a reduction in the level of the S. flexneri master virulence regulator VirF. Reduction of VirF corresponded with a decrease in expression of a secondary virulence regulator, virB, as well as expression of S. flexneri virulence genes required for invasion, intracellular motility, and spread. Repression of S. flexneri virulence factors by B. thetaiotaomicron-conditioned medium was not caused by either a secreted metabolite or secreted protein but rather was due to the presence of B. thetaiotaomicron outer membrane vesicles (OMVs) in the conditioned medium. The addition of purified B. thetaiotaomicron OMVs to S. flexneri growth medium recapitulated the inhibitory effects of B. thetaiotaomicron-conditioned medium on invasion, virulence gene expression, and virulence protein levels. Total lipids extracted from either B. thetaiotaomicron cells or B. thetaiotaomicron OMVs also recapitulated the effects of B. thetaiotaomicron-conditioned medium on expression of the S. flexneri virulence factor IpaC, indicating that B. thetaiotaomicron OMV lipids, rather than a cargo contained in the vesicles, are the active factor responsible for the inhibition of S. flexneri virulence.

Does Therapeutic Zinc Level of Supplementation for Diminutions of Acute Diarrheal Morbidity Varied in Public and Private Health Institutions in Ethiopia, Data from EDHS 2016?

Background Supplementation of zinc is a therapeutic medication for under-five children diminution incidence, severity, duration, and intensity of acute diarrhea morbidity. Nevertheless, levels of therapeutic zinc supplementation varied across public and private health institutions in Ethiopia. Thus, this study was aimed at estimating the levels of therapeutic zinc supplementation and factors associated for intent to be utilized among caregivers with their dyads, data from Ethiopia Demographic and Health Survey (EDHS 2016). Methods The data used were from a secondary analysis of the Ethiopia Demographic and Health Survey in 2016 (EDHS). Overall, 1090 under-five children with acute diarrheal cases of two weeks before the EDHS 2016 were included. After cleaning, editing, and coding variables, the result was presented with frequency, tables, and graphs. Bivariable and multivariable logistic regression was conducted to identify and determine factors associated after zinc is prescribed for utilizations by caregivers. Result The mean (±SD) age of participant children was found to be 36.4(±7.07) month. The overall levels of therapeutic zinc supplementation were 38.7% (95% CI: 35.8, 41.6) in public (29.08%) and private 138 (12.66%), respectively. The prescribed therapeutic zinc was influenced for utilization through maternal educational status (AOR = 2.55; 95% CI: 1.95, 3.47; P = 0.001), availability of health insurance (AOR = 10.7; 95% CI: 7.2, 16; P = 0.001), media exposure status (AOR = 2.1; 95% CI: 1.7, 3.6; P = 0.001). Conclusion More than twofold time therapeutic zinc was prescribed in public than in private health institutions. Health care workers should be encouraged both in public and private health institutions for zinc prescription.

Floods and diarrheal morbidity: Evidence on the relationship, effect modifiers, and attributable risk from Sichuan Province, China.

BackgroundAlthough studies have provided the estimates of floods-diarrhoea associations, little is known about the lag effect, effect modification, and attributable risk. Based on Sichuan, China, an uneven socio-economic development province with plateau, basin, and mountain terrains spanning different climatic zones, we aimed to systematically examine the impacts of floods on diarrheal morbidity.MethodsWe retrieved information on daily diarrheal cases, floods, meteorological variables, and annual socio-economic characteristics for 21 cities in Sichuan from January 1, 2017 to December 31, 2019. We fitted time-series Poisson models to estimate the city-specific floods-diarrhoea relation over the lags of 0-14 days, and then pooled them using meta-analysis for cumulative and lag effects. We further employed meta-regression to explore potential effect modifiers and identify effect modification. We calculated the attributable diarrheal cases and fraction of attributable morbidity within the framework of the distributed lag model.ResultsFloods had a significant cumulative association with diarrhoea at the provincial level, but varied by regions and cities. The effects of the floods appeared on the second day after the floods and lasted for 5 days. Floods-diarrhoea relations were modified by three effect modifiers, with stronger flood effects on diarrhoea found in areas with higher air pressure, lower diurnal temperature range, or warmer temperature. Floods were responsible for advancing a fraction of diarrhoea, corresponding to 0.25% within the study period and 0.48% within the flood season.ConclusionsThe impacts imposed by floods were mainly distributed within the first week. The floods-diarrhoea relations varied by geographic and climatic conditions. The diarrheal burden attributable to floods is currently low in Sichuan, but this figure could increase with the exposure more intensive and the effect modifiers more detrimental in the future. Our findings are expected to provide evidence for the formulation of temporal- and spatial-specific strategies to reduce potential risks of flood-related diarrhoea.

Epidemiologic Features of Acute Pediatric Diarrhea in Managua, Nicaragua, from 2011 to 2019.

ABSTRACT.Diarrhea remains a leading cause of death in children in developing countries, including Nicaragua, but little is known about patterns of diarrhea occurrence in Central America over long periods of time. The purpose of this study was to determine the incidence, risk factors, long-term trends, and seasonality of diarrhea in children age 2 to 14 years in Managua, Nicaragua. From 2011 to 2019, we examined episodes of diarrhea among 6,485 children who participated in a prospective cohort study and presented for care in a primary care facility. We performed a longitudinal analysis considering time-varying variables and the intra-subject correlation of outcomes. In addition, we analyzed the weekly incidence of diarrhea, applying seasonal trend decomposition to extract secular and seasonal patterns. The overall incidence rate of diarrhea was 133.4 episodes per 1,000 person-years (95% CI, 128.3–138.7). We observed a slight increase in the incidence of diarrhea from 2011 to 2019. Younger age was the strongest predictor of the risk of diarrhea, and incidence increased with every additional hour without running water in the household per day. Diarrhea incidence in Managua was seasonal, with high peaks each year between May and July. Despite reductions in childhood mortality since 1990 in Nicaragua, diarrheal morbidity remains a major problem in Managua.

Grandi Byen—Integrated Responsive Parenting, Nutrition, and Hygiene for Child Growth and Development: Protocol for a Randomized Controlled Trial

Objectives Grandi Byen—to grow well in Haitian Creole—tests the effectiveness of a multicomponent intervention encompassing nutrition, responsive parenting, and WASH (water, sanitation and hygiene) during the complementary feeding period on child growth and neurobehavioral development.MethodsThis study is a three-arm, longitudinal randomized controlled trial. Mothers/caregiver and their infants (ages 6–8 months at baseline) living in Cap-Haitien, Haiti (N = 600 dyads) will be randomly and equally assigned into the following groups: 1) standard well-baby care (control); 2) nutrition intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (one egg per day for 6 months + 12-week psychoeducational intervention on responsive parenting, nutrition, and WASH practices).ResultsPrimary outcomes for this study are child growth (length-for-age-, weight-for-age-, and weight-for-length Z scores) and development (cognitive, language, motor, and social-emotional). Secondary outcomes that are hypothesized as mediators to the primary outcomes are child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) and parent-specific outcomes (responsive parenting and parental mental health). Targeted genomics will also highlight potential interactions between host genetics, enteric pathogens, gut microbiota, and overall child development. Findings will demonstrate the reproducibility and feasibility of egg-based interventions, while testing their impact on reducing child stunting and suboptimal development. Additionally, the multicomponent intervention will demonstrate whether stimulating care and WASH education induces any incremental benefits on child nutrition and developmental outcomes.ConclusionsThis project shifts from the norm of single-component nutrition interventions (e.g., single nutrient supplements and other food-based interventions) in child health research. The Grandi Byen concept approaches child well-being holistically by addressing poor child growth and development through nutrition along with proximal environmental and psychosocial determinants of child development.Funding SourcesEunice Kennedy Shriver National Institute of Child Health and Development (NICHD).