Incidence Of Diarrheal Disease Research Articles

Safe Water Treatment and Storage in the Home

In many parts of the developing world, drinking water is collected from unsafe surface sources outside the home and is then held in household storage vessels. Drinking water may be contaminated at the source or during storage; strategies to reduce waterborne disease transmission must safeguard against both events. We describe a two-component prevention strategy, which allows an individual to disinfect drinking water immediately after collection (point-of-use disinfection) and then to store the water in narrow-mouthed, closed vessels designed to prevent recontamination (safe storage). New disinfectant generators and better storage vessel designs make this strategy practical and inexpensive. This approach empowers households and communities that lack potable water to protect themselves against a variety of waterborne pathogens and has the potential to decrease the incidence of waterborne diarrheal disease.

Viral infections: arthritis in the human immunodeficiency virus (HIV) infected patient

Reactive arthritis is common in HIV-positive patients and may be mistaken for septic arthritis. We feel that the association is probably, in part, due to the increased incidence of diarrhoeal diseases in HIV-infected patients rather than a specific effect of HIV on the synovium. Disabling, chronic, sero-negative polyarthritis is common in the later stages of HIV infection and further palliative therapeutic strategies are urgently needed.

Flies and water as reservoirs for bacterial enteropathogens in urban and rural areas in and around Lahore, Pakistan

The study was conducted to isolate and characterize campylobacter, enterotoxigenic Escherichia coli-labile toxin (ETEC-LT), shigella and salmonella in flies and water. The material for the study, flies (n = 300) and water samples (n = 148), was collected from different localities in and around Lahore, Pakistan. Cultivation of the samples was performed on conventional standard media. Membrane filtration technique was used for water prior to culture. Determination of ETEC-LT was done by GM1 ELISA. Results of our study showed that flies and water were reservoirs for all the four pathogens, campylobacter, ETEC-LT, shigella and salmonella. Flies from the village were carrying fewer enteropathogens, while water from the village was found to be more contaminated as compared to the city. Campylobacter and ETEC-LT were the most frequently isolated pathogens in both flies and water. Thus the incidence of diarrhoeal disease in children of developing countries may be decreased by providing plenty of safe drinking water, improving excreta disposal, toilet facilities and giving education in personal hygiene.

Effect of dietary nucleotide supplementation on diarrhoeal disease in infants.

The effects of a nucleotide-supplemented formula on diarrhoeal disease was studied in 141 infants (group 1) who belonged to the low socioeconomic stratum; 148 controls (group 2) received the same formula but unsupplemented. Group 1 experienced less episodes of diarrhoea (109 versus 140), including less first episodes (74 versus 102; chi-square = 8.19, p < 0.004; odds ratio 2.01) and for a lesser number of days (807 versus 996 days); 45.0% and 31.1% of infants in groups 1 and 2, respectively, never developed episodes of diarrhoea. There were no differences in the clinical characteristics of the episodes or in the enteropathogens isolated from symptomatic or asymptomatic infants. The mechanisms through which nucleotides decrease the incidence of diarrhoeal disease in infants remain unclear.

Is liberalisation damaging Albanian women's health?

Albania is suffering from low levels of economic development and political instability, which have led to impaired provision of basic health care. With 40% of the population under age 15 years, Albania is experiencing a high rate of natural increase and a high but falling birth rate. In January 1992, Albania legalized abortion for women over age 16 years who are less than 12 weeks pregnant. Women outside of these parameters must face a special commission to obtain an abortion. In the first quarter of 1992, there were 0.8 births/abortion. Rapidly deteriorating conditions in maternity homes and women's hospitals are characterized by a lack of anaesthetic, reuse of equipment including needles, and failure to change sheets between patients. There is little access to contraception or sex education, especially for poor women. Child care facilities are being closed as factories shut down and private individuals reclaim the villas used by the government as child care centers. Albanian children suffer from a very high incidence of viral hepatitis, diarrheal disease (with no production of oral rehydration salts in the country), and parasitoses. In rural areas, one nurse serves two or three villages, most births take place in single-roomed homes which lack disinfectants, and people suffer from poor nutrition caused by lack of access to food. Access to water is also limited and available only on a strict timetable. Current conditions in Albania make it dangerous for women to walk abroad at night alone. In addition, the number of traffic accidents is increasing, as are incidences of domestic burglary.

Early child health in Lahore, Pakistan: VII. Diarrhoea.

This study was carried out to obtain reliable prospective data on the incidence, home management and duration of infantile diarrhoeal disease in a developing and rapidly urbanizing community. Fourteen hundred and seventy six infants from 4 different communities of Lahore, representing different stages of urbanization, were followed prospectively from birth to 2 years of age. Each child had an average of 3.6 episodes of diarrhoea during one year; 4.3 episodes per child per year in the village, 4.4 in the periurban slum, 3.4 in the urban slum and 1.4 in the upper middle (Um) class control group. The maximum incidence of diarrhoeal episodes occurred in children between 9-10 months of age. No sex difference was found. The seasonal variation showed a peak incidence during April-June. Bloody diarrhoea, in 3-5% of the episodes, was predominantly seen in winter months and in older infants. The maximum use of ORS was seen in the Um class (53%). Antibiotics were used in 75% of all diarrhoeal episodes maximally in the Um class, and morphine derivatives in 1% of all cases. The overall incidence of persistent diarrhoea was 14% of all acute cases, being highest in the village (18%), followed by the periurban slum (14%), Um class (10%) and urban slum (8%) with peak incidence occurring in June and July. Our results confirm the magnitude of the problem of diarrhoea.(ABSTRACT TRUNCATED AT 250 WORDS)

Is health a sustainable state? A village study in The Gambia

The economic conditions and demographic status of Keneba village in The Gambia is summarized in order to obtain a general idea about the ability of the population to sustain itself. In 1949 a field station was established with the goal of surveying nutrition and disease. In 1974, a field station was established with the goal of surveying nutrition and disease. In 1974, the Dunn Nutritional Unit took over and found that the principal cause of childhood malnutrition and weight faltering was the incidence of diarrheal diseases. A regular free clinic was set up to serve the Keneba population as well as the neighboring villages of Kantonkunda and Manduar; the medical team provided 24-hour outpatient care with ready access to hospital services. Family planning was promoted. Records indicated that consultation grew from 5000 in 1975 to 18,000 in the late 1980s for the survey population of 2500. There was initial resistance because the clinic was free and staffed by outsiders The population is described as Mandinka. Farmers market groundnuts and/or work for the United Kingdom's Medical Research Council station and the International Trypanotolerance Center, 170 Gambians are employed at the centers. Between 1950 and 1989 the population doubled to 1614 and is now 1516 (1991). Birth rates for the same period have remained high. Mortality for children up to 5 years of age has decline from 400/1000 in 1975 to 20/1000 in 1980. Out-migration is slowing population increases. Between 1951 and 1975, 364 young people aged 15-29 years migrated to the coast. Most are young single men who marry women from their home villages 60% of the time. The changes in Keneba's population birth, and death rates have also occurred elsewhere in The Gambia, regardless of the difference in provision of medical care. As long as net migration continues to be out-migration, carrying capacity can be maintained. The danger is from reduced mortality rates, continuing high birth rates, increased longevity, limited use of contraception, and unpredictable food resources. Medical care has emphasized provision of family planning and individual health. Choices regarding family size are still determined by agricultural production, economic needs, and old age social security. The answer to long term sustainability is dependent on an understanding of the high birth rate.

Nutritional status and risk of infection among Ethiopian children.

This is a prospective study on the possible association between protein energy malnutrition and risk of infection in a pastoralist and in an agricultural community in southern Ethiopia. A total of 425 children under 5 years of age were observed for 8 months. In general, malnourished children had a significantly higher incidence of diarrhoeal disease, even after controlling for possible confounding social, economic, and environmental effects, as well as for past history of illness. However, the extent of this association between nutritional state and morbidity differed between the two study populations. Thus, only wasting was associated with increased incidence of diarrhoeal disease among the pastoralist, whereas wasting, stunting, low weight for age, and low arm circumference all showed such an association in the agricultural community. Demographic and socio-economic characteristics as well as differences in the prevalence of stunting may explain this discrepancy.

Epidemiologic Patterns of Acute Diarrhea and Endemic Shigella Infections in Children in a Poor Periurban Setting in Santiago, Chile

To prepare a field site for evaluating preventive interventions against endemic shigellosis, the authors followed prospectively a cohort of 360 children (90 each of children aged 0-11, 12-23, 24-35, and 36-47 months) in Santa Julia, a low socioeconomic area in Santiago, Chile, from November 1986 through April 1989 with twice weekly household visits for diarrheal disease; infants replaced children who reached 60 months of age. Coprocultures on 2 consecutive days from children with diarrhea and from age-matched controls within the cohort were cultured for Shigella. Bacteriologic surveillance was also maintained in the health center and children's hospital serving Santa Julia. In this community, where all households had access to potable water (68% inside) and all but 3% had access to a toilet, but where there was marked crowding, the overall incidence of diarrheal disease in the cohort was low (2.26 episodes/12 child months of observation in children aged 0-11 months and 2.09 in those aged 12-23 months), yet Shigella infections were common. Shigella accounted for 10% of diarrheal episodes in the cohort (vs. 3.2% isolation rate in controls, p less than 0.0001). The incidence of shigellosis in children aged 12-47 months was 0.16 cases per 12 child months of observation; in the first 5 years of life, a child had a 67% chance of experiencing shigellosis. Shigella sonnei, Shigella flexneri 2a, and S. flexneri 6 caused greater than 79% of the infections. Shigella occurred more often in hospitalized cases of diarrhea than in age-matched cases detected in the health center or by household surveillance (p less than 0.0001). An initial episode of Shigella diarrhea did not diminish overall the risk of subsequent shigellosis but did confer 72% protection (p = 0.05) against illness due to the homologous serotype. The high rate of both S. sonnei and S. flexneri shigellosis in a population with a low background rate of diarrhea makes Santa Julia an appropriate site for assessing the efficacy and effectiveness of measures to reduce Shigella infections.

Etiology and mechanisms of acute infectious diarrhea in infants in the United States

Infectious diarrhea, caused by a wide variety of viral, bacterial and parasitic pathogens, is a common reason for morbidity and hospitalization for children in the United States. Overall, rotavirus is the most common cause of acute diarrheal disease in infants. Salmonella, Shigella, and Campylobacter are the most frequently isolated bacterial pathogens, and Giardia and Cryptosporidium are the parasites that most commonly produce acute infectious diarrhea. The mechanisms by which these enteropathogens cause diarrhea are highly variable, and include crypt cell proliferation, cellular invasion, elaboration of enterotoxins or cytotoxins, and enteroadhesion. In infants the incidence of diarrheal disease is higher and the severity of the illness is greater than in older children and adults. An increased rate of exposure to enteropathogens, as a result of fecal-oral contamination, may explain some of the increased incidence of diarrhea in infants. However, age-specific differences in host defense mechanisms may also account for the increased susceptibility to and severity of certain enteric infections in infants.

Seasonal Effects on the Reported Incidence of Acute Diarrhoeal Disease in Northeast Thailand

This paper examines the seasonal variation in the reported incidence of acute diarrhoea for selected areas in the northeast of Thailand. Charts are presented which show rainfall, temperature and reported incidence of acute diarrhoea for the period 1982 to 1987. Incidence of diarrhoea appears to be inversely related to a sharp decrease in temperature around January each year. Although rainfall does not appear to have a direct effect on the relative incidence of acute diarrhoea, there is always a consistent reduction during July or August, after the rains have begun. Seasonal changes in climate may be indirectly related to other factors which have an important bearing on diarrhoeal disease. Rainwater collection is an important water source in this region and the affect this has on water use is discussed in relation to faeco-oral disease transmission.

Excess Female Deaths among Rural Bangladeshi Children: An Examination of Cause-Specific Mortality and Morbidity

Excess female over male mortality during childhood, well known in the northern Indian subcontinent, is particularly marked in rural Bangladesh. While the determinants of this phenomenon and the respective roles of cultural and economic factors are still debated, little data exist on cause-specific mortality, to identify the specific causes of death producing this differential. In 1986-1987 in Matlab, a study area under intensive demographic surveillance in rural Bangladesh, female children aged 1 to 4 years had a risk of dying 1.8 times higher than male children (95% confidence interval: 1.5-2.1). The causes of death which contributed the most to this excess female mortality were severe malnutrition and diarrhoeal diseases. The risks of dying were 2.5 and 2.1 higher for female than for male children for these two causes, respectively. Possible mechanisms are examined using data on incidence of selected diseases and admission rates to curative facilities. There was no gender difference in incidence of severe diarrhoeal diseases, but female children with diarrhoea were taken to the hospital significantly less often than male children. In contrast, there was a higher incidence of severe malnutrition in female than male children, and a lower rate of hospital admission. The data suggest that gender differentials in mortality may not be as much affected by preventive measures against diarrhoea as by efforts to provide equivalent curative services to female and male children.

Oral Iron Supplementation and Diarrhoeal Disease in Infants: A Prospective Bacteriological Study

The influence of chronic iron intake on the incidence and aetiology of acute diarrhoea was prospectively evaluated in a group of Chilean infants. A total of 430 spontaneously weaned infants, aged 3-12 mths, were fed either iron-fortified (IF) or non-enriched (NE) milk formulae. The 6 mths period of continuous surveillance was accomplished through biweekly home visits by trained nurses. Diarrhoeal episodes were recorded and stool samples obtained from symptomatic and paired asymptomatic infants. Results showed a similar incidence of diarrhoeal disease among infants fed IF and NE formulae (1.38 and 1.27 cases/child/6mths respectively). The isolation rate and pathogen distribution were also similar in both groups, either during diarrhoeal episodes (44 per cent and 45 per cent) or asymptomatic infection (19 per cent and 16 per cent). In addition, the number of diarrhoeal episodes associated with mixed bacterial pathogens or with protracted excretion (> 7 d) was apparently not influenced by the ingestion of ironsupplemented formula. These results suggest that chronic consumption of iron-enriched formula neither enhances the incidence of diarrhoea nor modifies the intestinal bacterial ecology in infants who live in areas with suboptimal sanitary conditions. Keywords: Oral iron supplementation; Infants’ diarrhoea; Bacterial enteropathogens; intestinal ecology.

Age-specific responsiveness of weight and length to nutritional supplementation

Evaluation of the responsiveness of weight and length to supplementary feeding shows that the two periods of greatest response coincide with weaning (ages 3-6 mo) and peak incidence and duration of diarrheal disease (ages 9-12 mo). Analyses were done for seven consecutive nonoverlapping intervals comparing children randomly assigned to receive supplemental feeding from birth to age 36 mo or to serve as control subjects. Absolute responsiveness was greatest between ages 3-6 mo; supplemented infants grew 0.61 cm more and gained 162 g more than did unsupplemented infants (p less than 0.005). Relative to rates of growth, responsiveness was greatest between ages 9 and 12 mo (the period of peak diarrheal prevalence), followed by ages 3-6 mo (the period of weaning). Responsiveness to supplementation is thus directly related to age-dependent risk patterns for malnutrition. Targeting supplementation programs to coincide with periods of high nutritional risk should maximize their effectiveness in reducing malnutrition, though caution should be exercised to avoid disruption of breast-feeding.

Nutritional status and the incidence and duration of diarrhoeal disease among children in Northeast Thailand

In Thailand, diarrhoeal diseases are among major community health problems. The relationship between nutrition status and the incidence and duration of diarrhoea was studied in a sample of 1,117 mothers and 1,364 children under the age of 5 years. The findings are reported and analysed.

Diarrhoeal disease in under five year olds: An epidemiological study in an Australian aboriginal community

The incidence of diarrhoeal disease was determined during a two year period 1985-1986 in under five year old children in an Aboriginal community in South Australia. The incidence was 1.02 episodes/child/year in 1985 and 0.90 episodes/child/year in 1986. In both years the highest incidence was in the 12-23 month age group. A total of 42 episodes of dehydration were recorded and 39 evacuations to hospital were effected. Children who lived in houses were more prone to develop diarrhoea than those who lived in camps or who alternated between living in camps and houses. The high incidence of diarrhoea may be due to lack of adequate facilities for personal and domestic hygiene, unsuitable housing and an unhygienic environment.

Limitations of Anthropometry During Acute Food Shortages: High Mortality Can Mask Refugees' Deteriorating Nutritional Status

Longitudinal comparison of anthropometric data from cross-sectional surveys is commonly used to assess nutritional status in relief operations. In a refugee camp in Sudan, assessment indicated a high level of childhood malnutrition, but nutritional status appeared relatively unchanged between cluster sample surveys in January (26.3% below 80% of median weight-for-height) and March 1985 (28.4% below 80% of median weight-for-height). However, in this interval, which was marked by irregular food supplies and relatively low energy (calorie) intake as well as by a high incidence of diarrhoeal disease and measles, nearly 13% of all children in the camp died. This deceptive appearance of stability in nutritional status in the face of high mortality may be explained by ongoing nutritional deterioration ("replacement malnutrition") among surviving children. These findings demonstrate that collection and analysis of mortality data are essential for the correct interpretation of anthropometric results during periods of uncertain food supply.

Association of malnutrition and diarrhea in children aged under five years. A prospective follow-up study in a rural Sudanese community.

Results are reported from a one-year follow-up study conducted in 1983 and 1984 of 445 Sudanese children aged under five years that was designed to address the hypothesis that malnutrition increases the incidence of diarrheal disease. Children were weighed and measured at two-month intervals ("child intervals") and diarrhea incidence was ascertained during biweekly house visits. During child intervals that followed a prior episode of diarrhea, underweight (weight-for-age less than 90% of expected) was associated with a higher incidence of diarrhea after adjusting for the potential confounding effects of age and socioeconomic factors (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.8). During child intervals with no history of diarrhea in the preceding interval, the association with underweight was less (OR = 1.2, 95% CI = 0.9-1.6); among these children, stunting (height-for-age less than 95% of expected) was significantly associated with diarrhea (OR = 1.4, 95% CI = 1.0-1.8). Moderate malnutrition (weight-for-age less than 75% of expected) was associated with a twofold increased risk of multiple episodes of diarrhea during a follow-up interval whether or not diarrhea had occurred in the preceding interval (OR = 2.0, 95% CI = 1.2-3.5) after adjusting for age, socioeconomic factors, and diarrhea in preceding interval. Age, rainy season, and history of diarrhea in preceding interval were found to be strongly associated with incidence of diarrhea. These data are consistent with the hypothesis that malnutrition increases the risk of childhood diarrhea.

Jakarta kampung morbidity variations: Some policy implications

Urban growth in the developing world is likely to be accompanied by health problems in crowded zones where services are not available. Geographical analyses of aggregated data may prove interesting, but reliability and utility of spatial correlations are greater when microscale data are acquired. In this study data for households in 11 Jakarta neighborhoods were collected in interviews. Malaria and diarrheal disease patterns have been correlated with environmental and socioeconomic variables at the household level. Several environmental characteristics seem to be closely associated with the incidence of malaria and diarrheal diseases.

An epidemiological study of rotavirus diarrhoea in a cohort of Nigerian infants: II. Incidence of diarrhoea in the first two years of life.

In a community-based prospective study of diarrhoeal diseases carried out in Ibadan, 131 infants were selected at birth. The maximum possible length of follow-up ranged from 16 to 24 months. Weekly surveillance for diarrhoea was carried out at home by Primary Health Care workers. Each child was also required to attend a monthly clinic. Of the 131 babies, 95 (73%) completed at least one year of follow-up. All of these had at least one episode of diarrhoea within the first year of life. The incidence rate of diarrhoea in the first year of life was 3.2 cases/child/year. The mean duration of diarrhoea days in the first year of life was 16 per child per year (range 3-34 days). The peak incidence of diarrhoea and the greatest number of diarrhoea days were in the age interval 6-9 months. The mean duration of diarrhoea was five days per episode. Faecal samples for 280 diarrhoea episodes during the first year of life were examined for rotavirus using the ELISA technique: 22 (7.7%) were found to be positive. The mean duration of rotavirus diarrhoea episodes was eight days.