Pediatric Diarrhea Research Articles

Potential for an Electronic Clinical Decision Support Tool to Support Appropriate Antibiotic Use for Pediatric Diarrhea Among Village Doctors in Bangladesh.

Potential for an Electronic Clinical Decision Support Tool to Support Appropriate Antibiotic Use for Pediatric Diarrhea Among Village Doctors in Bangladesh.

Identification, mapping, and self-reported practice patterns of village doctors in Sitakunda subdistrict, Bangladesh.

Informally trained health care providers, such as village doctors in Bangladesh, are crucial in providing health care services to the rural poor in low- and middle-income countries. Despite being one of the primary vendors of antibiotics in rural Bangladesh, village doctors often have limited knowledge about appropriate antibiotic use, leading to varied and potentially inappropriate dispensing and treatment practices. In this study, we aimed to identify, map, and survey village doctors in the Sitakunda subdistrict of Bangladesh to understand their distribution, practice characteristics, clinical behaviours, access to technologies, and use of these technologies for clinical decision-making. Using a 'snowball' sampling method, we identified and mapped 411 village doctors, with 371 agreeing to complete a structured survey. The median distance between a residential household and the closest village doctor practice was 0.37 km, and over half of the practices (51.2%) were within 100 m of the major highway. Village doctors were predominately male (98.7%), with a median age of 39. After completing village doctor training, 39.4% had completed an internship, with a median of 15 years of practice experience. Village doctors reported seeing a median of 84 patients per week, including a median of five paediatric diarrhoea cases per week. They stocked a range of antibiotics, with ciprofloxacin and metronidazole being the most prescribed for diarrhoea. Most had access to phones with an internet connection and used online resources for clinical decision-making and guidance. The findings provide insights into the characteristics and practices of village doctors and point to the potential for internet and phone-based interventions to improve patient care and reduce inappropriate antibiotic use in this health care provider group.

Clinical Epidemiology of Norovirus-Induced Diarrhea in Pediatric Patients at a Regional Public Hospital

Norovirus is The primary cause of acute conditions. gastroenteritis globally, particularly in children under five years old. This study aims to investigate the clinical epidemiology of norovirus infection among pediatric patients presenting with diarrhea at a regional public hospital. We conducted a retrospective analysis of children diagnosed with norovirus-induced diarrhea over a 12-month period, assessing demographic characteristics, clinical presentation, laboratory findings, and outcomes. Our findings indicate that norovirus is a significant etiological agent in pediatric diarrhea cases, underscoring the need for improved diagnostic and preventive strategies in healthcare settings.

Prevalence of Soil-Transmitted Helminthiasis and Its Association with Pediatric Diarrhea in Perobatang Village, Southwest Sumba

Background: Diarrhea is a prevalent health issues in developing countries, and often linked to soil-transmitted helminthiasis (STH). This study aims to investigate the association between STH and diarrhea in Perobatang, Southwest Sumba (SBD). Method: A cross-sectional study was conducted in Perobatang, SBD, in January 2017. Participants were children aged 1 – 15 years. Stool samples were collected from each child and examined macroscopically for signs of diarrhea and microscopically for STH eggs. Positive cases were treated with albendazole. Result: A total of 333 samples were analyzed and 257 children were infected with STH (77%). The prevalence of A. lumbricoides was 56%, T. trichiura was 55%, and hookworm was 5%. Mixed infections were more common in children 6 – 15 years. Ninety-two children (28%) exhibited diarrhea. A significant association was observed between the STH infection (combination of all three worm species) and diarrhea incidence (chi-square test, p < 0.05). However, no correlation was found between the prevalence of single infections or the combination of two worm species and diarrhea incidence. Conclusion: STH infections are associated with incidence of diarrhea in Perobatang, Sumba Barat Daya. This finding highlights the necessity for targeted, community-based interventions by local stakeholders to effectively address and mitigate this public health challenge.

Prevalence of Enterotoxigenic Escherichia coli -LT Gene Expression in Pediatric Diarrhea Patients in Makassar City, Indonesia: A Cross-Sectional Study

Enterotoxigenic Escherichia coli (ETEC) is a significant cause of diarrheal disease worldwide, particularly in children. The heat-labile toxin (LT) is a crucial virulence factor encoded by the LT gene. This study investigated the prevalence of ETEC LT gene expression in children with diarrhea in Makassar City, Indonesia. A cross-sectional study was conducted from January 2023 to December 2023. Rectal swabs were collected from children under five years of age presenting with diarrhea at outpatient clinics in Makassar. DNA was extracted, and the presence of the ETEC LT gene was detected using polymerase chain reaction (PCR). Demographic and clinical data were collected via questionnaires. The ETEC LT gene was detected in 81 (18%) children. The prevalence was significantly higher in children under one year of age (51%) compared to older age groups. ETEC LT positive children were more likely to experience vomiting and fever. ETEC expressing the LT gene contributes to a significant proportion of pediatric diarrhea cases in Makassar. The higher prevalence in younger children highlights the vulnerability of this age group. These findings emphasize the need for improved sanitation and hygiene practices to reduce ETEC transmission.

Estimation of IL-8 and TNF-α Levels in Pediatric Diarrhea Patients Infected with Enterohemorrhagic E. coli O157:H7

Abstract Background: Verotoxins are bacterial virulence factors produced by E. coli O157:H7, transmitted by the fecal-oral route. Objectives: The aim of this article was to diagnose E. coli O157:H7 which causes diarrhea and sometimes develops into HUS, which considers pig health problems and estimates the levels of interleukin (IL)-8 and tumor necrosis factor (TNF)-α in the sera of pediatric patients infected with Enterohemorrhagic E. coli compared to the control group. Materials and Methods: Stool and blood samples were collected from 421 pediatric patients with diarrhea, ranging in age from birth to 13 years old, from March to October 2022. Samples were collected from Al Noor Teaching Hospital, Babylon Hospital for Pediatric and Gynecology, Hilla, Iraq. E. coli O157:H7 was cultured on eosin methylene blue (EMB) and Sorbitol MacConkey agar (SMA), confirmed by biochemical test and cultured on HiCrome E. coli O157:H7 selective medium which was an agar base supplemented with cefixime tellurite agar. Serum from 30 pediatric diarrhea patients infected with E. coli O157:H7 compared with 30 healthy children as control group used to determine serum levels of IL-8 and TNF-α by sandwich ELISA. Results: The results revealed that out of the total 421 samples used in this study, E. coli O157H:7, represented 7% (30 of 421) stool samples. This 30serum samples of infected children as well as 30 samples from healthy children subjected to the estimate serum level of IL-8 and TNF-α which record significant differences P ≤ 0.01 and P ≤ 0.05 to this cytokines in different age group; the mean of IL-8 level was 283.62 ± 17.8 pg/mL (7–9 years), and the mean of TNF-α was 208.62 ± 28.7 pg/mL (10–13 years) comparative with the control group of 80.58 ± 15.4pg/mL and 32.50 ± 7.5 pg/mL, respectively, and also result showed an increased mean level of IL-8 than TNF-α in the male comparative with female 195.19 ± 10.4 pg/mL and 159.05 ± 12.4 pg/mL, respectively, comparative with the control group. The result showed no significant differences in IL-8 and TNF-α between watery diarrhea (192.43 ± 24.3 pg/mL and 136.05 ± 20.4 pg/mL) and bloody diarrhea (189.02 ± 22.5 pg/mL and 123.80 ± 13.5 pg/mL), and also result showed significant increase of mean sera level of IL-8 than TNF-α in formula feeding children comparative with breastfeeding children (187.87 ± 19.5 pg/mL and 119.93 ± 17.4 pg/mL, respectively). Conclusion: The finding of this study suggested that increased levels of IL-8 and TNF-α are present in all age groups, in male comparative with female, and also in pediatric diarrhea feeding by formula than breastfeeding and no differences of this cytokine according to consistency of diarrhea. These results contribute to using the immune profile as a serological marker for diagnosing diarrhea caused by E. coli O157:H7 in comparison with the control group.

Enteroaggregative Escherichia coli: Frequent, yet underdiagnosed pathotype among E. coli O111 strains isolated from children with gastrointestinal disorders in the Czech Republic

Enteroaggregative Escherichia coli (EAEC) strains including those of serogroup O111 are important causes of diarrhea in children. In the Czech Republic, no information is available on the etiological role of EAEC in pediatric diarrhea due to the lack of their targeted surveillance. To fill this gap, we determined the proportion of EAEC among E. coli O111 isolates from children with gastrointestinal disorders ≤ 2 years of age submitted to the National Reference Laboratory for E. coli and Shigella during 2013–2022. EAEC accounted for 177 of 384 (46.1 %) E. coli O111 isolates, being the second most frequent E. coli O111 pathotype. Most of them (75.7 %) were typical EAEC that carried aggR, usually with aaiC and aatA marker genes; the remaining 24.3 % were atypical EAEC that lacked aggR but carried aaiC and/or aatA. Whole genome sequencing of 11 typical and two atypical EAEC O111 strains demonstrated differences in serotypes, sequence types (ST), virulence gene profiles, and the core genomes between these two groups. Typical EAEC O111:H21/ST40 strains resembled by their virulence profiles including the presence of the aggregative adherence fimbriae V (AAF/V)-encoding cluster to such strains from other countries and clustered with them in the core genome multilocus sequence typing (cgMLST). Atypical EAEC O111:H12/ST10 strains lacked virulence genes of typical EAEC and differed from them in cgMLST. All tested EAEC O111 strains displayed stacked-brick aggregative adherence to human intestinal epithelial cells. The AAF/V-encoding cluster was located on a plasmid of 95,749 bp or 93,286 bp (pAAO111) which also carried aggR, aap, aar, sepA, and aat cluster. EAEC O111 strains were resistant to antibiotics, in particular to aminopenicillins and cephalosporins; 88.3 % produced AmpC β-lactamase, and 4.1 % extended spectrum β-lactamase. We conclude that EAEC are frequent among E. coli O111 strains isolated from children with gastrointestinal disorders in the Czech Republic. To reliably assess the etiological role of EAEC in pediatric diarrhea, a serotype-independent, PCR-based pathotype surveillance system needs to be implemented in the future.

Genomic investigation of Salmonella enterica Serovar Welikade from a pediatric diarrhea case first time in Shanghai, China

BackgroundSalmonella, an important foodborne pathogen, was estimated to be responsible for 95.1 million cases and 50,771 deaths worldwide. Sixteen serovars were responsible for approximately 80% of Salmonella infections in humans in China, and infections caused by a few uncommon serovars have been reported in recent years, though not with S. Welikade. This study reports the first clinical case caused by S. Welikade in China and places Chinese S. Welikade isolates in the context of global isolates via genomic analysis. For comparison, S. Welikade isolates were also screened in the Chinese Local Surveillance System for Salmonella (CLSSS). The minimum inhibitory concentrations (MICs) of 28 antimicrobial agents were determined using the broth microdilution method. The isolates were sequenced on an Illumina platform to identify antimicrobial resistance genes, virulence genes, and phylogenetic relationships.ResultsThe S. Welikade isolate (Sal097) was isolated from a two-year-old boy with acute gastroenteritis in 2021. Along with the other two isolates found in CLSSS, the three Chinese isolates were susceptible to all the examined antimicrobial agents, and their sequence types (STs) were ST5123 (n = 2) and ST3774 (n = 1). Single nucleotide polymorphism (SNP)-based phylogenetic analysis revealed that global S. Welikade strains can be divided into four groups, and these three Chinese isolates were assigned to B (n = 2; Sal097 and XXB1016) and C (n = 1; XXB700). In Group B, the two Chinese ST5123 isolates were closely clustered with three UK ST5123 isolates. In Group C, the Chinese isolate was closely related to the other 12 ST3774 isolates. The number of virulence genes in the S. Welikade isolates ranged from 59 to 152. The galF gene was only present in Group A, the pipB2 gene was only absent from Group A, the avrA gene was only absent from Group B, and the allB, sseK1, sspH2, STM0287, and tlde1 were found only within Group C and D isolates. There were 15 loci unique to the Sal097 isolate.ConclusionThis study is the first to characterize and investigate clinical S. Welikade isolates in China. Responsible for a pediatric case of gastroenteritis in 2021, the clinical isolate harbored no antimicrobial resistance and belonged to phylogenetic Group B of global S. Welikade genomes.

A Probiotic Bacterium with Activity against the Most Frequent Bacteria and Viruses Causing Pediatric Diarrhea: Bifidobacterium longum subsp. infantis CECT 7210 (B. infantis IM1®).

The second leading cause of death in children under five years old is diarrheal disease. Probiotics, specifically bifidobacteria, have been associated with a reduction in the number of diarrhea episodes and their severity in babies. In this paper, we summarize the preclinical and clinical evidence of the efficacy of B. longum subsp. infantis IM1® against various gastrointestinal pathogens using in vitro models, animal models, and clinical studies carried out in our laboratory. The preclinical data demonstrate that IM1® effectively inhibits rotavirus replication (by up to 36.05%) in MA-104 and HT-29 cells and from infection (up to 48.50%) through the production of an 11-amino-acid peptide. IM1® displays the capability to displace pathogens from enterocytes, particularly Cronobacter sakazakii and Salmonella enterica, and to reduce the adhesion to the HT29 cells of C. sakazakii and Shigella sonnei. In animal models, the IM1® strain exhibits in vivo protection against rotavirus and improves the clinical symptomatology of bacterial gastroenteritis. A clinical study involving infants under 3 months of age revealed that IM1® reduced episodes of diarrhea, proving to be safe, well tolerated, and associated with a lower prevalence of constipation. B. infantis IM1® emerges as an effective probiotic, diminishing episodes of diarrhea caused by gastrointestinal pathogens.

Assessing safety and efficacy of a novel glucose-free amino acid oral rehydration solution for watery diarrhea management in children: a randomized, controlled, phase III trial

Diarrhoeal disease poses a significant global health challenge, especially in children under three years old. Despite the effectiveness of oral rehydration therapy (ORT), its adoption remains low. Glucose-based ORS (GORS) is the standard, but novel formulations like glucose-free amino acid-based VS002A have emerged as potential alternatives. This study aimed to compare the safety and efficacy of VS002A against the standard WHO-ORS in treating non-cholera acute watery diarrhoea in children. A triple-blind, randomized trial enrolled 310 male infants and children aged 6-36 months, who were assigned to receive WHO-ORS or VS002A over a 16-month period, from June 2021 to September 2022. Both groups received standard of care, including zinc supplementation. The Primary study outcome measured was the duration of diarrhoea. Secondary outcomes included stool output, treatment failure and adverse events. Exploratory endpoints included urinary output, body weight changes, blood biochemistry, stool microbiology and gut health biomarkers. Both VS002A and WHO-ORS were well-tolerated with a low adverse event rate. While not different statistically (p=0.10), duration of diarrhoea was shorter in children treated with VS002A vs. WHO-ORS (65.4h vs. 72.6h). Similarly, stool output was also lower vs. WHO-ORS in children treated with VS002A, though not statistically different (p=0.40). Serum citrulline levels, an indicator of gut health, were higher in the VS002A group at 24h suggesting a potential protective effect (p=0.06). The findings of this study support the non-inferiority of VS002A, a glucose-free amino acid-based ORS compared to the WHO-ORS standard of care. VS002A was shown to be safe and effective in treating non-cholera acute watery diarrhoea in young children. VS002A may offer advantages in pathogen-driven diarrhoea, supported by trends toward a lower duration of diarrhoea and stool output within the per protocol group. Furthermore, individuals with prolonged diarrhoea, severe malnutrition, environmental enteric dysfunction or have issues with obesity or insulin resistance, could benefit from a glucose-free ORS. This research contributes to addressing the persistent challenge of childhood diarrhoea by presenting an alternative glucose-free ORS formulation with potential advantages in select scenarios, offering a promising avenue for improving paediatric diarrhoea management worldwide. The study was funded by Entrinsic Bioscience, LLC., Norwood, MA, USA.

The Role of Low Lactose Feeding for Preventing Childhood Malnutrition and Long-Term Gut Damage Caused by Recurrent Diarrhoeal Disease

Even though it has decreased over the past three decades, diarrheal sickness continues to be a major global cause of death for children. There is a strong correlation between childhood rotavirus, diarrhea, climate factors, and malnutrition. On the other hand, a significant nutritional shift (lower levels of undernutrition) among children mal five has been documented in the last ten years, especially in developing nations like Bangladesh, where rotavirus infection has also been on the rise. Given the pathophysiology of rotavirus, there may be a link between the changing diet, the environment, and other artificial factors in urban areas such as Dhaka, Bangladesh, and the rise in rotavirus infections. Under-five malnutrition is still a major problem in Bangladesh, despite significant socioeconomic progress and ten years of initiatives to reduce it. Many research have been conducted in an attempt to identify the primary risk factors for malnutrition; however, none of these have looked into the importance of low birth weight (LBW) 36%. Bangladesh has seen a notable decline in the incidence of pediatric diarrhea deaths in recent decades. Over the past few decades, Bangladesh, a heavily populated country with limited resources, has managed to achieve a notable reduction in the death rate of pediatric diarrhea. Some of the obstacles that still need to be overcome in order to further lower the burden of disease and mortality brought on by diarrhea are enhancing hand hygiene practices, expanding zinc coverage for diarrhea treatment, and maintaining nutritional improvement. To increase intervention coverage and hasten the end of diarrheal mortality among children in Bangladesh, ongoing collaboration with non-governmental organizations and the private sector is necessary, as is the adoption of pluralistic health system platforms for the delivery of preventative and curative services.

Etiology of diarrheal hospitalizations following rotavirus vaccine implementation and association of enteric pathogens with malnutrition among under-five children in India

Malnourished children are at higher risk of mortality and morbidity following diarrheal illness and certain enteropathogens have been associated with malnutrition in children. Very few studies have comprehensively looked at the etiology of diarrhea in malnourished children and most have used conventional diagnostic methods with suboptimal sensitivity. We used a highly sensitive molecular approach against a broad range of pathogens causing diarrhea and examined their association with malnutrition. In addition, we looked at the pathogen diversity of pediatric diarrhea, three years after the nationwide rotavirus vaccine introduction to understand the evolving landscape of pathogens, which is crucial for planning strategies to further reduce the diarrhea burden. Clinical details and diarrheal stool samples were collected from hospitalized children aged < 5 years from three sentinel sites in India for a period of one year. The samples were tested by qPCR for 16 established causes of diarrhea using TaqMan Array Cards. A total of 772 children were enrolled, from whom 482 (62.4%) stool specimens were tested. No specific pathogen was associated with diarrhea among children with acute or chronic malnutrition compared to those with better nutritional status. Overall, adenovirus was the leading pathogen (attributable fraction (AF) 16.9%; 95% CI 14.1 to 19.2) followed by rotavirus (AF 12.6%; 95% CI 11.8 to 13.1) and Shigella (AF 10.9%; 95% CI 8.4 to 16.4). The majority of diarrhea requiring hospitalization in children aged < 2 years could be attributed to viruses, while Shigella was the most common pathogen among children aged > 2 years. These data on the prevalence and epidemiology of enteropathogens identified potential pathogens for public health interventions.

Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR.

Diarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care. Simulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists' practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists' practice was categorized into adequate, less adequate, and poor. 182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription. A high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists' practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.

Evaluation of non-invasive diagnostic tools for diarrhea: a systematic review of point-of-care tests and biomarkers.

Diarrhea is a prevalent condition affecting millions worldwide. However, current standard diagnostic methods have many drawbacks. This review examines various non-invasive point-of-care (POC) tests and biomarkers aiding rapid diagnosis of diarrhea from different causes. PubMed, PubMed Central, ScienceDirect, Cochrane Library, and Google Scholar were searched from 2013 to present for relevant literature. Two reviewers independently assessed included studies' quality using the Critical Appraisal Skills Programme (CASP) checklist. The search yielded 1453 studies, of which 39 were included after screening and applying eligibility criteria. Polymerase chain reaction (PCR) was the POC test in 25 studies, providing consistent sensitivity and specificity. For biomarkers, C-reactive protein (CRP), fecal calprotectin, and procalcitonin offered high sensitivity and specificity for conditions like acute pediatric diarrhea, microscopic colitis, and inflammatory diarrhea, respectively. PCR proved the ideal POC test for rapid diarrhea diagnosis, while the procalcitonin biomarker helps differentiate inflammatory from non-inflammatory diarrhea. Other reviewed tools also demonstrated promising diagnostic performance, though improvements in sensitivity, specificity, and usability are still needed.

Trends and Interventions in Pediatric Diarrhea and Acute Respiratory Infections in India: A Comprehensive Analysis

Trends and Interventions in Pediatric Diarrhea and Acute Respiratory Infections in India: A Comprehensive Analysis

Epidemiology of Cefotaxime-Hydrolysing β-Lactamase-Producing Escherichia coli in Children with Diarrhoea Reported Globally between 2012 and 2022.

The global spread of cefotaxime-hydrolysing β-lactamase (CTX-M)-producing Escherichia coli (E. coli) and its associated impact on paediatric diarrhoeal treatment and management has become a public health concern. This review assessed surveillance studies on CTX-M-producing E. coli associated with diarrhoea in children published between 2012 and 2022 globally. A total of thirty-eight studies were included for data analysis, categorised into continental regions, and tabulated. The majority (68%) of studies were conducted in Asian countries while few studies were conducted in Europe (11%) and Africa (18%), respectively. On the African continent, the majority (11%) of studies were conducted in Northern Africa while no studies were reported in East Africa. On the American continent, 3% of the studies were reported from South America. The studies included were classified into diarrheagenic E. coli (74%; 28/38) and faecal carriage (26%; 10/38). Of all the E. coli pathotypes associated with CTX-M production, EPEC was frequently reported. The prevalence of CTX-M-producing E. coli including the CTX-M-15-producing variants ranged between 1% and 94%. About 37% of the studies generalised the report as blaCTX-M-positive E. coli. The use of sequencing in characterising the CTX-M-producing E. coli was reported in only 32% of all the studies. This review provides information on the epidemiology of CTX-M-15-producing E. coli in paediatric diarrhoea and the extent to which surveillance is being performed. This is relevant in informing clinical practice for the management of diarrhoea as well as the design of future surveillance studies.

Qualitative Assessment of a Smartphone-Based Mobile Health Tool to Guide Diarrhea Management in Bangladesh.

Diarrheal diseases are a major cause of morbidity and mortality in children worldwide and a significant contributor to antimicrobial resistance. In the absence of laboratory diagnostics to establish diarrhea etiology, electronic clinical decision support tools can help physicians make informed treatment decisions for children with diarrhea. In Bangladesh, we assessed the feasibility and acceptability of an electronic Diarrhea Etiology Prediction algorithm (DEP tool) embedded into a rehydration calculator, which was designed to help physicians manage children with diarrhea, including decisions on antibiotic use. A team of Bangladeshi anthropologists conducted in-depth interviews with physicians (N = 13) in three public hospitals in Bangladesh about their experience using the tool in the context of a pilot trial. Physicians expressed positive opinions of the DEP tool. Participants perceived the tool to be simple and easy to use, with structured guidance on collecting and entering clinical data from patients. Significant strengths of the tool were as follows: standardization of protocol, efficiency of clinical decision-making, and improved clinical practice. Participants also noted barriers that might restrict the widespread impact of the tool, including physicians' reluctance to use an electronic tool for clinical decision-making, increasing work in overburdened healthcare settings, unavailability of a smartphone, and patients' preferences for antibiotics. We conclude that an electronic clinical decision support tool is a promising method for improving diarrheal management and antibiotic stewardship. Future directions include developing and implementing such a tool for informal healthcare physicians in low-resource settings, where families may first seek care for pediatric diarrhea.

Vertebral compression fractures in pediatric patients with intestinal failure: A prospective observational case series.

BackgroundIntestinal failure associated bone disease (IFABD) poses a significant threat to bone health in pediatric patients with intestinal failure (IF) reliant on life-saving parenteral nutrition (PN). MethodsThis observational study sought to determine the prevalence of vertebral fractures (VF) detected through lateral thoracolumbar x-rays using Genant criteria in pediatric patients with IF at a single center. It was conducted as part of a larger observational database study of intestinal failure long term outcomes. ResultsFourteen out of 79 patients with IF were included in the study. The median age of our cohort was 9 years. Short bowel syndrome (SBS) was the cause of IF in nine patients (64 %), with two patients each having a pediatric onset congenital diarrhea & enteropathy (14 %) or dysmotility (14 %) as their primary IF diagnosis, and one patient (7 %) with normal intestinal length and absorption, requiring PN for growth support in the context of chronic vomiting. Three of 14 participants (21 %) had vertebral fractures confirmed on x-rays, two of whom were asymptomatic. Notably, bisphosphonate therapy was initiated in one patient with VF, highlighting the clinical impact of early detection. ConclusionDespite study limitations, including a small single center sample size, the identification of VF in 3 out of the 14 participants underscores the need for further investigation in pediatric patients with IF, especially because 2 of these 3 patients were asymptomatic. Multicenter studies in the future may explore risk factors for VF to create guidelines for radiographic screening, surveillance, and treatment in this pediatric population.

Caretaker's Knowledge, Attitudes, and Practices Regarding the Causes, Treatments, and Risks of Diarrhea Among Under-Five Children in North-Eastern Tanzania: A Cross-Sectional Study.

Background. Pediatric diarrhea remains a public health concern. This study explored caretaker's knowledge, attitudes, and practices regarding the causes, treatments, and risks of diarrhea among under-fives in Korogwe and Handeni districts, north-eastern Tanzania. Methods. We conducted a qualitative, cross-sectional study. Participants were selected through purposive sampling. Data were gathered through in-depth interviews and focus group discussions, and they were analyzed using thematic analysis. Results. Most participants had good knowledge about the risks of diarrhea among under-fives. However, most participants had poor knowledge of the causes and treatments of diarrhea. A significant proportion of participants had negative attitudes and poor practices about the treatment of diarrhea. A small percentage of participants possessed positive attitudes and appropriate practices for managing diarrhea. Conclusion. To bridge the knowledge gaps among caretakers and promote positive attitudes and behaviors about the management of diarrheal diseases, health authorities are urged to strengthen health education in the study communities.

Evaluation of Nitazoxanide versus Metronidazole in Pediatric Giardia lamblia-Induced Diarrhea: A Comparative Efficacy Analysis

Background: The choice between shorter-duration Nitazoxanide and longer-duration Metronidazole regimens for treating Giardia lamblia-induced diarrhea in children requires careful consideration of efficacy, safety, and treatment adherence. Objective: The objective of this study is to compare the efficacy of a 3-day treatment regimen with Nitazoxanide to a 5-day treatment regimen with Metronidazole in children with diarrhea caused by Giardia lamblia. Study Design: Randomized controlled trial (RCT). Settings: Department of Paediatric, Shahida Islam Medical College, Lodhran Pakistan. Duration: From 1st September, 2022 to February 2023. Methods: Pediatric patients aged 1 to 12 years diagnosed with diarrhea attributed to Giardia lamblia infection. Exclusion criteria were children suffering from chronic gastrointestinal diseases, immunodeficiency disorders, or those who had undergone anti-parasitic medication in the last month. Subjects were randomised to one of two treatment groups in a random manner: Nitazoxanide Group: The patients were administered a 3-day regimen of Nitazoxanide at a dosage of 15 mg/kg/day, split into two separate doses. Metronidazole Group: Patients were administered a 5-day regimen of Metronidazole at a dosage of 30 mg/kg/day, which was divided into three equal doses. The primary outcome measure was the resolution of diarrhea, assessed by the absence of loose or watery stools for at least 24 hours. Statistical analysis was performed using SPSS to compare outcomes between the two treatment groups. Results: The mean age of patients in the Nitazoxanide group was 6.7 ± 2.3 years, while in the Metronidazole group, it was slightly lower at 6.3±2.1 years. In terms of gender distribution, there were 40 males (53.3%) and 35 females (46.7%) in the Nitazoxanide group, whereas in the Metronidazole group, there were 35 males (46.7%) and 40 females (53.3%). In the Nitazoxanide group, 90% of patients achieved resolution, with 68 patients. In contrast, 85% of patients in the Metronidazole group had resolved diarrhea, totaling 64 patients. Conclusion: In conclusion, our study found comparable efficacy between nitazoxanide and metronidazole for treating Giardia lamblia-induced diarrhea with 95% parasite clearance in nitazoxanide and 90% in metronidazole. However, nitazoxanide exhibits superior parasite clearance, suggesting its potential as a promising alternative in pediatric clinical practice.