Risk Of Diarrhea Research Articles

Exploring the Relationship of Paediatric Nutritional Status with Diarrhoeal Disease in Children Below Two Years of Age

Background and objective: Paediatric malnutrition has a synergistic relationship with diarrhoea. In children under two years of age, diarrhoea occurs in more than half of malnutrition cases and is associated with increased duration of illness, increased length of hospital stays, increased morbidity, and mortality. A well-established relationship exists between diarrhoeal and various standalone forms of malnutrition, but their association with coexisting forms of malnutrition (CFM) has not yet been investigated. Thus, this study assessed the association of CFM with diarrhoea among Pakistani children using datasets retrieved from Demographic Health & Survey and UNICEF. Study design: A pooled analysis of datasets of Pakistan Demographic & Health Surveys (PDHS) and Multiple Indicator Cluster Surveys (MICS) from the year 2010 to 2018 was conducted. Methods: Data of 70,723 children aged below two years were analysed after excluding those with incomplete anthropometry and outliers. Findings: Of the total study population, this study reported the presence of either diarrhoea or malnutrition or both in over half of Pakistani children aged between 0 and 23.9 months. Both standalone forms of undernutrition and coexisting forms of undernutrition were significantly associated with increased odds of diarrhoea by 1.07 (1.02 to 1.12) and 1.21 (1.16 to 1.27) times. The practice of breastfeeding, secondary/higher level of maternal education, and improvement in socioeconomic status reduced the risk of diarrhoea, while the children aged between 6 and 23.9 months residing in urban areas showed a high risk of diarrhoea. Conclusions: The presence of any type of undernutrition, i.e., standalone and/or coexisting forms were associated with increased risk of diarrhoeal diseases in children. An improvement in socioeconomic status, adherence to the continuation of breastfeeding, and maternal education are keys to reducing the burden of diarrhoea among children.

The Effects of Prophylactic Laxative Use on Critically Ill Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study

Objective: To investigate the effects of prophylactic use of stimulant laxatives and/or docusate on the clinical outcomes in critically ill patients who required mechanical ventilation (MV). Methods: A single-center, retrospective, cohort study was conducted. Patients who received MV in the first 24 h after intensive care unit (ICU) admission were enrolled and divided into four groups: non-laxative, stimulant laxatives, docusate, and stimulant laxatives–docusate combination. The primary outcome was in-hospital mortality. The major secondary outcomes included ICU-free days and ventilator-free days at 28 days; the other outcomes were ventilation-associated pneumonia (VAP), enterobacterial infection, diarrhea, and electrolyte disturbances. Inverse probability treatment weighting (IPTW) was used to adjust for confounders. Results: A total of 2129 patients were included in this study, 263 of whom received stimulant laxatives, 253 received docusate, 368 received a combination, and 1245 did not receive any laxative. The prophylactic use of docusate was associated with a decreased risk of in-hospital mortality (OR: 0.59, 95% CI 0.42 to 0.83, p = 0.002) and VAP (OR: 0.62, 95% CI 0.47 to 0.81, p = 0.001). It was also associated with an increase in ICU-free days at 28 days (β: 0.89, 95% CI 0.83 to 0.95, p < 0.001). Importantly, laxatives prophylaxis was not associated with increased risks of diarrhea, electrolyte disturbances, and enterobacterial infections. Conclusions: Prophylactic use of docusate may improve certain prognoses and does not demonstrate any adverse events. However, further research is necessary to determine the optimal regimen and dosage of prophylactic laxatives in this specific population.

Exploring the Association Between Floods and Diarrhea among Under-five Children in Rural India.

Flood is one of the major public health concerns increasing the risk of childhood diarrhea. This study aims to explore the association of floods with diarrhea among under-five children in rural India. A cross-sectional study was carried out using large-scale nationally representative data from the National Family Health Survey-5. The Central Water Commission reports between the years 2018 and 2020 were used to group all the districts as non-flood-affected districts or flood-affected districts. Bivariate and multivariate logistic regression models were employed to assess the association of floods with childhood diarrhea. The prevalence of diarrhea was higher among children exposed to three consecutive floods during the year 2019-21 than those children not exposed to flood. Children exposed to flood three times between the year 2018-19 to 2020-21 were associated with a 34% higher likelihood of developing diarrhea than those children exposed to flood one or two times. Our study suggests that community health workers should target mothers belonging to the poor wealth quintile, young mothers, and mothers with young infants and more children to receive child health related counseling in flood-prone areas.

Short-term associations of diarrhoeal diseases in children with temperature and precipitation in seven low- and middle-income countries from Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study.

Diarrhoeal diseases cause a heavy burden in developing countries. Although studies have described the seasonality of diarrhoeal diseases, the association of weather variables with diarrhoeal diseases has not been well characterized in resource-limited settings where the burden remains high. We examined short-term associations between ambient temperature, precipitation and hospital visits due to diarrhoea among children in seven low- and middle-income countries. Hospital visits due to diarrhoeal diseases under 5 years old were collected from seven sites in The Gambia, Mali, Mozambique, Kenya, India, Bangladesh, and Pakistan via the Global Enteric Multicenter Study from December 2007 to March 2011. Daily weather data during the same period were downloaded from the ERA5-Land. We fitted time-series regression models to examine the relationships of daily diarrhoea cases with daily ambient temperature and precipitation. Then, we used meta-analytic tools to examine the heterogeneity between the site-specific estimates. The cumulative relative risk (RR) of diarrhoea for temperature exposure (95th percentile vs. 1st percentile) ranged from 0.24 to 8.07, with Mozambique and Bangladesh showing positive associations, while Mali and Pakistan showed negative associations. The RR for precipitation (95th percentile vs. 1st percentile) ranged from 0.77 to 1.55, with Mali and India showing positive associations, while the only negative association was observed in Pakistan. Meta-analysis showed substantial heterogeneity in the association between temperature-diarrhoea and precipitation-diarrhoea across sites, with I2 of 84.2% and 67.5%, respectively. Child diarrhoea and weather factors have diverse and complex associations across South Asia and Sub-Saharan Africa. Diarrhoeal surveillance system settings should be conceptualized based on the observed pattern of climate change in these locations.

Association between visceral adiposity index and bowel habits and inflammatory bowel disease: a cross-sectional study

Obesity has become a global public health problem, and its relationship with gastrointestinal diseases has become a major concern. The visceral adiposity index (VAI) is a novel index to assess the distribution and content of visceral fat, and this study aimed to investigate the association between VAI and bowel habits (chronic diarrhea, chronic constipation) and inflammatory bowel disease (IBD). The 2005–2010 National Health and Nutrition Examination Survey (NHANES) dataset was used for the cross-sectional survey. Bowel habits and IBD were defined by self-report. Multiple logistic regression models were used to test the linear association of VAI with bowel habits and IBD. Fitted smoothed curves and threshold effects analyses were used to characterize nonlinear relationships. This cross-sectional study included 10,391 adults (≥ 20 years). After adjusting for covariates, there was a significant negative association between VAI and chronic constipation (OR [95% CI]: 0.97 [0.95, 1.00]) but no significant association with IBD (OR [95% CI]: 0.97 [0.87, 1.07]). Additionally, there was a nonlinear association between VAI and chronic diarrhea with a breakpoint of 3.08, with a positive correlation between the two on the left side of the breakpoint and no statistical significance on the right side. Subgroup analyses and interaction tests showed that maintaining sleep health was associated with a low risk of chronic constipation. Elevated VAI levels were negatively associated with chronic constipation, and elevated levels were positively associated with chronic diarrhea at VAI < 3.08. This reminds us that maintaining moderate levels of visceral fat may prevent the onset of chronic constipation and circumvent the risk of chronic diarrhea. Notably, maintaining healthy sleep may play a positive role in reducing chronic constipation.

Efficacy and safety of vancomycin compared with those of alternative treatments for methicillin-resistant Staphylococcus aureus infections: An umbrella review.

To summarize the evidence on the efficacy and safety of vancomycin compared with those of alternative treatments in adult patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. PubMed, Embase, and Web of Science were searched up to December 15, 2023, for systematic reviews and meta-analyses comparing vancomycin with alternative MRSA treatments. Primary outcomes included clinical cure and microbiological eradication rates. Organ-specific safety outcomes were assessed. Summary estimates were recalculated using a random-effects model. Evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. This study was registered in PROSPERO (CRD42022340359). This umbrella review included 19 studies and 71 meta-analyses (46 efficacy and 25 safety) comparing vancomycin with 10 alternative treatments across different MRSA infection types and populations. GRADE assessment showed that 29.58% of the meta-analyses were of high quality. Linezolid and daptomycin showed higher efficacy in MRSA-induced skin and soft tissue infections and pneumonia (moderate evidence quality) and bacteremia (very low evidence quality), respectively, compared with that of vancomycin. Cephalosporins had a higher risk of nausea, whereas linezolid had a higher risk of nausea, diarrhea, and thrombocytopenia than that of vancomycin. Vancomycin posed a higher risk of rash, pruritus, red man syndrome, and nephrotoxicity than that of alternatives. The quality of evidence supporting the higher efficacy of alternative treatment over vancomycin for MRSA infection was not high. Given varying safety profiles and advancements in therapeutic monitoring, careful consideration of patient-specific factors and pharmacokinetics is crucial when selecting treatment alternatives to vancomycin.

Risk factors for diarrheal diseases among pilgrims during Arba’een mass gathering: a case-control study

BackgroundA significant portion of the Muslim community participates in the Arba’een pilgrimage, with participant numbers increasing each year. There have been relatively few studies on the health of Arba’een Mass gathering (MG). Researching the prevalence and distribution of diseases among Arba’een pilgrims is essential to recognize any outbreaks and take timely responses to contain them. The current study aimed to identify exposures and risk factors for diarrheal disease in pilgrims who referred to the clinics located in Iraq among the Arba’een MG in 2023.MethodsThis case-control study randomly selected 200 outpatients (100 cases and 100 controls) who were referred to Iraq clinics. Cases were patients with gastrointestinal symptoms (diarrhea), while controls were randomly selected from unaffected pilgrims at the same time for the cases. The study groups matched for age, and sex. Face-to-face interviews using a reliable field based checklist of the Center for Disease Control and Prevention of Iran’s Ministry of Health to collect potential exposures and risk factors for diarrheal disease. Multiple logistic regression was used to estimate the crude and adjusted odds ratio (AOR) for the risk of diarrhea with a 95% confidence interval (CI).ResultsThe average age of the participants was 38.6 years. Diarrhea in 100% and fever in 81% were the most common clinical symptoms in patients. Having underlying diseases was not associated with an increased risk of diarrhea disease (P > 0.05). Regarding risk factors for diarrheal, the final analysis after adjusting for potential confounders indicated that consumption of insanitary (unpackaged) drinking water (AOR = 1.95; 95% CI: 1.05–3.6; P = 0.024), inappropriate hand washing (AOR = 3.82; 95% CI: 1.7–8.6; P = 0.001), ritual foods (AOR = 2.56; 95% CI: 1.3–5.2; P = 0.004), and public toilets (AOR = 1.46; 95% CI: 1.04–4.3; P = 0.038) were significantly increased the likelihood of diarrheal disease.ConclusionsContamination of water sources, food, inadequate and poor hand washing were the most common sources of diarrheal diseases among Arba’een pilgrims. The results indicate that the potential occurrence of outbreaks, especially water- and foodborne diseases, threatens participants in the Arba’een MG. It is recommended to provide risk assessment, improve pilgrims’ awareness, pre-and post-screening, vaccination, compliance with personal hygiene, improvement of the environment, provision of sanitary water and food sources and hygienic disposal of sewage, laboratory diagnosis to identify the common types of pathogens in Arba’een MG.

Vincristine Induced Adverse Effects in Lymphoma Bearing Dogs With Asymptomatic Neutropenia at the Time of Drug Administration.

Vincristine sulphate, a microtubule inhibitor, is used extensively in veterinary oncology for treating lymphoma. Neutropenia during multiagent protocols is a common reason for treatment delay and reduced dose intensity. This study evaluated toxicities associated with treating systemically well neutropenic lymphoma patients with vincristine. Lymphoma patients undergoing CHOP were evaluated retrospectively for instances of vincristine administration when absolute neutrophil counts (ANC) were 1.5 × 109/L or below. Instances of vincristine administration when ANC was equal to or less than 1.5 × 109/L were compared to vincristine administration where ANC was greater than 1.5 × 109/L in the same patient. Univariate and multivariate modelling compared VCOG-CTCAE v1.1 grading of vomiting, diarrhoea, anorexia and 7-day neutrophil nadir between groups. The median dose of vincristine administered was 0.7 mg/m2 for both study groups. A total of 112 doses of vincristine were administered to neutropenic patients (grade 2 n: 76, grade 3 n: 26, and grade 4 n: 10). These were compared to 223 doses of vincristine administered to the same patients when ANC was above 1.5 × 109/L. Neutropenic administration was most prevalent 7 days following cyclophosphamide administration. Day 7 post-administration neutropenia was more prevalent in patients with ANC greater than 1.5 × 109/L at the time of vincristine administration (neutropenic 9%; non-neutropenic 18%). Relative risk of 7-day neutropenia, vomiting, diarrhoea, and anorexia was similar between groups on multivariate analysis. Patients with lymphoma who receive vincristine when ANC is 1.5 × 109/L or below are at no greater risk of adverse effects than the same patient who receives vincristine when neutrophil counts are greater than 1.5 × 109/L.

Probabilistic human health risk assessment of commercially supplied jar water in Gopalganj municipal area, Bangladesh

Every day, the amount of quality fresh water decreases notably due to contamination of drinking water. As a result, people use commercially supplied jar water in the southern part of Bangladesh as well as in the Gopalganj municipal area. This study aims to investigate the physicochemical parameters, trace elements, and microbial parameters for assessing human health risks from oral ingestion of these elements. This study gathered commercially supplied jar water samples from 15 companies in the Gopalganj municipal area during the post-monsoon season. Temperature, potential of hydrogen (pH), total dissolved solids (TDS), electrical conductivity (EC), and salinity showed significant variation among the samples, and the level was within the national and international standard limits. The concentrations of iron (Fe) and arsenic (As) were measured using a UV–VIS spectrophotometer and atomic absorption spectroscopy (AAS), respectively. The microbial analysis was conducted by the membrane filtration method. The study found that the water samples had an average concentration of 0.16 mg/L in terms of Fe and 0.016 mg/L in terms of As, with the mean value of As exceeding the standard limits. On the other hand, the mean Fe concentration value did not exceed the standards. Probable human health risk from heavy metal in the jar water was determined by hazard quotient (HQ), hazard index (HI), and carcinogenic risk (CR) assessments. A child (HI = 3.5914) is more vulnerable to non-carcinogenic human health risks than an adult (HI = 1.6931). Furthermore, pollution in water samples was found to pose a high carcinogenic risk, with children (CR = 1.6 × 10−3) being more vulnerable to carcinogenic risk than adults (CR = 7.5 × 10−4). In the microbial analysis, 100% of the samples exceeded the total coliform and fecal coliform standard limits, and 80% of the samples exceeded the Escherichia coli standard limits. Among the samples, 7% present high risk, around 47% present medium risk, 26% show low risk, and 20% show no risk based on the E. coli standard limits. This study did not find any samples that exceeded the extremely high limit for E. coli concentration. This study found that drinking jar water samples had inadequate quality, which may increase the risk of water-borne infections such diarrhea as well as heart disease, diabetes, and cancer. As a result, the manufacturer of drinking water in jars must carry out the essential quality control procedures, and the government should regularly monitor the procedures.

Do they really boil their drinking water? a descriptive study in a rural district of the Lao people’s democratic republic

BackgroundFor safe drinking water, household water treatments (HWT) is important to reduce the risk of diarrhea in low-and-middle countries including Lao People’s Democratic Republic (Lao PDR). However, the measurement of HWT relies chiefly on self-report in most nationwide surveys. Thus, the validity of self-reported measurement is of concern. The objective of this study was to determine the proportion of households with the presence of boiled water among households that report boiling practices in a rural area of the Lao PDR.MethodsThis study was conducted with randomly selected 108 households in the four villages in the catchment area of the two health centers, in Xepon district of the Savannakhet province, between September and October 2023. The inclusion criterion of the households was the households that report boiling as HWT. Surveyors conducted interviews with an adult household member and observations on boiled water through household visits, using a questionnaire. Descriptive statistics were conducted to summarize the collected information using the frequency with proportion for categorical variables and the median with interquartile range for continuous variables. Bivariate analyses were conducted to assess an association between each of the factors and the presence of boiled water, using Fisher’s exact test.ResultsAmong the 108 households that reported boiling practice, 91 households were able to show the surveyor self-reported boiled water. Thus, the proportion of households with the presence of boiled water was 90.1% (95% confidence interval: 82.5–95.1%). Households with a fixed schedule of boiling were significantly more likely to present boiled water, compared to households without (94.5% vs. 50.0%). Not all household members do not necessarily drink boiled water: approximately a quarter (25.7%) of the participants reported that some household members drink unboiled water.ConclusionsThis study showed that among households that reported boiling drinking water, 90.1% were able to present a container with self-reported boiled water. It suggests that the self-reported measure of boiling practices can be valid in the study villages.

Food Hygiene Practices and the Risk of Diarrhea in Children of Working Mothers in Rural Bangladesh

Background: This study addresses the imperative role of maternal personal and household hygiene in safeguarding young children from diarrhea in rural Bangladesh. With young children facing heightened susceptibility to diarrhea during weaning, potential sources of contamination include traditional weaning foods, water quality, and utensil hygiene. This study aims to investigate the influence of maternal hygiene practices on the prevalence of diarrhea among young children in rural area of Khulna, Bangladesh. Materials and methods: A cross-sectional study was conducted in rural areas of Bangladesh from January to June 2023, focusing on under-five children and their working mothers. Results: The study revealed significant associations between hygiene practices and diarrhea prevalence. Proper hand washing by mothers before food preparation exhibited a protective effect (OR: 1.83, 95% CI: 1.03 - 3.24). Ensuring utensil hygiene was correlated with lower diarrhea risk (OR: 11.29, 95% CI: 5.19 - 24.55). Moreover, consistent maternal hand washing after using the toilet (OR: 6.92, 95% CI: 3.08 - 15.55) and before feeding (OR:2.38, 95% CI: 1.17 - 4.82) significantly reduced diarrhea risk among children. Conclusion: The study underscores the critical role of maternal personal and household hygiene practices in preventing diarrhea among young children in rural Bangladesh. IAHS Medical Journal Volume 6(2) December 2023; 73-77

A Poisson regression approach for assessing morbidity risk and determinants among under five children in Nigeria

In this paper, we have provided more insights on the relationship between under five morbidity in Nigeria and some background characteristics using a Poisson regression model and the most recent 2018 NDHS data on Acute Respiratory Infection (ARI), diarrhoea and fever. Some of our results are that children 36-47 months old have the highest risk of ARI [OR=1.45; CI (1.31,1.60)] while children less than 6 months old have the lowest risk of ARI [OR=0.14; CI (0.11,0.17)]. The prevalence of diarrhoea is generally high among children under 48-59 months old but highest among children 6-11 months old [OR=4.34; CI (3.69,5.09)]. Compared to children 48-59 months old, children in all other age categories except 24-34 months old have a high risk of fever [OR=0.95; CI (0.73,1.24)]. ARI is more prevalent among female children [OR=8.88; CI (8.02,9.82)] while diarrhoea [OR=21.75; (19.10,24.76)] and fever [OR=4.78; CI (4.31,5.32)] are more prevalent among male children. Children in urban areas are more likely to suffer ARI [OR=9.49; CI (8.31,10.85)] while children in rural areas are more likely to suffer both diarrhoea [OR=21.75; CI (19.10,24.76)] and fever [OR=4.90; CI (4.26,5.63)]. Children in the South-South have the highest risk of ARI [OR=4.03; CI (3.65,4.454)] while children in the North Central have the lowest risk of ARI [OR=1.55; CI (1.38,1.74)] and highest risk of diarrhoea [OR=3.34; CI (2.30,5.11)]. Children in the Northeast have the highest risk of fever [OR=1.30; CI (1.14,1.48)]. In the Northcentral region, Kogi state has the highest prevalence of fever [OR=2.27; CI (1.62,3.17)], while Benue state has the lowest [OR=0.35; CI (0.20,0.60)]. Children in Abuja state face similar risks of fever and diarrhoea [OR=0.84; CI (0.55,1.27)], with the risk of diarrhoea in Abuja being comparable to that in Plateau state [OR=1.57; CI (0.92,2.70)]. Nasarawa state records the highest incidence of diarrhoea in the Northcentral [OR=5.12; CI (3.03,8.65)], whereas Kogi state reports the lowest [OR=0.29; CI (0.16,0.53)]. In the Northeast, Borno state has the highest rate of fever [OR=3.28; CI (2.80,3.84)], and Bauchi state the lowest [OR=0.38; CI (0.29,0.50)]. In Adamawa state, the risks of fever and diarrhoea are nearly equivalent [OR=1.17; CI (0.97,1.41)], and the risk of fever there is similar to that in Taraba state [OR=0.92; CI (0.75,1.12)]. Diarrhoea is most prevalent in Yobe state [OR=3.17; CI (2.37,4.23)] and least prevalent in Borno state [OR=0.26; CI (0.20,0.33)]. In the Northwest, the risk of fever is similarly high in Zamfara and Kebbi states [OR=1.04; CI (0.93,1.17)], with Kastina state showing the lowest risk [OR=0.39; CI (0.34,0.46)]. Children in Zamfara state experience notably different risks of fever and diarrhoea [OR=0.07; CI (0.05,0.10)]. Kaduna state reports the highest incidence of diarrhoea [OR=21.88; CI (15.54,30.82)], while Kano state has the lowest [OR=2.50; CI (1.73,3.63)]. In the Southeast, Imo state leads in fever incidence [OR=8.20; CI (5.61,11.98)], while Anambra state has the lowest [OR=0.40; CI (0.21,0.78)]. In Abia state, the risk of fever is comparable to that in Enugu state [OR=1.03; CI (0.63,1.71)], but the risks of fever and diarrhoea in Abia differ significantly [OR=2.67; CI (1.75,4.06)]. Abia state also has the highest diarrhoea rate in the Southeast [OR=2.67; CI (1.75,4.06)], with Ebonyi state having the lowest [OR=0.05; CI (0.03,0.09)]. In the South-South region, Bayelsa and Edo states have similar risks of fever [OR=1.28; CI (0.84,1.95)], with Akwa Ibom state reporting the highest fever rate [OR=4.62; CI (3.27,6.52)] and Delta state the lowest [OR=0.08; CI (0.02,0.25)]. Children in Bayelsa state face distinctly different risks of fever and diarrhoea [OR=0.56; CI (0.34,0.95)]. Rivers state shows the highest incidence of diarrhoea in the South-South [OR=10.50; CI (4.78,23.06)], while Akwa Ibom state has the lowest [OR=0.30; CI (0.15,0.57)]. In the Southwest, Lagos and Osun states have similar risks of fever [OR=1.00; CI (0.59,1.69)], with Ogun state experiencing the highest incidence [OR=3.47; CI (2.28,5.28)] and Oyo state the lowest [OR=0.18; CI (0.07,0.46)]. In Lagos state, the risks of fever and diarrhoea are comparable [OR=0.96; CI (0.57,1.64)], and the risk of diarrhoea is similar to those in Ekiti, Ogun, and Ondo states. Oyo state has the highest diarrhoea rate in the Southwest [OR=10.99; CI (3.81,31.67)], with Ogun state reporting the lowest [OR=0.77; CI (0.42,1.42)]. Children of mothers with more than secondary education are significantly less likely to suffer ARI [OR=0.35; CI (0.29,0.42)], whereas children of mothers without any education run a higher risk of diarrhoea [OR=2.12; CI (1.89,2.38)] and fever [OR=2.61; CI (2.34,2.91)]. Our analysis also indicated that household wealth quintile is a significant determinant of morbidity. The results in this paper could help the government and non-governmental agencies to focus and target intervention programs for ARI, diarrhoea and fever on the most vulnerable and risky under five groups and populations in Nigeria.

Impacts of climate change on diarrhoeal disease hospitalisations: How does the global warming targets of 1.5-2°C affect Dhaka, Bangladesh?

Dhaka is one of the world's densely populated cities and faces significant public health challenges including high burden of diarrhoeal diseases. Climate change is intensifying existing environmental problems including urban heat island effect and poor water quality. While numerous epidemiological studies have linked meteorological factors to diarrhoeal diseases in Bangladesh, assessment of the impacts of future climate change on diarrhoeal diseases is scarce. We provide the assessment of climate change impacts on diarrhoeal disease in Dhaka and project future health risks under climate change scenarios. About 3 million acute diarrhoea cases presenting to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) during 1981-2010 were linked to daily temperature, rainfall and humidity and association investigated using time series adapted negative binomial regression models employing constrained distributed lag linear models. The findings were applied to climate projections to estimate future risks of diarrhoea under various global warming scenarios. There was a significantly raised risk of diarrhoea hospitalisation in all ages with daily mean temperature (RR: 3.4, 95% CI: 3.0-3.7) after controlling for the confounding effects of heavy rainfall, humidity, autocorrelations, day of the week effect, long-term time, and seasonal trends. Using the incidence rate ratio (IRR) of 1.034, temperature increases based on the global warming targets of 1.5-2°C could result in an increase of diarrhoea hospitalisations by 4.5-7.4% in all age groups by the 2100s. These effects were more pronounced among <5 children where the predicted temperature increases could raise diarrhoea hospitalisation by 5.7% - 9.4%. Diarrhoea hospitalisation will increase significantly in Dhaka even if the global warming targets adopted by the Paris Agreement is reached. This underscores the importance of preparing the city for management and prevention of diarrhoeal diseases.

Factors Water Characteristic and Exclusive Breastfeeding as Predicting Diarrhea Under 5 Years

Background: The incidence of death diarrheal disease for children under 5 years are 5 million. The prevalence of diarrhea up to 24.8%. The exclusive breastfeeding for infants up to 6 months will provide immunity to against various diseases such as diarrhea. The proportion of Infants not exclusive breastfeeding up to 65.8%. Factors such as washing hands, consumption of drinking water are factors caused diarrhea in children. The study aims to known at the prediction of the risk of diarrhea and the dominant factors related the incidence of diarrhea in Kebumen District.Methods: The study design used case control. The population is mothers who have toddlers 1-4 years in the working area of Berbah Health Center Services was estimated 3,407 toddlers. The sample of case is a toddler who suffers from diarrhea and the control is a toddler who does not suffer from diarrhea in the surrounding environment. The sample was estimated of 50 cases of diarrhea and 50 control without diarrhea who qualified inclusion and exclusion criteria. The instruments were used questionnaires and medical records of diarrhea. Data were analysis with chi square test and logistic regression with 95% confidence interval.Result: Based on bivariate analysis shown that the exclusive breastfeeding was significant risk of diarrhea incidence OR = 3.22 (1.41-7.35). Based on Handwashing that the handwashing variable has no significant risk of diarrhea incidence OR = 1.792 (0.80-4.01). Based on multivariate analysis that exclusive breastfeeding significant caused diarrhea for children OR = 2.76 (95%CI: 1.18-6.47) whereas hand washing did not significantly cause diarrhea in children OR = 1.15 (95% CI: 0.66-3.64) and drinking water did not significantly affect diarrhea in children OR 2.19 (95% CI: 0.91-5.27).Conclusion: The study concluded that the dominant risk factor significantly for diarrhea in toddlers is exclusive breastfeeding.

High-Throughput Assay for Predicting Diarrhea Risk Using a 2D Human Intestinal Stem Cell-Derived Model.

Gastrointestinal toxicities (GITs) are the most prevalent adverse events (AE) reported in clinical trials, often resulting in dose-limitations that reduce drug efficacy and delay development and treatment optimization. Preclinical animal models do not accurately replicate human GI physiology, leaving few options for early detection of GI side effects prior to human studies. Development of an accurate model that predicts GIT earlier in drug discovery programs would better support successful clinical trial outcomes. Chemotherapeutics, which exhibit high rates of clinical GIT, frequently target mitotic cells. Therefore, we hypothesized that a model utilizing proliferative cell populations derived from human intestinal crypts would predict the occurrence of clinical GITs with high accuracy. Here, we describe the development of a multiparametric assay utilizing the RepliGut® Planar system, an intestinal stem cell-derived platform cultured in an accessible high throughput Transwell™ format. This assay addresses key physiological elements of GIT by assessing cell proliferation (EdU incorporation), cell abundance (DAPI quantification), and barrier function (TEER). Using this approach, we demonstrate that primary proliferative cell populations reproducibly respond to marketed chemotherapeutics at physiologic concentrations. To determine the ability of this model to predict clinical diarrhea risk, we evaluated a set of 30 drugs with known clinical diarrhea incidence in three human donors, comparing results to known plasma drug concentrations. This resulted in highly accurate predictions of diarrhea potential for each endpoint (balanced accuracy of 91% for DAPI, 90% for EdU, 88% for TEER) with minimal variation across human donors. In vitro toxicity screening using primary proliferative cells may enable improved safety evaluations, reducing the risk of AEs in clinical trials and ultimately lead to safer and more effective treatments for patients.

Acute toxicity patterns and their management after moderate and ultra- hypofractionated radiotherapy for prostate cancer: A prospective cohort study

ObjectiveHypofractionation has become the new clinical standard for prostate cancer. We investigated the management of acute toxicity in patients treated with moderate hypofractionation (MHF) or Ultrahypofractionation (UHF). MethodsIn a prospective cohort setting, patients (N=316) received either MHF (20 fractions of 3/3.1 Gy, 5 fractions per week, N=156) or UHF (7 fractions of 6.1 Gy, 3 fractions per week, N=160) to the prostate +/- (base of the) seminal vesicles between 2019 and 2023. UHF was not indicated in case of significant lower urinary tract symptoms (LUTS) or T3b disease. Patient-reported outcomes (PRO) were online distributed at baseline, end of treatment (aiming at last fraction +/- 3 days), 3 months. Acute toxicity rates, management, and associations with baseline factors were analysed using Chi-square test and logistic regression. CTCAE scores (version 5) were calculated. ResultsTreatment for acute urinary complaints was prescribed in 46 % (MHF) and 29 % (UHF). Taking into consideration baseline LUTS, MHF and UHF showed similar rates of PROs and management. Medication for acute gastrointestinal (GI) symptoms was prescribed for 21.1 % (MHF) and 14.1 % (UHF) with more loperamide for diarrhea in MHF (9.0 %) vs UHF (1.9 %, p = 0.005). Grade ≥ 2 (MHF / UHF) was scored in 40 % / 28 % for GI (p = 0.03) and 50 % / 31 % for GU (p < 0.01). PROs for GI reported after last fraction of UHF were significantly worse compared to before last fraction. ConclusionUHF was safe with respect to acute toxicity risks in the selected population. MHF is associated with risks of significant diarrhea which needs further investigation. Furthermore, optimal registration of acute toxicity for UHF requires measurements up to 1–2 weeks after the last fraction.

Association of habitual sleep duration with abnormal bowel symptoms: a cross-sectional study of the 2005–2010 national health and nutrition examination survey

ObjectivesNowadays, few studies have examined the relationships between sleep duration and abnormal gut health. In this study, we used data from the National Health and Nutrition Examination Survey (NHANES) to investigate the correlations between habitual sleep duration and abnormal bowel symptoms in adults.MethodsThis study included 11,533 participants aged ≥ 20 years from the NHANES conducted during 2005–2010. Chronic constipation and chronic diarrhea were defined based on the Bristol Stool Form Scale (BSFS) and frequency of bowel movements. Sleep duration was assessed based on the self-report questionnaire and classified into three groups: short sleep duration (< 7 h), normal sleep duration (7–9 h), and long sleep duration (> 9 h). Weighted data were calculated according to analytical guidelines. Logistic regression models and restricted cubic spline curves (RCS) were used to assess and describe the association between sleep duration and chronic diarrhea and constipation. Univariate and stratified analyses were also performed.ResultsThere were 949 (7.27%) adults aged 20 years and older with chronic diarrhea and 1120 (8.94%) adults with constipation among the 11,533 individuals. A positive association was found between short sleep duration and chronic constipation, with a multivariate-adjusted OR of 1.32 (95% CI: 1.05–1.66). Additionally, long sleep duration was significantly associated with an increased risk of chronic diarrhea (OR: 1.75, 95% CI: 1.08–2.84, P = 0.026). The RCS models revealed a statistically significant nonlinear association (P for non-linearity < 0.05) between sleep duration and chronic diarrhea. Furthermore, obesity was found to modify the association between sleep duration and chronic diarrhea and constipation (p for interaction = 0.044).ConclusionsThis study suggests that both long and short sleep durations are associated with a higher risk of chronic diarrhea and constipation in the general population. Furthermore, a non-linear association between sleep duration and these conditions persists even after adjusting for case complexities.

Actitan: A Natural Complex for Managing Diarrhea—Insights from Cross-Sectional Survey Research Involving Patients, Pharmacists and Physicians

Diarrhea continues to be a global health problem as acute diarrhea carries the risk of dehydration, while both acute and chronic diarrhea can significantly affect patients’ quality of life and reduce productivity. The innovative medical device Actitan, which consists of a complex of natural molecules, could be an effective option for the treatment of diarrhea from various causes. The aim of this post-market cross-sectional study was to evaluate the perceived efficacy, safety and usage pattern of the two formulations for adults (Actitan-P) and children (Actitan-F) among patients/child caregivers, physicians and pharmacists. Participants completed online questionnaires with closed multiple-choice questions that were rated on a verbal 5-point Likert scale. These surveys were conducted via the online platform Real World Data, which provides digital questionnaires for patients, doctors and pharmacists. Two separate surveys were conducted for the two formulations, with a total of 2630 participants (1488 participants for Actitan-P and 1142 participants for Actitan-F). Overall, the results indicate a high level of efficacy and safety of the product. In the case of Actitan-F, more than 96% of caregivers rated safety as good or excellent, and over 92% rated efficacy as good or excellent. Actitan-P also received positive feedback: nearly 86% of patients reported good/excellent efficacy, and more than 93% rated safety as good or excellent. These positive evaluations were confirmed by physicians and pharmacists, who also did not report adverse effects. In summary, this study confirms the role of Actitan as a safe and effective option for the treatment of diarrhea of different causes and in different patient groups, including young children.

Water, sanitation, and hygiene–specific risk factors of recent diarrheal episodes in children aged under 5 years: analysis of secondary data from the multiple indicator cluster survey (MICS 2019)

ObjectivesAccess to safe drinking water, sanitation, and hygiene, collectively called WASH, is a fundamental human right and a cornerstone of public health. However, inadequate WASH practices and environments significantly contribute to the global burden of diarrheal diseases, particularly, in children aged under 5 years. Inadequate WASH conditions are the primary drivers of various infectious diseases, including cholera, dysentery, hepatitis A, typhoid, and polio. MethodsWe conducted secondary data analysis using the 2019 Zimbabwe Multiple Indicator Cluster Survey to investigate the specific WASH risk factors associated with recent diarrheal episodes in children aged under 5 years. ResultsA total of 853 (14%) of 6092 children were reported to have experienced an episode of diarrhea in the last 2 weeks preceding the survey. Having insufficient water in the household was associated with 17.0% diarrhea episodes compared with 13.6% in those who did not face this problem. The availability of soap or detergents to wash hands was associated with a risk of diarrhea, with an odds ratio and 95% confidence interval of 1.19 (1.01-1.40), P = 0.033. The use of surface water, including rivers, dams, lakes, ponds, streams, canals, and irrigation channels, was associated with differences in diarrheal episodes, although this was of borderline significance, P = 0.082. Of the children who had a recent episode of diarrhea, 41.0% had their parents or caregivers seeking medical attention. ConclusionsThere is need for an improvement in safe water supply to households and an improvement in health education on the importance of using soap after using the toilet to avoid contamination of food and water.

The Impact of Saline Water on Women's Health in the Coastal Region of Bangladesh: Special Attention on Menstrual Hygiene Practices.

Introduction Salinity intrusion is the most common global concern along coastlines, but it can happen inland also. The lack of freshwater is the primary issue affecting the coastal areas. Many health problems are prevalent among the inhabitantsdue to their frequent use of salted water. The health of women living along the coastline is getting progressively compromised due to salinity intrusion. Objectives The study aims to determine menstrual health practices and other health problems faced bywomen in the coastal region of Bangladesh. Methods The study was conducted using a survey research designfrom May 2023 to October 2023 on rural women aged 18 to 45 years, who lived in the Bangladeshi village of Koyra Upazila in the Khulna district. Thesample size of the study was 101. Open- and closed-ended questions from a planned interview schedule were used to gather primary data. Additional information from appropriate sources, e.g., newspapers, publications, and books, was utilized to enhancethe comprehensiveness of statistical analysis and support rationality. A p-value of 0.05 was considered significant. Statistical analysis was performed using STATA version 15 (StataCorp LLC, College Station, TX). Results Menstrual hygiene practices showed a higher prevalence of using fabric rags and reusing them after rinsing them in salt water (72.3%) than sanitary pads (25.7%). It was observed that the risk of diarrhea among tubewell water and rainwaterusers was significantly lowered by 0.25 times (95% CI = 0.06, 0.99; p = 0.049) and 0.06 times (95% CI = 0.01, 0.43; p = 0.005), respectively, compared to pond water users. Conclusion Salinityhas a significant impact on the livelihoods and health of coastal women. The village womenare unaware of the health risks of excessive saline water use. Establishing an adequate supply of freshwater reservoirsfor the entire communitythroughout the yearis analternativefor womento use as a source of water for hygiene necessities.