The Burden and Etiology of Childhood Diarrhea in Asia and Africa
Targeting five pathogens — rotavirus, Cryptosporidium, Escherichia coli (enterotoxigenic and enteropathogenic), and Shigella — could substantially reduce the burden of childhood diarrhea in developing countries.
Worldwide, diarrhea accounts for about 10% of all deaths in children aged <5 years. The prospective, case-control Global Enteric Multicenter Study was designed to better define the burden and etiology of diarrheal disease in infants and young children in sub-Saharan Africa and South Asia.
Between December 2007 and March 2011, children aged 59 months treated for new-onset, moderate-to-severe diarrhea at sentinel health centers were enrolled, each along with one to three randomly selected matched controls (total, 9439 cases and 13,129 controls). Using standardized methods across sites in seven countries, investigators collected clinical and epidemiologic data and fecal samples and followed up about 60 days later.
Four pathogens — rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli producing heat-stable toxin, and Shigella — were significantly associated with diarrhea at all seven study sites; Aeromonas, Vibrio cholerae O1, and Campylobacter jejuni were important at some sites. Rotavirus had the highest attributable fraction of any pathogen. The dominant pathogens by age were rotavirus and Cryptosporidium in infants, rotavirus and Shigella in toddlers, and Shigella and rotavirus in children. The overall annual incidence of diarrhea per 100 child-years was 31 in infants, 23 for toddlers, and 8 for children. Most deaths (88%) occurred before age 24 months. The odds of death during the follow-up period were 8.5-fold higher in case-children than in controls. Linear growth faltering — a risk factor for death — was significantly more common case-children than in controls.
CITATION(S):
Kotloff KL et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): A prospective, case-control study. Lancet 2013 May 14; [e-pub ahead of print].
Natchu UCM and Bhatnagar S. Diarrhoea in children: Identifying the cause and burden. Lancet 2013 May 14; [e-pub ahead of print].
