Impact of COVID-19 on admission due to diarrhea to the emergency department of the largest specialized Pediatric Hospital, Kinshasa, the Democratic Republic of the Congo: A retrospective analysis

Context and objective. The COVID-19's lockdown effect on pediatric healthcare utilization has been demonstrated. However, little is known about this impact on the burden of diarrheal diseases among children in sub-Saharan Africa. This study aimed at studying the impact of the COVID-19 pandemic on admissions due to diarrhea into the largest specialized Pediatric Hospital in the city of Kinshasa. Methods. A retrospective study was conducted on diarrhea cases admitted into the emergency department of the Kalembe-Lembe Pediatric Hospital between January 1st and July 31st of 2019 and 2020. Variables were compared during the pandemic's lockdown period in 2020 to the equivalent period in 2019. Results. Overall, 422 medical records were examined. A 45% drop in diarrhea cases was observed in the pediatric emergency department between the study periods in 2019 and 2020. Daily admissions were significantly higher in 2019 than in 2020 (p < 0.001). The majority of patients were admitted with moderate dehydration in 2019 than in 2020 (p < 0.001) but an increase in proportion of patients with mild and severe dehydration was observed in 2020 than in 2019 (p < 0.001). The hospitalization rate was significantly higher in 2019 than in 2020 (p < 0.001). Conclusions; The COVID- 19's restrictions led to a substantial decrease in admissions due to diarrhea among children to the pediatric emergency department. Public health interventions are needed to promote an ambulatory healthcare system during future crises.

Contexte et objectif. L'effet de confinement dû à la COVID-19 sur l'utilisation des soins pédiatriques a été démontré sous d'autres cieux. Cependant, on en sait peu concernant cet impact sur le fardeau des maladies diarrhéiques chez les enfants en Afrique subsaharienne. Cette étude visait à rechercher l'impact de la pandémie à COVID-19 sur les admissions dues à la diarrhée dans un hôpital pédiatrique. Méthodes. Etude documentaire des cas de diarrhées recensés, au service des urgences de l'hôpital pédiatrique de Kalembe-Lembe, entre les 1er janvier et 31 juillet 2019 et 2020. Les variables ont été comparées, entre la période du confinement de la pandémie en 2020 et la période équivalente en 2019. Résultats. Au total 442 dossiers médicaux ont été colligés. Une baisse de 45 % d'admissions des cas de diarrhée a été observée, aux urgences pédiatriques pendant le confinement. Les admissions quotidiennes étaient significativement plus élevées en 2019 qu'en 2020 (p <0,001). La majorité des patients ont été admis avec une déshydratation modérée en 2019 qu'en 2020 (p <0,001) mais une augmentation de la proportion de patients avec une déshydratation légère et sévère a été observée en 2020 par rapport à 2019 (p <0,001). Le taux d'hospitalisation était significativement plus élevé en 2019 qu'en 2020 (p <0,001). Conclusion. Les restrictions dues à la COVID-19 ont conduit à une diminution substantielle des admissions dues à la diarrhée chez les enfants aux urgences pédiatriques. Des interventions de santé publique sont nécessaires pour promouvoir un système de santé ambulatoire lors d'une telle crise dans un proche avenir.

The role of Escherichia coli in the etiology of piglet diarrhea in selected pig producing districts of central Uganda

Background: Pig production in Uganda is highly constrained by rampant piglet mortalities with diarrhea being a key feature. The present study was conducted to determine possible involvement of Escherichia coli (E. coli) as agents of diarrhea in piglets and elucidate the factors for their spread and virulence, towards development of mitigation strategies in the smallholder pig value chains in Uganda. Methodology: This was a cross-sectional study carried out from January to August 2020 on pre- and post-weaned piglets from households in Kayunga and Mityana districts of Central Uganda, selected by snowballing method to redundancy. Data about herd management and risk factors for colibacillosis were collected from selected farmers in the two districts. A total of 179 faecal samples were collected from randomly selected neonatal and pre-weaning piglets for bacteriological isolation of Escherichia coli. Virulence (enterotoxin and fimbrial) genes from the isolates were detected by multiplex polymerase chain reaction (PCR) assay. Results: From the 179 faecal samples, a total of 158 (88.3%) E. coli isolates were obtained. Virulence gene markers were detected in 18.4% (29/158) of the isolates. Among the investigated genes encoding for enterotoxin production, STb was the most prevalent (16/158, 10.13%), followed by STa (12/158, 7.59%), while gene for LT was not detected. The gene coding for F4 adhesin was the only one detected while F18 adhesin was not detected from the isolates. On multiple logistic regression analysis, only tertiary educational level (OR=0.141; 95% CI=0.30-0.666; p=0.013) and infrequent use of antibiotics (OR=0.231, 95% CI=0.062-0.859; p=0.029) among the farmers, were the two factors significantly protective of the piglets from diarrhoea. Conclusion: This study reports a high prevalence of enterotoxin gene markers among E. coli isolates in piglets and revealed the potential role of these bacteria in the aetiology of piglet diarrhoea and mortalities in Uganda. Additionally, this study identified risk factors that can be useful in formulating treatment and control strategies of infection caused by these bacteria. Further studies are needed to identify more adhesins these E. coli isolates employ for intestinal colonization, a step that will help inform vaccine development.

Socio-demographic determinants of diarrhoeal diseases among under five years old children in Rwanda

Background Diarrhoeal disease is a worldwide public health issue and remains a major cause of mortality and morbidity in children under five years old. Low and middle income countries (LMIC) of Africa and part of Asia are more affected by diarrhoeal diseases. Objectives To measure the prevalence of Diarrhoeal Diseases and to assess Socio-demographic determinants among Under Five Years Old Children in Rwanda. Methods A cross-sectional design was used. Secondary data analysis was carried out on a sample of 7474 drawn from Rwanda Demographic and Health Survey (RDHS). RDHS used multistage sampling technique. Results After running multiple logistic regression, Sociodemographic determinants associated with diarrhoeal included age of children, wealth index category, mother education, husband/partner education, types of place of residence (P-Value) Conclusion The results of the study showed that diarrhoeal remains an important health issue in Rwanda. Occurrence of diarrhoeal was statistically associated with child age, wealth index, education of parents, types of place of residence.

Environmental and nutritional determinants of diarrhoea disease among children under five years in Rwanda: A secondary data analysis of the Rwanda demographic and health survey 2014-15

Background Diarrhoea remains one of the leading of causes of deaths in children under five years old globally. Children under five years are more vulnerable to diarrhea especially those from low and middle countries. The aim of this study was to explore the environmental and nuttitional factors associated with diarrhea among children underfive years in Rwanda. Methods A secondary data analysis of the Rwanda Demographic and Heralth Survey 2014-2015 (RDHS 2014-2015) was used. A total sample of 7,558 children under five years old was included. The data were analysed using Stata 13. Bivariate with Chi-square test and multivariable logistic regression analysis were performed to assess the relashionship of factors associsted with diarreha. A 95% confidence interval and a significance level of 0.05 were set. Results Two environmental factors (Source of drinking water and shared toilets facilities with other households) were associated with child diarrhea. Pvalues: 0.029, OR:1.79, CI [1.06-3.01]; 0.019, OR:1.26, CI: [1.04-1.53] respectively. None of the selected nutritional factors was associated with childhood diarrhea. Conclusion Based on the findings, drinking borehole water and shared toilet facilities were associated with diarrhea. The study therefore recommends the provision of potable water and supporting/enabling the households to own toilets.

Epidemiology and factors associated with diarrhoea among children under five years of age in the Engela District in the Ohangwena Region, Namibia

Background: Diarrhoea remains a public health problem and an important cause of morbidity and mortality amongst children, mainly in low- and middle-income countries. In Namibia, the national prevalence of diarrhoea was 17%; it was responsible for 5% of all deaths in children under 5 years old and is the second leading cause of death. Aim: The purpose of this study was to assess the epidemiology and factors associated with acute diarrhoea amongst children less than 5 years of age in Engela district in the Ohangwena region, Namibia. Setting: The study was conducted in Ohangwena Region in Namibia which extends east to west along the borders of the southern part of Angola. Methods: A cross-sectional study was conducted. A structured questionnaire was administered through face-to-face interviews. Descriptive statistics were used to describe the socio-demographic and epidemiological data of diarrhoea and logistic regression analysis was used to determine the factors associated with the prevalence of diarrhoea. Results: The study found a prevalence of 23.8% for diarrhoea in the 2 weeks period preceding the survey amongst children aged under 5 years. The prevalence of diarrhoea was statistically significantly associated with children (p < 0.05). The strongest predictor of the prevalence of diarrhoea was the residential area 'informal settlement', with an odds ratio of 36.42. This implies that children living in the informal settlement are 36.42 times at risk of contracting diarrhoea as compared to those living in other residential areas. Conclusion: epidemiology; factors; diarrhoea; under-5 years children; Engela district; Ohangwena region; Namibia

Intestinal parasites among HIV/AIDS patients attending University of Gondar Hospital, Northwest Ethiopia

Background: Opportunistic intestinal parasitic infections are the major public health problem among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. In the absence of anti-retroviral therapy (ART), HIV/AIDS patients in developing countries such as Ethiopia continue to suffer from the consequences of intestinal parasites. This study aimed to determine the prevalence of opportunistic and other intestinal parasites among on-ART HIV/AIDS patients. Methods: A comparative cross-sectional study was conducted from December 2015 to January2016 among pre-ART and on-ART adult HIV/AIDS patients at University of Gondar Hospital, northwest Ethiopia. A pre-tested structured questionnaire was used to collect data on socio-demographic and associated risk factors. Systematic random sampling was used to select the study participants. Stool samples were collected and processed using a direct, wet-mount, formol-ether concentration technique and modified Ziehl-Neelsen staining technique. The CD4 counts were estimated by using the BD FACS Count system. Data were entered and analyzed using SPSS 20 software. Results: A total of 150 study participants (48ARTnaïve and102 on ART) were included in the study. The overall prevalence of intestinal parasitic infections was 45.3% ­ 25.3% in pre-ART patients and 20% in on-ART patients. Two thirds (8/12) of opportunistic parasitic infections were found in the ART-naïve patients and significantly associated with CD4 counts <200 cells/mm3. Those who have no toilet [AOR=5.21, 95% CI: 1.82, 16.03], source of water from stream [AOR = 2.8; 95% CI: 1.05, 7.72], who have diarrhea [AOR = 11.38; 95% CI: 4.69, 15.61], WHO stage III [AOR =5.3; 95% CI: 2.47, 11.56] and ART status [AOR = 4.2; 95% CI: 2.02, 8.77] were significantly associated with the prevalence of intestinal parasites. Key words: Opportunistic intestinal parasites, CD4 T-cells, Anti-retroviral therapy, diarrhea, Gondar

Enteropathogens in under-five children with diarrhea in health facilities of Debre Berhan Town, North Shoa, Ethiopia

BACKGROUND: Diarrheal disease is a major cause of mortality and morbidity for under-five children in Ethiopia. The purpose of this study was to investigate the behavioral and socioeconomic risk factors, etiology, and drug susceptibility of bacteria isolated from under-five children with acute diarrhea who were treated at Debre Berhan Referral Hospital or Health Center in Ethiopia. METHODS: A health facility based cross-sectional study design was used to investigate enteropathogens from 163 under-five children with acute diarrhea. After obtaining written consent from parents or guardians, data were collected using a standardized questionnaire. Freshly passed stool samples were collected for microbiological tests for bacteria and parasites. The chi-square test was used for assessing the relationships of variables. RESULTS: Enteropathogens were detected among 55.8% (91/163) participants. There was a 46%(75/163) bacterial culture positivity rate and a 9.8%(16/163) prevalence of parasites. The isolated enteropathogens were Escherchia coli, Klebsiella specie, Proteus species, Salmonella species, Shigella species, Enterobacter species, Giardia lamblia, Enteameba histolytica, Ascaris lumbricoides, Trichuris trichiura and Hymnoleps nana. Level of antimicrobial resistance of bacterial isolates ranged from 0 to 87.2%. Poor hand washing and poor cleaning of feeding utensils showed significant association with the presence of enteropathogens. CONCLUSION: Bacterial enteropathogens with drug resistance were observed in this study. Continuous health education and promotion about diarrheal disease for mothers/caretakers and regular surveillance of entropathogenes are recommended to reduce under-five mortality

Enteric pathogens and antimicrobial susceptibility profile among pediatric patients with diarrhea in Addis Ababa, Ethiopia

Background: Diarrheal disease remain a major public health problem in developing countries including Ethiopia. The current study was designed to isolate medically important bacterial enteric pathogens and assess the antimicrobial susceptibility pattern for prescribed drugs. Methods: A cross-sectional study was performed between November 2016 and May 2017 to determine bacterial enteric pathogens that cause diarrhea and assess their antimicrobial susceptibility profile. Stool specimens from pediatric patients aged 0-14 years were collected from two health centers and one specialized hospital to identify bacterial enteric pathogens. Antimicrobial susceptibility tests were performed on bacterial isolates using the Kirby-Bauer disc diffusion method. Results: Out of 290 study patients with diarrhea examined, the majority of bacterial enteropahogens isolated in the study were Shigella species 22(7.6%) followed by enterohemorrgic E.coli O157:H7 13(4.5%) and Salmonella species 7(2.4%). Among the Salmonella species 42.9% showed resistance to trimethoprim-sulphamethoxazole. Among the Shigella species, 77.3% were resistant to ampicillin and 68.2% to trimethoprim-sulphamethoxazole whereas E.coli O157:H7 strains were resistant mostly to ampicillin (69.2%), and trimethoprim-sulphamethoxazole (46.1%). The overall prevalence of multi-drug resistance (MDR) (to ≥3 classes of antibiotics) among the isolates was 26.2%. Conclusion: Salmonella species, enterohemorrhagic E.coli O157:H7and Shigella species were the most frequently isolated pathogens in children with diarrhea. A high proportion of the Salmonella and Shigella isolates identified in the study showed resistance to the most frequently prescribed drugs ampicillin and trimethoprim-sulphamethoxazole. Ciprofloxacin was found to be the best drug of choice for the treatment of diarrhea caused by Salmonella and Shigella. When antibiotics are indicated to treat diarrhea in children, clinicians should rely on stool culture and antimicrobial susceptibility testing before prescribing drugs

Survey on visual acuity among intra-city commercial vehicle drivers in Ibadan, southwestern Nigeria

Driving is recognized to be a visually intensive task and accordingly legal minimum standard of vision required for all motorists is stipulated. This study was carried out to find out how many commercial drivers in Ibadan North L.G.A met minimum legal requirement for driving in Nigeria. A cross sectional descriptive study was conducted among 340 commercial vehicle drivers selected by multistage sampling from eight transport stations (motor parks) in the city. Visual impairment was defined as vision acuity (VA) in both eyes which is below 3/18 but above 3/60 (VA <6/18≥3/60) and was assessed with the Snellen's chart. All participants have valid driving licenses. One sixth [52, (15.3%)] have visual acuity below 6/9 and 18 (5.3%) have visual impairment (VA <6/18≥3/60). More of those drivers aged 40 years and more had visual impairment compared to the younger drivers (P<0.05). These findings suggest that regulatory standards for licensing drivers are being circumvented by some of the drivers. Mechanisms for ensuring compliance to the regulatory standards especially visual acuity is therefore recommended

Assessment of the relationship between water insecurity, hygiene practices, and incidence of diarrhea among children from rural households of the Menoua Division, West Cameroon

The objectives of a cross-sectional, semi-quantitative study were to: i) assess the prevalence of water insecurity and its association with water access-related behaviors such as time, distance, and sources of water; ii) identify major themes of concern raised in reference to anxiety, water quality/quantity, and perceived health risk domains of water insecurity, and; iii) examine the relationship between water insecurity, hygiene practices, and diarrhea lincidence among children in rural areas of the Menoua Division in the Western Region of Cameroon In-person interviews were conducted with 18 years or older women living with at least one child between 2 and 5 years old (n=134). Participants spent on average 17±12 minutes walking to a drinking water source. Prevalence of water insecurity was 58%, and it was associated with a lower hygiene score among caretakers, i.e., hygiene score of water secure: 9.2±1.2 vs. insecure: 8.2±2.2, F(1, 132)=8.096, P<0.01). Overall, the incidence of diarrhea among children was 18%, and it was significantly higher among water insecure house-holds (79%) compared with secure house-holds (21%, P=0.02). In conclusion, access to improved sources of water is an issue in rural areas. Addressing water insecurity is critical in promoting optimal health and development of children due to its association with poor hygiene practices among caretakers

Breastfeeding and common childhood diseases in Zambia: does breastfeeding have a protective effect against diarrhea, fever and acute respiratory infections among children in Zambia?

Background: This paper aimed at answering two specific questions: does breastfeeding reduce the occurrence of ARIs, Fever and Diarrhea in children who are breastfeeding; and is the occurrence of these common childhood diseases affected by duration (period) of breastfeeding? Data source and Method: Secondary analysis of the 2013 Zambia Demographic and Health Survey (ZDHS) was applied by using the children recode dataset (ZMKR61FL). Analysis was done at three levels: Descriptive, bivariate and multivariate (Binary and Multinomial Logistics regressions). Results: Results in this paper show that breastfeeding does not protect children against Diarrhea (OR 1.3; 1.1-1.4) but does so against Fever and ARIs (OR 0.9; 0.8-1.0). Children whose mothers were employed were more likely to suffer from all the three disease outcomes compared to those not employed (OR Diarrhea 1.2; Fever 1.5; ARIs 1.2). Conclusion: Diarrhea seems to be more pronounced in children who are breastfeeding than those not breastfeeding, especially those breastfed beyond 6 months

Prescribing practices in the management of childhood diarrhoea in primary health care centres in a sub-urban community in Nigeria

Background: Childhood diarrhoea remains the second leading cause of morbidity and mortality among children under the age of five. Oral rehydration therapy and zinc tablets are the cornerstone for its management both at home and in the health facilities. Primary health care is the first level of contact of individuals and communities with the health care system and appropriate prescription is crucial for sustainable health benefits. This study assessed the prescribing pattern for childhood diarrhoea management and determined the appropriateness of treatment for acute watery diarrhoea without comorbidities in Primary Health Care (PHC) facilities in a sub-urban community in Nigeria.Methods: This descriptive study was done in 19 PHC facilities in Ikorodu Local Government Area of Lagos State, Nigeria. A retrospective review of 1271 prescriptions for diarrhoeal cases of children between 6 to 59 months was done using the records from the Outpatient Department register for a period of one year. Descriptive analysis was done. Results: From the cases reviewed, 1239 (97.5%) had acute watery diarrhoea (AWD), either alone 819 (64.4%), or with malaria/fever 347 (27.3%), cough/URTI 59 (4.6%), and other conditions 14 (1.1%). For cases of AWD alone, there were 499 (60.9%) prescriptions for ORS/Zinc, 249 (30.4%) for antibiotics and 203 (28.4%) for antimalarials. Antibiotic and antimalarial injections were also included in the prescriptions.Conclusion: This study found the prescription pattern for childhood diarrhoea to be inadequate with suboptimal prescriptions of ORS/Zinc. The prescriptions of antibiotics and antimalarials for acute watery diarrhoea was high and unnecessary

Etiology and pathogenicity of bacterial isolates: a cross sectional study among diarrheal children below five years in central regions of Kenya

Introduction: bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education.Methods: a cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable.Results: there were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%).Conclusion: salmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001)

Determinants of antibiotic prescription in paediatric patients: The case of two hospitals in Maputo, Mozambique

Background. The need for healthcare in paediatric patients is often due to respiratory diseases, acute diarrhoea and viral fever, which suggests a limited need for the use of antibiotics.Objectives. To identify the determinants of antibiotic prescription in hospitalised paediatric patients in Mozambique.Methods. A cross-sectional study was conducted between January and June 2015. A total of 454 medical prescriptions and clinical records of children aged 0 - 14 years from Hospital Central de Maputo (HCM) and Hospital Geral de Mavalane (HGM) were analysed.Results. Antibiotics were used in 97.6% of the patients, with no significant differences (p>0.05) in the prescription rates of the hospitals. The most commonly used antibiotics were beta-lactams (57.3%), aminoglycosides (28.3%) and co-trimoxazole(9.4%). Antibiotics were prescribed in all cases of bronchopneumonia, fever, sepsis and acute gastroenteritis. For malaria and undefined diagnoses, antibiotics were prescribed 97.8% and 99.3% of cases, respectively. It was clear that most severe clinical conditions (odds ratio (OR) 9.06; 1.13 - 12.14) and age <5 years (OR 5.47;1.54 - 7.60) were treated with antibiotics.Conclusion. The prescription of antibiotics for paediatric patients at both HCM and HGM was largely influenced by patients' clinical condition and age. It showed that physicians used an empirical approach, in the absence of laboratory tests, often leading to unnecessary antibiotic treatments with negative causative effects. Physicians should be encouraged to use an evidence-based approach for managing the cases correctly

Copro-antigen versus classical microscopy as diagnostic tool for giardia lamblia infection in Egyptian patients

Background: Giardia lamblia, a flagellate protozoa, is a one of the most common causes of non-viral (parasitic) diarrheal illness in humans. Laboratory diagnosis mainly consists of direct microscopic examination of stool specimen for trophozoites and cysts. However, due to intermittent fecal excretion of the parasite, the patient may be misdiagnosed, continue excreting the parasite and infecting others. Therefore, other methods of diagnosis should be looked for, which overcome the drawbacks of microscopy when used alone for diagnosis. The present study aimed to evaluate the efficacy of coproantigen detection by ELISA test in comparison to direct microscopy in the diagnosis of G. lamblia in stool specimens from patients with diarrhea and other gastrointestinal symptoms. Patients and methods: stool samples were collected form 250 child included in the present study (150 symptomatic and 100 apparently healthy as a control group) aged between 1-10 years old, and subjected for direct microscopic examination and ELISA test for copro-antigen detection. Results: out of 250 stool samples, 53 specimens (21.2%) were positive for Giardia by direct microscopy, while 68 specimens (27.2%) were positive by ELISA test. Conclusion: ELISA test for copro-antigen detection in stool samples is a rapid and effective method with high sensitivity and specificity for diagnosis of giardiasis in stool specimens even when the parasitic count is low, thus reducing the chances of missing even in the asymptomatic cases

Accès à l'assainissement, eau et maladies diarrhéiques des enfants dans les ménages de Bamendjou, Cameroun

Introduction : Les maladies diarrhéiques sont une importante cause de morbidité et mortalité chez les nourrissons et les jeunes enfants dans les pays en voie de développement. Le district de santé de Bamendjou, à l'ouest Cameroun, n'en est pas épargné.Objectif : Principalement, il était question de mesurer l'association entre la qualité de l'eau de boisson, assainissement dans les ménages et les cas de diarrhées chez les enfants de moins de cinq ans.Matériel et méthode : Il s'agissait d'une étude cas-témoins. La population cible était les enfants de moins cinq ans résidant dans le district de santé de Bamendjou. Une approche adaptée de l'autopsie verbale en communauté était utilisée pour diagnostiquer les cas de diarrhées. Chaque cas était apparié à deux témoins. L'analyse des données s'est faite par régression et test de Khi2 à l'aide de l'outil Epi-info 7.1.4.0. Une valeur de P inférieure à 5% était considérée comme significative.Résultats : Sur 99 enfants (33 cas et 66 témoins), 38,71% des cas de maladies diarrhéiques, issus des ménages n'utilisant pas une source d'eau améliorée contre 30,8% des ménages utilisant une source d'eau améliorée (OR = 1.4535 ; IC = 0,582- 3,432). Sur les 33 cas diarrhéiques, 63,6% étaient issus des ménages n'utilisant pas de toilettes améliorées contre 36,3% issus ménages utilisant les toilettes améliorées (OR = 7,1346 ; CI = 2,805- 18,142).Conclusion : Les cas diarrhéiques sont attribuables à un accès limité à l'assainissement. Nous recommandons la mise en place d'un projet de promotion d'hygiène et assainissement dans le district de santé de Bamendjou

A community-wide cholera outbreak caused by drinking unsafe water: Kasese District, Western Uganda, February ­July 2015

Introduction: Kasese District is prone to cholera outbreaks and this was its third outbreak in 15 years. In May 2015, Kasese District reported a cholera outbreak that had lasted 3 months and caused >100 infections. A team from Ministry of Health set out to support the local response team in identifying the mode of transmission and informing control measures.Methods: we defined a suspected case as onset of acute watery diarrhoea from 1st February 2015 onward; a confirmed case was a suspect case with Vibrio cholerae cultured from a stool sample. We reviewed medical records for case finding and conducted a case-control study to compare the exposures of 49 confirmed cases with those of 201 asymptomatic controls, matched by village and age group. We conducted environmental assessments and tested water samples for faecal contamination.Results: we identified 183 suspected cases including 61 confirmed cases (serotype inaba) and 2 deaths from February to July. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in persons aged 5-14 years (4.1/10,000). Stratified epidemic curves showed that the outbreak started in Bwera Sub-county bordering the Democratic Republic of Congo, and spread eastward. 94% (46/49) of cases compared with 75% (152/201) of controls drank water without boiling or treatment (ORM-H = 5.9; 95%CI = 1.6-22). The main water sources, public piped water (consumed by 39% of cases and 38% of controls) and stream water (consumed by 29% of cases and 24% controls), both had high levels of E. coli, a marker of faecal contamination. Environmental assessment revealed evidence of open defaecation along the streams. No food items were significantly associated with illness.Conclusion: drinking unsafe water contaminated by feces caused this outbreak. We recommended rigorous disposal of patients' feces, chlorination of piped water, and drinking boiled or treated water. The outbreak stopped 6 weeks after initiating implementation of these control measures

Prevalence and genetic diversity of rotavirus infection in children with acute gastroenteritis in a hospital setting, Nairobi Kenya in post vaccination era: a cross-sectional study

Introduction: Rotavirus is the leading cause of severe diarrhoea among infants and young children. Each year more than 611 000 children die from rotavirus gastroenteritis, and two million are hospitalized, worldwide. In Kenya, the impact of recent rotavirus vaccinations on morbidities has not been estimated. The study aimed at determining the prevalence and identity of rotavirus strains isolated from rotavirus-associated diarrhoea in vaccinated children presenting with acute gastroenteritis.Methods: Two hundred and ninety eight specimen from children presented at Gertrude Childrens' Hospital from January to June 2012 were tested by EIA (Enzyme-linked Immunosorbent Assay) for rotavirus antigens. Molecular characterization was conducted on rotavirus-positive specimens. Extracted viral RNA was separated by polyacrylamide gel electrophoresis (PAGE) and the specific rotavirus VP4 (P-types) and VP7 (G-types) determined.Results: The prevalence rate of rotavirus was 31.5% (94/298). Of the rotavirus dsRNA, 57 (60.1%) gave visible RNA profiles, 38 (40.4%) assigned long electropherotypes while 19 (20.2%) were short electropherotypes. The strains among the vaccinated were G3P [4], G12P [6], G3P [6], G9P [4], G mixed G9/3P [4] and G1/3P [4]. Specifically, the G genotypes were G9/3 (5.3%), G9 (4.3%), G3 (4.3%), G12 (2.1%) and mixed G1/3 (1.1%). The P genotypes detected were P [4] (5.3%) and P [6] (5.3%).Conclusion: The present study demonstrates diversity in circulating genotypes with emergence of genotypes G3, G9, G12 and mixed genotypes G9/3 and recommends that vaccines should be formulated with a broad range of strains to include G9 and G12

Facility-Based Treatment of Under Five Diarrhoea in Cross River State: A Clinical Audit

Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks second among the top 10 priority child health problems in Nigeria. The World Health Organization (WHO) has recommended some cost-effective; evidence- based interventions for diarrhoea case management. It is needful to evaluate the current practice in the treatment of diarrhoea in under-fives in health facilities in the country.Objective: To determine the extent to which current treatment practice for diarrhoea in underfives conforms to the WHO recommendation.Method: A clinical audit was conducted between May and June 2013 in 32 health facilities in the Southern Senatorial district of Cross River State; Nigeria. Trained field workers extracted information from patients' case records using a validated audit tool. Treatment was checked as appropriate; inappropriate; wrong or none; based on prescription on patients' case records.Result: Of the 370 case records audited; prescription for diarrhoea was appropriate in 40 (10.8%); inappropriate in 231 (62.4%); wrong in 82 (22.2%) and no prescription was made in 17 (4.6%).Conclusion: Treatment of diarrhoea in under-fives in health facilities in the State is suboptimum. Retraining of health workers on the current WHO and UNICEF treatment guidelines is highly recommended

Prevalence of rotavirus among children under five years of age with diarrhea in Kaduna State, Nigeria

Rotavirus (RV) is a major etiological agent of acute infantile gastroenteritis and is associated with 20%-25% of diarrhea cases in infants. Nigeria continues to be among the first five countries with greatest number of RV disease associated deaths per year. The objective was to determine some demographic factors that might be associated with rotavirus diarrhea among children in Kaduna State. From September 2013-August 2014, 401 diarrheic stool samples were collected from children under 5 years of age in Kaduna State, Nigeria and analyzed for RV antigen using ELISA. An overall RV prevalence of 32.2% (129/401) was obtained with the infection occurring throughout the study period. The infection was higher in males (33.0%:63/111) compared to females (31.4%:66/210). The highest burden was detected in children 25 -36 months of age (37.3%:22/59). Highest prevalence was detected in children whose parents had primary education (35.8%:19/53) and those whose parents were civil servants (35.6%:36/101). There was no statistically significant association between breast feeding and RV infection (P> 0.05). The study has revealed that rotavirus remains an important cause of acute diarrhea in children under five years in Kaduna State, Nigeria. Hence the need to introduce the vaccines into the childhood immunization program in the country