Disease Severity and Common Etiology of Diarrhea among Children Under-five in Mirzapur, Rural Bangladesh.

Aim: There is lack of information on the severity of diarrheal disease with etiology. Thus the study aimed to compare the etiology of under-five children with moderate-to-severe disease (MSD) and mild disease (MD). Study Design: Diarrheal disease surveillance. Place and Duration of Study: Mirzapur Kumudini Hospital, Tangail, rural Bangladesh, January 2010 – December 2011. Methodology: Overall, 2,324 under-5 diarrhea children were enrolled in the hospital who came from the demographic surveillance system (DSS) catchment area. Whole stool samples were collected from each enrolled child to detect rotavirus, Shigella, ETEC and V. cholerae. Information on socio-demographic and clinical characteristics was also collected. Results: Among all the study children, 1,098 (47%) were aged 0-11 months; 789 (34%) were 12-23 months, and 437 (19%) were 24-59 months. Rotavirus (33%) was mainly responsible for diarrhea amongst children under-5 and 90% of them were less than 2 years. Shigella represented 14%; of which, 45% were 24-59 months old. However, ETEC and V. cholerae represented only 3% and 2% respectively. Shigella was the most commonly detected pathogen (27%) for MSD followed by rotavirus (16%). Conversely, rotavirus (43%) was responsible for MD. MSD were most likely to be infected with Shigella flexneri [OR-9.81; 95% CI (6.38, 15.18)] and Shigella sonnei [6.29; (3.67, 10.87)] compared to their counterparts with MD. In logistic regression analysis, Shigella was responsible for a 2.25 times higher risk for MSD. Children with Shigella were 3.28 times at higher risk for bloody stool and 2.45 times more likely to have fever. However, rotavirus diarrhea was more likely to be presented with vomiting (OR-2.46) and fever (OR-1.28), and Vibrio cholerae, most often with watery diarrhea (OR-4.35). None of the clinical features were significantly associated with ETEC. Conclusion: Shigella was the leading pathogen that was detected most often in MSD, whereas rotavirus was often associated with MD.

Familial Aggregation of Vibrio cholerae-associated Infection in Matlab, Bangladesh.

Vibrio cholerae is a major cause of diarrhoeal illness in endemic regions, such as Bangladesh. Understanding the factors that determine an individual’s susceptibility to infection due to V. cholerae may lead to improved prevention and control strategies. Increasing evidence suggests that human genetic factors affect the severity of V. cholerae-associated infection. This study, therefore, sought to characterize the heritable component of susceptibility to infection due to V. cholerae using the Matlab Health and Demographic Surveillance System database of the International Centre for Diarrhoeal Disease Research, Bangladesh. In total, 144 pedigrees that included a cholera patient and 341 pedigrees without a cholera patient were evaluated during 1 January–31 December 1992. The odds of the sibling of a patient being admitted with cholera were 7.67 times the odds of the sibling of an unaffected individual being admitted with cholera [95% confidence interval (CI) 2.40-24.5, p<0.001], after adjustment for gender, age, socioeconomic status, and hygiene practices. Although exposure to environmental reservoirs is essential in the epidemiology of cholera, household-specific factors, such as familial relatedness to an index case, may also be important determinants of risk of cholera. Further analysis of human genetic factors that contribute to susceptibility to cholera may be productive.

Zinc treatment to under-five children: applications to improve child survival and reduce burden of disease.

Zinc is an essential micronutrient associated with over 300 biological functions. Marginal zinc deficiency states are common among children living in poverty and exposed to diets either low in zinc or high in phytates that compromise zinc uptake. These children are at increased risk of morbidity due to infectious diseases, including diarrhoea and respiratory infection. Children aged less than five years (under-five children) and those exposed to zinc-deficient diets will benefit from either daily supplementation of zinc or a 10 to 14-day course of zinc treatment for an episode of acute diarrhoea. This includes less severe illness and a reduced likelihood of repeat episodes of diarrhoea. Given these findings, the World Health Organization/United Nations Children's Fund now recommend that all children with an acute diarrhoeal illness be treated with zinc, regardless of aetiology. ICDDR.B scientists have led the way in identifying the benefits of zinc. Now, in partnership with the Ministry of Health and Family Welfare, Government of Bangladesh and the private sector, the first national scaling up of zinc treatment has been carried out. Important challenges remain in terms of reaching the poorest families and those living in remote areas of Bangladesh.