The epidemic trend and influencing factors of diarrhea in children under 5 years old in Nepal based on the demographic and health survey data / 中华疾病控制杂志

Objective To describe the current situation of diarrhea in children under five years old in Nepal and to explore its influencing factors. Methods Data were collected from the open-access database, Nepal Demographic and Health Surveys in 2006, 2011 and 2016. Chi-square ( 2) and Wilcoxon rank sum test were used to compare difference of potential risk factors between groups with and without diarrhea. Multiple Logistic regression model was adopted to identify significant influencing factors on diarrhea in children under five years old in Nepal. Results In 2006, 2011 and 2016, the incidence of diarrhea children under five in Nepal was 12.3%, 13.3% and 6.8%, respectively. Univariate analysis of the potential influencing factors showed that there were significant differences in the gender, water source, toilet facilities and fuel type, age of children, age of mother when she gave birth to the child and education years of mother and children with and without diarrhea (all P＜0.05). Multiple analysis revealed that improved toilet facilities (OR=0.874, 95% CI: 0.769-0.994, P=0.041) and the age of children(OR=0.613, 95% CI: 0.580-0.645, P＜0.001) were protective factors of childhood diarrhea, and the risk of boys was higher than that of girls(OR=1.277, 95% CI: 1.147-1.423, P＜0.001). Conclusions From 2006 to 2016, the incidence of diarrhea in children under five years old in Nepal was decreasing. Toilet facilities, age of children and gender of children were identified as the influencing factors of childhood diarrhea.

Escherichia coli enterotoxigénica y enteroagregativa: prevalencia, patogénesis y modelos múridos / Enterotoxigenic and enteroaggregative Escherichia coli: prevalence, pathogenesis and murine models

Resumen Los patotipos de Escherichia coli enterotoxigénica (ETEC) y enteroagregativa (EAEC) son importantes agentes etiológicos causantes de diarrea en niños menores de cinco años de México y países en desarrollo, en quienes causan numerosas muertes. Ambos se han asociado con retraso en el crecimiento infantil y son los principales agentes causales de la "diarrea del viajero". La patogénesis de ambas bacterias se inicia cuando estas se adhieren al epitelio intestinal mediante fimbrias, denominadas factores de colonización en las cepas ETEC aisladas de humano y fimbrias de adherencia agregativa en las cepas de EAEC. Una vez que ETEC se adhiere al enterocito produce una o ambas de sus toxinas e induce la secreción de iones de cloruro, sodio y agua al lumen intestinal, produciendo su característica diarrea acusa. EAEC se une al epitelio intestinal formando una biopelícula, induce la producción de moco, libera sus toxinas y promueve inflamación. Modelos de infección de EAEC y ETEC con ratones C57BL/6 silvestres y deficientes del ligando de CD40 (con microbiotas intactas), respectivamente, revelaron que la desnutrición y la dieta baja en cinc incrementan la infección de EAEC causando retraso en el crecimiento y que ETEC coloniza, persiste e induce respuesta inmune humoral local y sistémica.

Abstract Enterotoxigenic (ETEC) and enteroaggregative Escherichia coli (EAEC) pathotypes are important etiological agents causative of diarrhea in children younger than 5 years of age in Mexico and in developing countries, where they cause numerous deaths. Both have been associated with delayed growth in children and are the main causative agents of traveler's diarrhea. The pathogenesis of both bacteria starts by adhering to the intestinal epithelium by means of fimbriae, called colonization factors in human ETEC isolates and aggregative adherence fimbriae in EAEC isolates. Once ETEC adheres to the enterocyte, it produces one or both of its toxins and induces the secretion of chloride and sodium ions and water into the intestinal lumen, producing its characteristic watery diarrhea. EAEC binds to the intestinal epithelium forming a biofilm, induces the production of mucus, releases its toxins and promotes inflammation. EAEC and ETEC infection models with wild-type C57BL/6 and CD40 ligand-deficient mice (with intact microbiota), respectively, revealed that undernutrition and low-zinc diet increases EAEC infection, causing growth retardation, and that ETEC colonizes, persists and induces local and systemic humoral immune response.

Effect evaluation of potassium sodium dehydroandrographolide succinate for injection in combination with smecta enema treatment for children with autumn diarrhea / 中国实用护理杂志

Objective To observe the effect of potassium sodium dehydroandrographolide succinate for injection (PSDS)combining with smecta enema treatment on children with autumn diarrhea.Methods 102 children patients with autumn diarrhea were selected and divided into the control group,the PSDS group and the combination group with 34 patients in each group.The control group received symptomatic supportive treatment,based upon this,the PSDS group received PSDS,and the combination group adopted PSDS and smecta enema treatment.The treatment effect was compared between the three groups.Results The effect of the PSDS group and the combination group was better than the control group,the effect of the combination group was better than the PSDS group.Conclusions Combination of PSDS with smecta enema treatment for children with autumn diarrhea has significant effect,but enough attention should be paid to peri-anal nursing.

Factors associated with diarrhea and acute respiratory infections among children less than 5 years old in Thailand : a secondary analysis of Thailand multiple indicator cluster survey 2006 / ปัจจัยที่มีความสัมพันธ์กับโรคท้องร่วงและการติดเชื้อระบบทางเดินหายใจในเด็กอายุ ต่ำกว่า 5 ปีในประเทศไทย: การวิเคราะห์ข้อมูลทุติยภูมิจากการสำรวจแบบพหุดัชนีแบบจัดกลุ่มของ ประเทศไทย ปี พ.ศ. 2549

This study examined factors associated with diarrhea and ARI among children aged less than 5 years in Thailand using data from the MICS conducted from December 2005 to February 2006. A stratified two stage sampling technique was used with provinces constituting strata. Primary sampling units were blocks for municipal areas or villages for non municipal areas. Sample selection of blocks/villages was done using probability proportional to size. Secondary sampling units were systematically sampled individual households in each block/village. Data were collected for 9444 children with 9409 children who had complete data on age being included in the analysis. Bivariate analysis was done using Chi square and Fisher’s exact tests with multivariate analysis being done using binary logistic regression. The study found increased risk of diarrhea among children in households with one child under 5 years or with Thai heads. Male children and those with elderly caretakers were also at increased risk of diarrhea. The highest risk of diarrhea was in children aged 6-23 months. Household wealth index quintile also had an association with diarrhea with children in the poor, middle and fourth wealth index quintiles being at increased risk of diarrhea compared to children in the richest wealth index quintile. Unsafe disposal of child’s feces and not breastfeeding at all were associated with increased risk of diarrhea in children aged less than 2 years. As for ARI, living in rural areas, living in North East region, having a Thai household head, being a male child, being aged 13-23 months and having never breastfed were associated with increased risk of ARI in children aged less than 5 years. Not being breastfed was associated with increased risk of ARI in children aged less than 2 years. Continued efforts to promote recommended child feeding practices, providing health education to targeted populations on hygienic practices in child care, special attention in the care of male children and those aged 6-23 months, targeting teenage and elderly child caretakers in diarrhea prevention efforts and longitudinal studies on diarrhea and ARI in children are recommended.

Incidence of diarrhea: poor parental recall ability

Several methodological issues may have an impact on the incidence rates of childhood acute diarrhea reported by community-based studies. This study was performed to assess the impact of parental recall ability and definition of diarrhea on the estimate of incidence of acute diarrhea. Eighty-four children younger than 40 months were randomly selected and visited every other day for four weeks and the occurrence of diarrhea was registered. On the last day of the study, another visit was performed and the informants were inquired about the occurrence of diarrhea during the previous four weeks. Data gathered during the four weeks were compared to those obtained on the last visit. Additionally, the informants' definition of diarrhea was investigated and compared to the one adopted by this study. During the observation period, 33 children suffered diarrhea, but only 10 (30.3 percent) informants reported the occurrence of diarrhea. Although 42.4 percent of those informants reported that their children had been ill over that period, they did not report diarrhea. Further, 60.6 percent children who had diarrhea suffered at least one episode in the two weeks prior to the visitation. The same definition of diarrhea used in this study was adopted by 52.1 percent of the informants inquired. Parental recall is an unreliable method to estimate the incidence of diarrhea and studies with a short interval between the visits should be necessary to correctly evaluate this important health problem. Moreover, assessing the informants' own definition of diarrhea is a significant contribution to the interpretation of the results.