Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED).

نویسندگان

  • James A Platts-Mills
  • Sudhir Babji
  • Ladaporn Bodhidatta
  • Jean Gratz
  • Rashidul Haque
  • Alexandre Havt
  • Benjamin Jj McCormick
  • Monica McGrath
  • Maribel Paredes Olortegui
  • Amidou Samie
  • Sadia Shakoor
  • Dinesh Mondal
  • Ila Fn Lima
  • Dinesh Hariraju
  • Bishnu B Rayamajhi
  • Shahida Qureshi
  • Furqan Kabir
  • Pablo P Yori
  • Brenda Mufamadi
  • Caroline Amour
  • J Daniel Carreon
  • Stephanie A Richard
  • Dennis Lang
  • Pascal Bessong
  • Esto Mduma
  • Tahmeed Ahmed
  • Aldo Aam Lima
  • Carl J Mason
  • Anita Km Zaidi
  • Zulfiqar A Bhutta
  • Margaret Kosek
  • Richard L Guerrant
  • Michael Gottlieb
  • Mark Miller
  • Gagandeep Kang
  • Eric R Houpt
چکیده

BACKGROUND Most studies of the causes of diarrhoea in low-income and middle-income countries have looked at severe disease in people presenting for care, and there are few estimates of pathogen-specific diarrhoea burdens in the community. METHODS We undertook a birth cohort study with not only intensive community surveillance for diarrhoea but also routine collection of non-diarrhoeal stools from eight sites in South America, Africa, and Asia. We enrolled children within 17 days of birth, and diarrhoeal episodes (defined as maternal report of three or more loose stools in 24 h, or one loose stool with visible blood) were identified through twice-weekly home visits by fieldworkers over a follow-up period of 24 months. Non-diarrhoeal stool specimens were also collected for surveillance for months 1-12, 15, 18, 21, and 24. Stools were analysed for a broad range of enteropathogens using culture, enzyme immunoassay, and PCR. We used the adjusted attributable fraction (AF) to estimate pathogen-specific burdens of diarrhoea. FINDINGS Between November 26, 2009, and February 25, 2014, we tested 7318 diarrhoeal and 24 310 non-diarrhoeal stools collected from 2145 children aged 0-24 months. Pathogen detection was common in non-diarrhoeal stools but was higher with diarrhoea. Norovirus GII (AF 5·2%, 95% CI 3·0-7·1), rotavirus (4·8%, 4·5-5·0), Campylobacter spp (3·5%, 0·4-6·3), astrovirus (2·7%, 2·2-3·1), and Cryptosporidium spp (2·0%, 1·3-2·6) exhibited the highest attributable burdens of diarrhoea in the first year of life. The major pathogens associated with diarrhoea in the second year of life were Campylobacter spp (7·9%, 3·1-12·1), norovirus GII (5·4%, 2·1-7·8), rotavirus (4·9%, 4·4-5·2), astrovirus (4·2%, 3·5-4·7), and Shigella spp (4·0%, 3·6-4·3). Rotavirus had the highest AF for sites without rotavirus vaccination and the fifth highest AF for sites with the vaccination. There was substantial variation in pathogens according to geography, diarrhoea severity, and season. Bloody diarrhoea was primarily associated with Campylobacter spp and Shigella spp, fever and vomiting with rotavirus, and vomiting with norovirus GII. INTERPRETATION There was substantial heterogeneity in pathogen-specific burdens of diarrhoea, with important determinants including age, geography, season, rotavirus vaccine usage, and symptoms. These findings suggest that although single-pathogen strategies have an important role in the reduction of the burden of severe diarrhoeal disease, the effect of such interventions on total diarrhoeal incidence at the community level might be limited.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Rotavirus Infection and Disease in a Multisite Birth Cohort: Results From the MAL-ED Study.

Background In a multicountry birth cohort study, we describe rotavirus infection in the first 2 years of life in sites with and without rotavirus vaccination programs. Methods Children were recruited by 17 days of age and followed to 24 months with collection of monthly surveillance and diarrheal stools. Data on sociodemographics, feeding, and illness were collected at defined intervals. Stoo...

متن کامل

A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community-Based Cohort Study

OBJECTIVES There is a lack of consensus on how to measure diarrheal severity. Within the context of a multisite, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), 2 previously published scores (Clark and CODA [a diarrheal severity score (Community DiarrheA) published by Lee et al]), and a modified definition of moderate-to-severe diarrhea (MSD) based ...

متن کامل

Establishment of the MAL-ED birth cohort study site in Vellore, Southern India.

The Indian Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) site is in Vellore, Tamil Nadu, in south India and is coordinated by the Christian Medical College, Vellore, which has many years of experience in establishing and following cohorts. India is a diverse country, and no single area can be represe...

متن کامل

Assessment of environmental enteropathy in the MAL-ED cohort study: theoretical and analytic framework.

Individuals in the developing world live in conditions of intense exposure to enteric pathogens due to suboptimal water and sanitation. These environmental conditions lead to alterations in intestinal structure, function, and local and systemic immune activation that are collectively referred to as environmental enteropathy (EE). This condition, although poorly defined, is likely to be exacerba...

متن کامل

Addressing Cryptosporidium Infection among Young Children in Low-Income Settings: The Crucial Role of New and Existing Drugs for Reducing Morbidity and Mortality

Diarrheal disease is the world’s second leading cause of death among young children. It claims more than half a million lives of children under five years old each year, accounting for 9% of global child deaths [1,2]. It is also a leading cause of morbidity in children, including chronic malnutrition [3]. The original United Nations Millennium Development Goals included a target to reduce the m...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • The Lancet. Global health

دوره 3 9  شماره 

صفحات  -

تاریخ انتشار 2015