Prevalence and risk factors of acute gastroenteritis caused by Rotavirus among children in tertiary hospitals, southeastern Nigeria

Background: Diarrhea is a worldwide problem and rotavirus is the commonest viral etiologic agent. In Nigeria, diarrhea causes more than 315,000 deaths of preschool-age children annually. In Ebonyi State, it is among the leading causes of pediatric emergency visits and one of the major causes of infant morbidity and mortality. This study was aimed at determining the prevalence and associated risk factors of acute gastroenteritis due to rotavirus infection among under-five children in Abakaliki, Ebonyi state. Methodology: This was a cross-sectional study of 275 children under 5 years of age hospitalized for acute watery diarrhea, who were consecutively recruited into the study. Stool samples were collected from each child for rotavirus antigen detection using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic information of each child and selected risk factors were collected using structured questionnaire. Data analysis was done on SPSS software version 20.0, and association of demographic characteristics and risk factors with rotavirus diarrhoea was measured using Chi-square test, odds ratio (and 95% confidence interval). Significant value was set at p < 0.05. Results: The prevalence of rotavirus diarrhea among children under 5 years of age in this study was 26.5% (73/275). Aside from educational level of the mothers, there was no significant association between any of the sociodemographic characteristics and prevalence of rotavirus diarrhoea (p>0.05). Although the prevalence of diarrhoea in the children was lower with the use of maize gruel (pap) as weaning feed (26.3%, 71/270) compared to the use of other complementary feeding such as ‘Cerelac’ and ‘NAN’ (40%, 2/5), this association did not reach a significant level(OR=0.5352, 95% CI=0.0875-0.3270, p=0.6110), probably due to the small number of children weaned using other complementary feeds. Conclusion: The relatively high prevalence of rotavirus diarrhea in children under 5 years of age in this study is an indication of the need for the parents/guardians of these children to improve child feeding hygiene

Intestinal antimicrobial gene expression: impact of micronutrients in malnourished adults during a randomized trial.

BACKGROUND: Because both micronutrients and antimicrobial peptides protect against diarrhea, we looked for an effect on intestinal antimicrobial peptide gene expression during a randomized controlled trial of multiple micronutrient (MM) supplementation. METHODS: Consenting adults (n=287) in Lusaka, Zambia, were randomized to receive a daily MM supplement or placebo and were followed up for 3.3 years, with a crossover after 2 years. Intestinal biopsy samples were obtained at annual intervals, and messenger RNA of the intestinal antimicrobial peptides human alpha defensin (HD) 5, HD6, human beta-defensin (hBD) 1, hBD2, and LL-37 were quantified by real-time reverse-transcriptase polymerase chain reaction. Samples were also obtained during diarrhea episodes and after convalescence. RESULTS: There was no effect overall of treatment allocation. However, in malnourished adults (body mass index < or =18.5), HD5 mRNA was increased by 0.8 log transcripts/microg total RNA in MM recipients, compared with HD5 mRNA in placebo recipients (P=.007). During diarrhea, HD5 expression was reduced by 0.8 log transcripts in placebo recipients (P=.02) but was not reduced in MM recipients, nor was it reduced after the crossover. Correlations between HD5 and nutritional status were found that were sex-specific but not explained by serum leptin or adiponectin concentrations. CONCLUSIONS: Micronutrient supplementation was associated with up-regulation of HD5 only in malnourished adults. Interactions between antimicrobial gene expression and nutritional status may help to explain the increased risk of infection in individuals with malnutrition

Role of Exclusive Breastfeeding and S-iga Antibodies Antirotavirus Breast Milk Towards Risk of Acute Rotavirus Diarrhea in Infants Age of 1-6 Months: Do They Corelate to Breastfeeding "Daily Dose" and Antibody Titers?

Exclusive breastfeeding reduces the incidence of diarrhea, especially in children who live in densely populated neighborhood. This study aims to determine the relationship between exclusive breastfeeding and breast milk contains antirotavirus s-IgA antibodies towards risk of acute rotavirus diarrhea in infants aged of 1-6 months. Case-control study design is applied to determine the relationship between exclusive breastfeeding and breast milk contains s-IgA antibodies antirotavirus with risk of acute rotavirus diarrhea. Cases in this study were patients with acute rotavirus diarrhea and controls were patients without acute rotavirus diarrhea. Cases and controls were matched based on age. There were 23 cases and 69 controls. The proportion who received exclusive breastfeeding was 34.8% in cases and 34.4% in controls, with OR of 1.21 (95% CI: 0.45 to 3.28) and p = 0.28. Breast milk contains sIgA antibodies antirotavirus for case was 17.39% and controls was 23.2%, OR was 1.12 (95% CI: 0.29 to 4.29), p = 0.203. In conclusion, exclusive breastfeeding and breast milk contains sIgA antibodies antirotavirus were not associated with risk of acute rotavirus diarrhea in infants 1-6 months. This may be caused by differences in population and demographic studies as well as low of milk sIgA antibody antirotavirus titters. Further research of breastfeeding regardless of antirotavirus containing high antibody titters sIgA is needed

Achieving the Millennium Development Goals : The role of infrastructure

The authors provide an empirical analysis of the determinants of three child-health outcomes related to the Millennium Development Goals: the infant mortality rate, the child mortality rate, and the prevalence of malnutrition. Using data from Demographic and Health Surveys, they go beyond traditional cross-country regressions by exploiting the variability in outcomes and explanatory variables observed within countries between asset quintiles. The authors show the relationships existing between the prevalence of diseases (diarrhea and malnutrition) and mortality. Their findings suggest that apart from traditional variables (income, assets, education, and direct health interventions), better access to basic infrastructure services has an important role in improving child health outcomes. Their analysis of interaction effects between interventions also suggests the importance of combining interventions to meet the Millennium Development Goals.Public Health Promotion,Health Monitoring&Evaluation,Health Economics&Finance,Early Child and Children's Health,Decentralization,Early Child and Children's Health,Health Monitoring&Evaluation,Health Economics&Finance,Hygiene Promotion and Social Marketing,Regional Rural Development

Spatial analysis of risk factors for childhood morbidity in Nigeria

Recent Demographic and Health Surveys (DHS) from Sub-Saharan Africa (SSA) indicate a decline in childhood vaccination coverage but a high prevalence of childhood diarrhea, cough, and fever. We used Nigerian DHS data to investigate the impact of geographical factors and other important risk factors on diarrhea, cough, and fever using geoadditive Bayesian semiparametric models. A higher prevalence of childhood diarrhea, cough, and fever is observed in the northern and eastern states, while lower disease prevalence is observed in the western and southern states. In addition, children from mothers with higher levels of education and those from poor households had a significantly lower association with diarrhea; children delivered in hospitals, living in urban areas, or from mothers having received prenatal visits had a significantly lower association with fever. Our maps are a novel and relevant tool to help local governments to improve health-care interventions and achieve Millennium Development Goals (MDG4)

Determinants Of the Prevalence of Diarrhoea in Adolescents Attending School: A Case Study of an Indian Village School

In developing countries, including India, diarrhoea is a leading killer throughout the age pyramid. However, most of the medical literature on the determinants of diarrhoea focuses only on young children or the elderly, with health policy mainly targeting the former. Thus, the present article attempts to contribute to a better understanding of the determinants of diarrhoea in adolescents -- the understudied population. The paper develops a model using the medical literature, refines it to fit an Indian village context and tests the hypotheses identified through administering a questionnaire to 114 adolescents in an Indian village school. Results confirm the well known importance of household sanitation. In addition, the contribution of the present study is to assert that access to school toilets and usage of school toilets are also crucial. Furthermore, usage of toilets at school varies as a function of gender and the existence of a toilet in the student's household. Finally, the installation of toilets in schools is not enough, sustainable financial models must be found to maintain toilets and induce students to use them

Health intervention and decline in infant mortality rates. Milk depots in Spain (1900-1936)

The role of public health has been a central topic on the classical debate about the historical mortality decline in Europe. One of these health initiatives were the Milk Depots. Spain set up those centres from the late 19th century until the beginning of the Civil War. The goal of this paper is to evaluate the effect of this health intervention on the infant mortality decline during this period. This study works out three kinds of sources: Statistical Yearbooks, Official documents and local records produced by the same Milk Depot. It analyses data available for all the country and one local case such as the Barcelona’s Milk Depot (1904-1935). The main methodological issue deals with the measurement of the effect of the Milk Depot activities on the pattern of changes of infant mortality. Results suggest that Milk Depots have a positive but quite moderate effect on the improving of overall levels of child survival.

Cost-Effective Prevention of Diarrheal Diseases: A Critical Review

This paper critically reviews the existing research on the cost-effective prevention and treatment of diarrheal diseases, and identifies research priorities in this area aimed at finding ways to reduce the diarrheal disease burden. In contrast to the empirical knowledge base that exists for traditional child health programs to reduce diarrheal morbidity and mortality, evidence on the relative effectiveness and costeffectiveness of various environmental health interventions is limited and subject to significant methodological concerns. There is a limited understanding of the determinants of longterm water and sanitation technology adoption and behavior change at the individual level. Even less is known about how collective action problems in water and sanitation infrastructure maintenance can be overcome. An agenda for future research includes evaluating alternative transmission interruption mechanisms, improving understanding of the determinants of individual-level technology adoption in the water and sanitation sector, and assessing the quality of infrastructure maintenance under different management schemes.Diarrheal Diseases, Global Health,

Water, Sanitation, Hygiene, and Nutrition in Bangladesh: Can Building Toilets Affect Children's Growth?

This report provides a systematic review of the evidence to date, both published and grey literature, on the relationship between water and sanitation and nutrition. It also examines the potential impact of improved water, sanitation, and hygiene (WASH) on undernutrition. This is the first report that undertakes a thorough review and discussion of WASH and nutrition in Bangladesh

Limited Resource Families and Child Health Status: A Case Study in Montero, Bolivia

Child malnutrition is a problem that poses social and economic costs to individuals, households, communities, and nations, like Bolivia. Childhood malnutrition can be reduced through effective policy and health interventions such as those of the Consejo de Salud Rural Andino (CSRA) in Montero, Bolivia. The CSRA is a non-profit, private organization that operates three health care clinics in Montero, Bolivia. Low-income mothers and their children are provided with free or minimal-cost public health education and basic pre- and post natal medical services . Three separate clinic areas serve three different populations in terms of child nutritional status and demographic and socioeconomic characteristics. Effectiveness and priority intervention points for reducing childhood malnutrition can be identified by a thorough understanding of socio-economic and demographic characteristics as they relate to child nutrition status. Survey data were collected from 180 women with children under the age of five living in the CSRA clinic coverage area. Data focused on child health, nutrition, anthropometric data, and household socioeconomic and demographic characteristics. Multivariate regression analysis was used to explain child nutrition status as indicated by anthropometric indices. The regression models included child-specific, maternal, and household factors. Regression models were estimated for three anthropometric indices: weight-for-age, height-for-age, and weight-for-height. CSRA initiatives were found to have made a positive contribution to child and maternal health care. However, child malnutrition remains which is inversely associated with critical demographic and socioeconomic characteristics of the various households such as maternal education and household income and wealth.Health Economics and Policy,