Etiologies, Risk Factors and Impact of Severe Diarrhea in the Under-Fives in Moramanga and Antananarivo, Madagascar

<div><p>Background</p><p>Diarrheal disease remains a leading cause of death in children in low-income countries. We investigated the etiology, risk factors and effects on nutritional status of severe diarrhea in children from two districts in Madagascar.</p><p>Methods</p><p>We performed a matched case-control study in 2011 to 2014, on children under the age of five years from Moramanga and Antananarivo. The cases were children hospitalized for severe diarrhea and the controls were children without diarrhea selected at random from the community. Stool samples were collected from both groups. Anthropometric measurements were made during follow-up visits about one and two months after enrolment.</p><p>Results</p><p>We enrolled 199 cases and 199 controls. Rotavirus infection was the most frequently detected cause of diarrhea. It was strongly associated with severe diarrhea (OR: 58.3; 95% CI: 7.7–439.9), accounting for 42.4% (95% CI: 37.6–43.1) of severe diarrhea cases. At the household level, possession of cattle (OR = 0.3; 95% CI: 0.1–0.6) and living in a house with electricity (OR = 0.4; 95% CI: 0.2–0.8) were protective factors. The presence of garbage around the house was a risk factor for severe diarrhea (OR = 3.2; 95% CI: 1.9–5.4). We found no significant association between severe diarrhea and the nutritional status of the children at follow-up visits, but evident wasting at enrolment was associated with a higher risk of severe diarrhea (OR = 9; 95% CI: 4.5–17.9).</p><p>Conclusions</p><p>Severe childhood diarrhea is mostly caused by rotavirus infection. An anti-rotavirus vaccine has already been introduced in Madagascar and should be promoted more widely. However, post-licensing surveillance is required. Interventions to improve the nutritional status of children, preventive measures focused on household and personal hygiene and nutritional rehabilitation during severe diarrheal disease should be reinforced.</p></div

Clinical symptoms associated with the enteric pathogens isolated from children with diarrhea in Antananarivo and Moramanga, 2011–2014.

<p>Clinical symptoms associated with the enteric pathogens isolated from children with diarrhea in Antananarivo and Moramanga, 2011–2014.</p

Comparison of weight-for-height or length (WHZ) scores at enrolment, and change in WHZ (ΔWHZ/WHZ₀) between enrolment and follow-up at 30 and 60 days, between children with diarrhea and their matched controls from Antananarivo and Moramanga, 2011–2014.

<p>Comparison of weight-for-height or length (WHZ) scores at enrolment, and change in WHZ (ΔWHZ/WHZ₀) between enrolment and follow-up at 30 and 60 days, between children with diarrhea and their matched controls from Antananarivo and Moramanga, 2011–2014.</p

Individual and household characteristics of the cases and controls from Antananarivo and Moramanga, 2011–2014.

<p>Individual and household characteristics of the cases and controls from Antananarivo and Moramanga, 2011–2014.</p

Case-Control Study of the Etiology of Infant Diarrheal Disease in 14 Districts in Madagascar

<div><h3>Background</h3><p>Acute diarrhea is a major cause of childhood morbidity and mortality worldwide. Its microbiological causes and clinico-epidemiological aspects were examined during the rainy seasons from 2008 to 2009 in 14 districts in Madagascar.</p> <h3>Methods</h3><p>Stool specimens of 2196 children with acute diarrhea and 496 healthy children were collected in a community setting. Intestinal parasites were diagnosed by microscopy and bacteria by culturing methods. Rota-, astro and adenoviruses were identified using commercially available ELISA kits and rotaviruses were confirmed using reverse transcriptase polymerase chain reaction (RT-PCR).</p> <h3>Results</h3><p>Intestinal microorganisms were isolated from 54.6% of diarrheal patients and 45.9% of healthy subjects (p = <0.01). The most common pathogens in diarrheic patients were intestinal parasites (36.5%). Campylobacter spp. and Rotavirus were detected in 9.7% and 6.7% of diarrheic patients. The detection rates of <em>Entamoeba histolytica</em>, <em>Trichomonas intestinalis</em> and <em>Giardia lamblia</em> were much greater in diarrheal patients than in non diarrheal subjects (odds ratios of 5.1, 3.2, 1.7 respectively). The abundance of other enteropathogens among the non diarrheal group may indicate prolonged excretion or limited pathogenicity.</p> <h3>Conclusion</h3><p>In developing countries, where the lack of laboratory capacities is great, cross sectional studies of enteropathogens and their spatial distribution, including diarrheal and non diarrheal subjects, are interesting tools in order to advise regional policies on treatment and diarrheic patient management.</p> </div

Kaplan-Meier curve of cumulative treatment failure over the 28-day follow-up period, adjusted by genotyping

<p><b>Copyright information:</b></p><p>Taken from "Assessment of the efficacy of antimalarial drugs recommended by the National Malaria Control Programme in Madagascar: Up-dated baseline data from randomized and multi-site clinical trials"</p><p>http://www.malariajournal.com/content/7/1/55</p><p>Malaria Journal 2008;7():55-55.</p><p>Published online 4 Apr 2008</p><p>PMCID:PMC2311320.</p><p></p

Clinical symptoms associated with the enteric pathogens isolated from diarrheic children in Madagascar 2008–2009.

<p>Clinical symptoms associated with the enteric pathogens isolated from diarrheic children in Madagascar 2008–2009.</p

Location of study sites in Madagascar.

<p>Location of study sites in Madagascar.</p

Enteric pathogens isolated from diarrheal and non diarrheal stools.

*<p>Random effect mutivariate analysis controled for study sites.</p