Unstratified bivariate and multivariate analysis of characteristics associated with bacteremia in parasitemic children <15 years (with p < 0.1).

<p>¹ OR (CI), odds ratio (95% confidence interval)</p><p>² Children who cannot hold their head at the age of three months, roll over at the age of 6 months, sit unsupported at the age of 9 months, stand unsupported at the age of 12 months or walk single steps at the age of 18 months</p><p>³ Circulation impaired = cold extremities and/or capillary refill time >2 sec. and/or tachycardia</p><p>⁴ Dehydration ≥dehydration grade 1 (3–5%)</p><p>⁵ Variables <i>developmental delay</i>, <i>exclusive breastfeeding</i> and <i>watery stool</i> were removed from multivariate analysis due to small case number (<300 cases)</p><p>* Predicts failure perfectly</p><p>** No calculation possible due to small case numbers</p><p>Unstratified bivariate and multivariate analysis of characteristics associated with bacteremia in parasitemic children <15 years (with p < 0.1).</p

Parsimonious multivariate regressions model of characteristics positively associated with bacteremia in parasitemic children, stratified for parasite count.

<p>¹ OR (CI), odds ratio (95% confidence interval)</p><p>² Dehydration ≥ grade 1 (3–5%)</p><p>Parsimonious multivariate regressions model of characteristics positively associated with bacteremia in parasitemic children, stratified for parasite count.</p

Bivariate analysis of characteristics associated with bacteremia in parasitemic children <15 years stratified for parasite count (with p < 0.1).

<p>¹ Circulation impaired = cold extremities and/or capillary refill time ≤2 sec. and/or tachycardia</p><p>² Diarrhea >7 days</p><p>³ Dehydration ≥dehydration grade 1 (3–5%)</p><p>⁴ Leukocytosis = white blood cell count ≥10,000/μl; Leukopenia = white blood cell count <4,000/μl</p><p>Bivariate analysis of characteristics associated with bacteremia in parasitemic children <15 years stratified for parasite count (with p < 0.1).</p

Observed prevalence (solid line) and predicted prevalence (dashed line) of intended hospital attendance by symptom along the travel distance to the nearest hospitals, Asante Akim North District, Ghana, 2008.

<p>Observed prevalence (solid line) and predicted prevalence (dashed line) of intended hospital attendance by symptom along the travel distance to the nearest hospitals, Asante Akim North District, Ghana, 2008.</p

Admissions, enrollment, frequencies and percentages of parasitemia/bacteremia.

<p>Admissions, enrollment, frequencies and percentages of parasitemia/bacteremia.</p

CART – model for children between 2 and 12 months of age (N = 1304).

<p>¹ Number of patients with the respective combination of variables given by the branches of the decision tree. ² Number of patients positive for <i>P. falciparum</i> parasitaemia. ³ Odds Ratio for <i>P. falciparum</i> parasitaemia with the combination of variables in comparison to all other combinations.</p

Sensitivity and specificity of symptoms for prediction of <i>P. falciparum</i> parasitaemia in different age groups.

<p>Note: Percentage refers to the total number of patients within each age group.</p>a<p>ROF = <i>report of fever</i>;</p>b<p>EBT = <i>elevated body temperature</i>;</p>c<p>NRS = <i>no respiratory symptoms</i>.</p

Classification and comparison of CART model and IMCI algorithm.

a<p>IMCI-algorithm for identification of children with malaria in high-risk areas: Fever by history of fever or feeling hot/elevated body temperature of ≥37.5°C on admission and/or some palmar pallor.</p>b<p>CART-model: For calculation only those variables were used, which were included in the CART-analysis for the certain age group.</p>c<p>PPV = Positive predictive value.</p>d<p>NPV = Negative predictive value.</p

Gastrointestinal Infections and Diarrheal Disease in Ghanaian Infants and Children: An Outpatient Case-Control Study

<div><p>Introduction</p><p>Diarrheal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in resource-poor areas. This case-control study assessed the associations between gastrointestinal infections and diarrhea in children from rural Ghana.</p><p>Methods</p><p>Stool samples were collected from 548 children with diarrhea and from 686 without gastrointestinal symptoms visiting a hospital from 2007–2008. Samples were analyzed by microscopy and molecular methods.</p><p>Results</p><p>The organisms most frequently detected in symptomatic cases were <i>Giardia lamblia</i>, <i>Shigella</i> spp./ enteroinvasive <i>Escherichia coli</i> (EIEC), and <i>Campylobacter jejuni</i>. Infections with rotavirus (adjusted odds ratio [aOR] = 8.4; 95% confidence interval [CI]: 4.3–16.6), <i>C</i>. <i>parvum/hominis</i> (aOR = 2.7; 95% CI: 1.4–5.2) and norovirus (aOR = 2.0; 95%CI: 1.3–3.0) showed the strongest association with diarrhea. The highest attributable fractions (AF) for diarrhea were estimated for rotavirus (AF = 14.3%; 95% CI: 10.9–17.5%), <i>Shigella</i> spp./EIEC (AF = 10.5%; 95% CI: 3.5–17.1%), and norovirus (AF = 8.2%; 95% CI 3.2–12.9%). Co-infections occurred frequently and most infections presented themselves independently of other infections. However, infections with <i>E</i>. <i>dispar</i>, <i>C</i>. <i>jejuni</i>, and norovirus were observed more often in the presence of <i>G</i>. <i>lamblia</i>.</p><p>Conclusions</p><p>Diarrheal diseases in children from a rural area in sub-Saharan Africa are mainly due to infections with rotavirus, <i>Shigella</i> spp./EIEC, and norovirus. These associations are strongly age-dependent, which should be considered when diagnosing causes of diarrhea. The presented results are informative for both clinicians treating gastrointestinal infections as well as public health experts designing control programs against diarrheal diseases.</p></div

Signs and symptoms and their association with <i>P. falciparum</i> parasitaemia in children.

a<p>To be positive for this (inverse) variable patients must not present <i>malnourished condition</i>.</p>b<p>To be positive for this (inverse) variable patients must not present <i>skin abnormalities</i>, <i>skin rash</i>, <i>skin depigmentation</i> and <i>other skin problem</i>.</p>c<p>To be positive for this (inverse) variable patients must not present <i>vomiting</i> and <i>diarrhoea</i>.</p>d<p>To be positive for this (inverse) variable patients must not present <i>respiratory distress, breathing difficulties, fast breathing, deep breathing, chest indrawing, running nose</i>, blocked nose and <i>cough</i>.</p>e<p>CI: 95% Confidence interval.</p