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Background: Diarrhoea is one of the leading causes of infant mortality. This article analyzes its contribution towards the realization of millennium development goal number 4 (MDG-4)., Methods: A PubMed search using keywords acute infant diarrhea together with prevalence, management, or prevention 23 of the 634 generated articles were reviewed for inclusion., Results: WHO first expressed concern about diarrhoeal mortality in 1979. Two decades later it reported diarrhoea as the second leading cause of infant mortality worldwide. The annual death toll of 1.5 million is greater than AIDS, malaria and measles combined. Short term repercussions (dehydration, electrolyte imbalance, malnutrition, shock, death) plus long-term diminished fitness index, cognitive function, and school performance have major impact on society. Ever since its 1971 success, Oral Rehydration Therapy has been the cornerstone treatment of diarrhoea. Decreased compliance has been recorded worldwide with Kenya ranking first. Intravenous therapy is useful in preventing complications while anti-diarrhoeals and anti-microbials, are indicated in severe cases. Zinc supplementation has also proven effective, and is recommended along with rehydration. Furthermore, immunization and good hygiene prevent faecal-oral transmissions., Conclusion: MDG-4 aims to reduce childhood mortality by 2/3 by 2015. Studies, however, show minimal progress, and the target is likely to be missed. Efforts must therefore be made to review existing strategies and formulate newer ones. Research priorities need to move away from perceived 'killer diseases' since far more children die in a day than have ever died from avian influenza for example.

To establish the prevalence of strains of diarrheagenic Escherichia coli (DEC) associated to acute diarrhea in children of Cumaná, Venezuela, stool samples were taken from 200 children aged < 5 years with acute diarrheal disease, and from 30 healthy children used as control. Isolation and bacterial identification was performed by conventional biochemical tests and stool cultures. The presence of pathogenic genes of each type of DEC was investigated by the technique of polymerase chain reaction (PCR), determining the genes eae and bfp (EPEC), st and lt (ETEC), ipaH and virF (EIEC) Stx1/Stx2 (STEC), aafII (EAEC) and daaE (ADEC). From 169 E. coli, isolates we determined by PCR 10.65% positive for EPEC (1.18% "typical", 9.47% "atypical"); ETEC (5.91%); EAEC (1.78 %), EIEC (0.59%). There were no statistically significant differences regarding the frequency of each "pathotype" in relation to age, but it did occur when related to the sex (p<0.05). The most relevant clinical features were: fever, vomiting and abdominal pain and the greatest percentage of children affected were of the working and marginal classes. These results shown that the strains of DEC are important etiological agents in acute infectious diarrhea in children of Cumaná.

Background: Microvillous inclusion disease (MVID) is a rare congenital disease producing intractable secretory diarrhea in early infancy. It is characterized by diffuse intestinal villous atrophy with no inflammatory reaction. Ultrastructural identification of apical microvillous inclusions in the surface enterocytes is diagnostic. However, there is difficulty in the diagnosis of MVID due to the existence of variants (e.g., microvillous dystrophy), possible disease resolution, and tissue orientation for electron microscopy (EM). The authors analyzed materials from 4 patients with MVID from a single institution. The morphologic features, distribution of lesions, biomarkers, and complementary ultrastructural characteristics were studied., Design: Materials of MVID cases were collected from 6 different hospitals in the United Kingdom between 1990 and 2008. Epidemiological data, including age range, median, mode, sex ratios, and follow-up, were retrieved. All intestinal biopsy specimens were analyzed histologically, histochemically (for PAS, n = 17), immunohistochemically (for CD10, n = 2 and polyclonal CEA, n = 4), and ultrastructurally (n = 9)., Results: Ultrastructurally, apical microvillous inclusions in surface enterocytes in duodenal biopsies were identified in all cases, while 1 case had variant morphology (microvillous dystrophy and very occasionally atypical microvillous inclusions). Tissue orientation for EM was supportive for identification of inclusions in apical enterocytes. Morphologically, a bubbly vacuolated appearance of the apical cytoplasm with extensive or patchy absence of the brush border with occasional cytoplasm inclusions was observed in the enterocytes. Some of these changes vaguely resembled gastric mucin cell metaplasia. Architecturally, villous blunting with either crypt hypoplasia or hyperplasia and absence of inflammation were common findings. The epithelial changes were also found in colon biopsies. PAS, CD10, and p-CEA showed a bright apical cytoplasmic blush/staining, which correlated ultrastructurally with apical granules with inclusions of variable electron density in all cases. These stains also highlighted the targetoid inclusions., Conclusion: Besides electron microscopy identification of inclusions, the light microscopic morphological features together with the biomarker studies highlighting the apical cytoplasmic blush are quite unique and diagnostic of MVID. Furthermore, it is the opinion of the authors that a diagnosis of MVID can be made without electron microscopy.

Objective: In Latin America and the Caribbean, Bolivia has the third highest rate of mortality among children under five years of age (57 per 1 000), with 14.0% of under-five deaths attributable to diarrhea. Because a child's world is predominantly controlled by and experienced through his or her mother, this investigation aims to understand what maternal dimensions may determine child diarrhea., Methods: Variables were selected from the 2003 Bolivia Demographic and Health Survey to create indices of three maternal dimensions using principal components analysis: behavior and experience, access to care, and agency. The three indices were included in a logistic regression model while controlling for economic status, maternal education, and residence type., Results: A total of 4 383 women who had children less than 5 years old were included in the final sample and 25.0% of mothers reported that their most recent born child had experienced an episode of diarrhea in the 2 weeks before the survey. Mothers with high levels of maternal agency or of high economic status were significantly less likely to report their child experienced an episode of diarrhea than women of low levels. Women with primary education were significantly more likely to report that their child experienced diarrhea than women with no education., Conclusions: High levels of agency have a significant protective effect even when controlling for other factors. Increasing maternal agency could have a positive impact on child health in Bolivia, and future work should aim to understand what accounts for different levels of agency and how it may be strengthened.

Objective: Intestinal microbiota plays an important role in the prevention of certain diseases during the pediatric years. Thus, there is an increasing interest in the addition of probiotics to infant formulas. The aim of this study was to evaluate the safety of a follow-on formula with Lactobacillus salivarius CECT5713 in 6-mo-old children., Methods: The antibiotic susceptibility of L. salivarius CECT5713 was analyzed by a dilution method. A double-blinded, randomized, placebo controlled study was performed. Children (n = 80) were distributed in two groups and consumed the formula supplemented or not with probiotics (2 × 10(6) colony-forming units [cfu]/g) during 6 mo. Fecal samples were collected at enrollment, at 3 mo, and at the end of trial. Clinical and anthropometric evaluations were performed. Depending on the variable, one-way or two-way repeated measures analysis of variance were used for the statistical analysis., Results: The antibiotic susceptibility profile of the strain resulted as safe. No adverse effects associated with the consumption of the probiotic formula were reported. In addition, clinical parameters did not differ between groups. Consumption of the probiotic supplemented formula led to an increase in the fecal lactobacilli content (7.6 ± 0.2 versus 7.9 ± 0.1 log cfu/g, P < 0.05). Lactobacillus salivarius CECT5713 was detected in the feces of volunteers from the probiotic group. Probiotic consumption induced a significant increase in the fecal concentration of butyric acid at 6 mo., Conclusion: Thus, a follow-on formula with L. salivarius CECT5713 is safe and well tolerated in 6-mo-old infants., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The present study estimates the prevalence of some enteropathogens in infants and preschoolers with acute diarrhea. From 2006 to 2007, 5459 consecutive stool samples were evaluated. Cryptosporidium parvum was the parasite identified with the higher frequency (5.1%), followed by Giardia lamblia (1.2%). Campylobacter jejuni was isolated in 858 cases (15.7%) and was the most frequent enteropathogen overall. The rates of C parvum, Shigella, and Salmonella were higher in the summer. Rotavirus had the expected winter peak and it was the third enteropathogen because of its frequency. Overall frequency of stool-reducing substances was 15.6% and was associated with a rotavirus-positive test.

Although many African countries, along the equator, receive a great amount of rainfall and possess a dense hydrographic network, access to drinking-water remains a great challenge. In many households, water is used for various purposes, including domestic and crafts activities. According to the World Health Organization, an estimated four billion cases of diarrheoa occurs worldwide, of which 88% are ascribed to unsafe drinking-water. This study aimed at evaluating health risks in the usage of contaminated drinking-water and its relationship with the prevalence of diarrhoeal diseases in Yaound6, Cameroon. In this cross-sectional epidemiological design, 3,034 households with children aged less than five years were investigated. Households were selected from among 20 representative neighbourhoods out of 105 that made up the city. The study revealed a diarrheoa prevalence of 14.4% (437 diarrheoa cases out of 3,034 children tested). Among various risk factors examined, water-supply modes and quality of drinking-water were statistically associated with diarrheoa cases. Moreover, levels of diarrheoa attacks varied considerably from one neighbourhood to the other. The spatial analysis helped determine neighbourhoods of higher and lower prevalence of diarrheoa in the city.

Background/objectives: Micronutrient deficiencies are prevalent worldwide, and a major cause of infant death. Supplementation with multiple micronutrients during pregnancy might improve micronutrient status of the newborn, thereby reducing morbidity and death. Moreover, maternal supplementation might affect the newborn's immune development. Therefore, this study investigated the effects of maternal zinc and β-carotene supplementation on the infant's morbidity and immune function during the first 6 months of life., Subjects/methods: Mothers were supplemented during pregnancy with β-carotene and/or zinc, in addition to iron and folic acid, in a randomized, double-blind controlled trial. Newborn infants (n=136) were followed up for 6 months., Results: Infants born from mothers receiving zinc during pregnancy had significantly fewer episodes of diarrhoea than infants born from mothers not receiving zinc (0.2 and 0.4, respectively), but more episodes of cough (1.3 and 0.9 respectively) during the first 6 months. Maternal β-carotene supplementation had no effect on infants' morbidity. Cytokine production in the newborns was affected by maternal zinc and β-carotene supplementation, with zinc supplementation giving higher interleukin-6 production (16% higher), and β-carotene supplementation leading to lower interferon-γ production (36% lower)., Conclusions: This study shows that maternal supplementation with zinc and β-carotene affected the newborn's immune development in specific ways, but only maternal zinc supplementation significantly affected morbidity in the infants. Addition of zinc to routine iron and folic acid supplements for pregnant women could be an effective way to reduce diarrhoeal disease during the first 6 months of life, albeit at the expense of more episodes of cough.

Severe rotavirus diarrhea in children <5 years of age is a major public health problem; however, limited regional and country specific data on rotavirus disease burden are available from sub-Saharan Africa. In June 2006, the World Health Organization Regional Office for Africa initiated rotavirus surveillance in selected African countries. With use of standardized methodology developed by the World Health Organization, children <5 years of age who were hospitalized with severe diarrhea were enrolled, and stool specimens were collected for detection of rotavirus strains with use of a commercial enzyme immunoassay. Rotavirus strains were further characterized for G and P types with use of a reverse-transcriptase polymerase chain reaction. From June 2006 through December 2008, rotavirus surveillance was established at 14 sites in 11 African countries. Of 5461 stool samples collected from children enrolled in 8 countries with 1 or 2 complete years of data, 2200 (40%) were positive for rotavirus. Ninety percent of all rotavirus hospitalizations occurred among children aged 3-12 months. Predominant types included G1P[8] (21%), G2P[4] (7%), and P [8] (29%); however, unusual types were also detected, including G8P[6] (5%), G8P[8] (1%), G12P[6] (1%), and G12P[6] (1%). A high percentage of mixed rotavirus infections was also detected. These preliminary results indicate that rotavirus is a major cause of severe diarrheal disease in African children.

Appropriate home management can alleviate many of the consequences of diarrhea including malnutrition, impaired development, growth faltering, and mortality. Maternal cognitive ability, years of schooling, and acquired academic skills are hypothesized to improve child health by improving maternal child care practices, such as illness management. Using information collected longitudinally in 1996-1999 from 466 rural Guatemalan women with children <36 months, we examined the independent associations between maternal years of schooling, academic skills, and scores on the Raven's Progressive Matrices and an illness management index (IMI). Women scoring in the lowest and middle tertiles of academic skills scored lower on the IMI compared to women in the highest tertile (-0.24 [95% CI: -0.54, 0.07]; -0.30 [95% CI: -0.54, -0.06], respectively) independent of sociodemographic factors, schooling, and Raven's scores. Among mothers with less than 1 year of schooling, scoring in the lowest tertile on the Raven's Progressive Matrices compared to the highest was significantly associated with scoring one point lower on the IMI (-1.18 [95% CI: -2.20, -0.17]). Greater academic skills were independently associated with maternal care during episodes of infant diarrhea. Schooling of young girls and/or community based programs that provide women with academic skills such as literacy, numeracy and knowledge could potentially improve mothers' care giving practices.

Introduction: Rotavirus (RV) is the most frequent causative agent of severe diarrhoea in infants and young children worldwide, also in Denmark. However, the actual number of diagnosed RV cases among Danish children is unknown. If a new RV-vaccine is to be introduced in Denmark, updated data on RV disease burden is important and the validity of potential surveillance systems needs to be explored., Material and Methods: We established a nation-wide database on all children below the age of 5 years who had a RV-positive sample detected from 2001 to 2004 at one of the 13 laboratories in Denmark performing RV diagnostics. Hospital discharge diagnoses among the RV-positive children were retrieved from the Danish Hospital Discharge Register (DHDR)., Results: A total of 1,789 children < 5 years were registered with 1,800 episodes of RV-diarrhoea. The overall Danish annual incidence rate (IR) of RV-episodes in the 2001-2004 period was calculated to 1.3 per 1,000 children < 5 years. IR varied considerably between counties, the highest being estimated in the county of Copenhagen (IR = 2.6 per 1,000 children < 5 years) and the lowest in the county of Vejle. According to the DHDR, 1,072 RV-positive episodes were associated with hospitalisation, but only 32% were correctly diagnosed as RV-gastroenteritis., Conclusion: The low IR of RV-episodes among Danish children, the geographic variation and the diagnostic inaccuracy of hospitalised RV-episodes indicates an incomplete and uneven examination of RV-episodes in Denmark.

Objective: To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory (URTI), lower respiratory (LRTI), and gastrointestinal tracts (GI) in infancy., Methods: This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life onward in the Netherlands. Rates of breastfeeding during the first 6 months (never; partial for <4 months, not thereafter; partial for 4-6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended infections in the URTI, LRTI, and GI until the age of 12 months were assessed by questionnaires and available for 4164 subjects., Results: Compared with never-breastfed infants, those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI, LRTI, and GI until the age of 6 months (adjusted odds ratio [aOR]: 0.65 [95% confidence interval (CI): 0.51-0.83]; aOR: 0.50 [CI: 0.32-0.79]; and aOR: 0.41 [CI: 0.26-0.64], respectively) and of LRTI infections between the ages of 7 and 12 months (aOR: 0.46 [CI: 0.31-0.69]). Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer. Partial breastfeeding, even for 6 months, did not result in significantly lower risks of these infections., Conclusions: Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants. Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries.

Objectives: To determine whether continuing with zinc supplementation after zinc treatment (ZT) of an acute diarrhoea episode will result in additional clinical benefits beyond ZT alone., Methods: Children 6-23 months of age, living in an urban slum in Dhaka, Bangladesh with acute childhood diarrhoea (ACD), were enrolled in a randomized, double-blind field trial. All children received 10 days of ZT (20 mg/day) and were then randomized to zinc (10 mg/day) or placebo supplementation for 3 months. Weekly follow-up of all children occurred over a period of 9 months., Results: A total of 353 subjects were enrolled, with 93% of the zinc supplemented and 96% of the placebo children followed for 9 months. The incidence density of ACD among those receiving zinc supplementation compared to those receiving placebo was reduced by 28% (2.64 vs.3.66 episodes/p-y follow-up) over the 3 months while on supplementation and by 21% (2.05 vs.2.59 episodes/p-y follow-up) over the 9 months of follow-up. There was no observed effect on the incidence of acute respiratory infections (ARIs) or on growth., Conclusions: Zinc supplementation after treatment provides additional preventive ACD benefits to children in early childhood. Larger, effectiveness trials of this strategy are warranted.

A complete economic study was carried out to assess the economical impact of two rotavirus vaccine in Colombia. A Markov decision model was built to assess the health outcomes from birth to 24 months of age for three hypothetical cohorts: one unvaccinated, one vaccinated with 2 doses of Rotarix and the third, with 3 doses of Rotateq. Without vaccination, the annual number of medical visits by diarrhea in children under 2 years would be 1,293,159 cases, with 105,378 medical visits and 470 deaths (IC95% 295-560) related to rotavirus. Without vaccination, rotavirus disease would cost around USD$8 millions including direct and indirect costs. Assuming a cost per dose of USD$7.5, average cost-effectiveness ratio would be USD$663/DALY with Rotarix and USD$1391 with Rotateq. When price per dose falls below USD$7 both vaccines yield a similar average cost-effectiveness ratio (USD$1063/DALY). Incremental cost-effectiveness ratio of Rotateq versus Rotarix was USD$7787/DALY. Cost-effectiveness ratio was influenced mainly by vaccine cost and cost per case hospitalized. Other programmatic aspects such as number of doses to be applied, likelihood of completing vaccination schedule with shorter versus longer schedules, and storage space within the chain cold should be considered to make decisions on which vaccine should be introduced. In conclusion, vaccinating against rotavirus in Colombia with either vaccine would be very cost effective. If cost per vaccinated children falls below USD$3 per dose vaccination would be cost saving., (Copyright 2010 Elsevier Ltd. All rights reserved.)

To study the incidence and types of morbidity in the first year of life in a birth cohort, a longitudinal study. This study was undertaken in northern part of Karnataka state in India. Birth cohort consisted of all the children born during first six months of the study period. They were assessed at the time of enrollment and monthly follow up was done till they attained one yr of age. Out of the 194 newborns, 46.4% were boys and 53.6% were girls. 24.8% of newborns were of low birth weight and 5.1% were preterm. Four (2.1%) had congenital anomalies and 2.5% developed birth asphyxia. Diarrhea (10.8%) and skin diseases (8.2%) were the commonest morbidities in the neonatal period. The incidence of morbidity was 3.28 per infant per yr. It was more among boys and in the second half of infancy. Commonest morbidities during infancy were respiratory tract infection (62.4%), diarrhea 42.8% and skin diseases (21.6%). Incidence of disease in infancy highlights the need to improve and plan health programmes.

Aim: To describe the perception of the acute gastroenteritis (AGE) and the interest for the vaccination of the AGE due to Rotavirus., Material and Methods: Observational investigation realized by phone by the IPSOS institute, with 1002 French women of 18 years and more, constituting a representative national sample, having at least a child below 2 years, between 7 and January 31st, 2008., Results: AGE is mainly considered by the mothers questioned as a grave pathology (43.1%) or very grave (51.3%) for the children below 2 years. This perception is bound to the symptoms and to the complications known for the disease. For the questioned mothers, the AGE comes along very often or often with diarrheas (97.2%), vomits (94.3%) or dehydration (94%). Hospitalizations are also perceived as frequent. The quasi-totality of the questioned women (98.3%) considers finally that it is about a very contagious disease (75.4%) or rather contagious (22.8%). The AGE at the child below 2 years provoke very frequently a medical consultation (91.8%), during which some solutions of oral rehydration are prescribed in six cases on 10 (62%). The questioned mothers are for the greater part favorable (86.3%) to a drinkable vaccine to prevent the AGE due to Rotavirus, and 88.1% say that they would intend to protect their child with this vaccine., Conclusion: The questioned mothers know the potential gravity of the AGE and a very wide majority of them (86.3%) declare themselves favorable to the prevention of the AGE at Rotavirus by the vaccination., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

From November 2008 to January 2009, a sharp increase of diarrhea in children in Guangdong province appeared, we randomly collected 53 stool specimens from out-patient children with dirrhea in 3 major hospitals (Guangzhou City Children's Hospital, Shenzhen Baoan District Maternal and Child Health Hospital, First Affiliated Hospital of Shantou University). Rotavirus and calicivirus were screened by ELISA and RT-PCR. We found 29 cases of rotavirus infection with diverse serotypes. Only four cases were identified as calicivirus infection. The result indicated that rotavirus was a major pathogen of this high incidence of diarrhea from November 2008 to January 2009 in Guangdong Province.

Background: Two vaccines to prevent disease from rotavirus among young children were recently approved in the United States. Although previous studies of the burden of rotaviral disease have focused on hospitalizations, the assessment of baseline disease burden in ambulatory settings is useful for evaluating the overall impact of the vaccine., Methods: Outpatient and emergency department (ED) data for 1994-2006 were analyzed from 2 nationally representative databases: the National Ambulatory Medical Care Survey and the National Hospital Medical Care Survey. Visits by children (younger than 5 years) with acute gastroenteritis (AGE) were identified by using a defined set of International Classification of Diseases, Ninth Revision, Clinical Modification codes. Two previously described methods (the winter-residual-excess [WRE] and Brandt methods) were used to estimate the proportion of AGE attributable to rotavirus and to determine the annual number of visits, annual average visits, and annual visit rates in each setting., Results: The estimated average annual number of rotavirus-associated visits over the 13-year period was 782 453 outpatient visits and 164 261 ED visits from the WRE method and 665 773 outpatient visits and 205 206 ED visits from the Brandt method. This resulted in an average of 39.1 and 33.3 outpatient visits per 1000 children and 8.2 and 10.3 ED visits per 1000 children for both the WRE and Brandt methods, respectively. The average annual proportion of visits for AGE attributed to rotavirus was 34.2% (29.1% from the Brandt method) in the outpatient setting and 21.8% (27.1% from the Brandt method) in the ED, with wide variations in individual years., Conclusions: Before the rotavirus vaccine, rotavirus seemed to be associated with a large number of outpatient and ED visits among young children. Rotavirus vaccine has the potential to reduce many outpatient and ED visits.

Background: Investigators use prospective community-based studies to collect longitudinal information on childhood diarrhea. The interval in which data are collected may affect the accuracy and interpretation of results. Our objective was to compare data of reported daily clinical symptoms from surveys conducted daily versus twice-weekly surveys., Methods: We conducted our study in Lima, Peru, between October and December 2007. We asked 134 mothers to report daily symptoms by using a twice-weekly survey. We conducted daily surveys for the same data on 25% of participants randomly selected each day. We analyzed intersurvey variability by using Cohen's kappa and Signal Detection Theory (SDT)., Results: We collected 6157 and 1181 child-days of data through the twice-weekly and daily surveys, respectively. The prevalence of diarrhea, fever, vomiting, and cough were 6.4%, 1.6%, 2.1%, and 22.7% from the twice-weekly survey and, 6.4%, 2.0%, 2.4%, and 26% from the daily survey, respectively. Despite similar prevalence, 20% of days with reported diarrhea were discrepant between the two surveys, and agreement in the report of diarrhea decreased as time between the interviews increased (p = .03)., Conclusions: Although twice-weekly surveys provide an adequate estimate of diarrheal prevalence compared with daily surveys, the prevalence of other symptoms based on dichotomous questions was lower under the former. Additionally, the agreement between the two surveys in the report of diarrhea decreased as the recall period increased, suggesting that data from daily interviews were of greater quality. Our analysis is a novel application of SDT to measure respondent certainty and bias, from which better inference about the quality of collected data may be drawn., (2010 Elsevier Inc. All rights reserved.)

This case control study evaluates the association between hospitalization due to infection and feeding practices among infants aged >or= 3 days to < 6 months. Mothers of 191 cases hospitalized for infections and 208 healthy controls were interviewed using a standardized questionnaire documenting infant-feeding history. Results given in odds ratio and 95% confidence intervals (OR, 95% CI) were adjusted for age, education, and place of delivery. Exclusively formula-fed infants were more likely to be hospitalized for any infection (3.7, 1.8-7.5), pneumonia (3.0, 1.2-7.4), and diarrhea (10.5, 2.5-41.9) compared to exclusively breastfed infants. Infants who did not receive any breast milk were more likely to be hospitalized for any infection (3.5, 2.1-5.9), neonatal sepsis (4.9, 1.3-18.3), pneumonia (2.8, 1.5-5.4), and diarrhea (19.6, 6.5-58.6) than infants who received any breast milk. This study showed a strong positive association between the intake of formula and/or nonbreast milk supplements and the risk of hospitalization for infectious causes.

Background: Rotavirus is the most common cause of severe gastroenteritis among young children worldwide. Data are needed to assess the efficacy of the rotavirus vaccine in African children., Methods: We conducted a randomized, placebo-controlled, multicenter trial in South Africa (3166 infants; 64.1% of the total) and Malawi (1773 infants; 35.9% of the total) to evaluate the efficacy of a live, oral rotavirus vaccine in preventing severe rotavirus gastroenteritis. Healthy infants were randomly assigned in a 1:1:1 ratio to receive two doses of vaccine (in addition to one dose of placebo) or three doses of vaccine--the pooled vaccine group--or three doses of placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis caused by wild-type rotavirus during the first year of life were assessed through active follow-up surveillance and were graded with the use of the Vesikari scale., Results: A total of 4939 infants were enrolled and randomly assigned to one of the three groups; 1647 infants received two doses of the vaccine, 1651 infants received three doses of the vaccine, and 1641 received placebo. Of the 4417 infants included in the per-protocol efficacy analysis, severe rotavirus gastroenteritis occurred in 4.9% of the infants in the placebo group and in 1.9% of those in the pooled vaccine group (vaccine efficacy, 61.2%; 95% confidence interval, 44.0 to 73.2). Vaccine efficacy was lower in Malawi than in South Africa (49.4% vs. 76.9%); however, the number of episodes of severe rotavirus gastroenteritis that were prevented was greater in Malawi than in South Africa (6.7 vs. 4.2 cases prevented per 100 infants vaccinated per year). Efficacy against all-cause severe gastroenteritis was 30.2%. At least one serious adverse event was reported in 9.7% of the infants in the pooled vaccine group and in 11.5% of the infants in the placebo group., Conclusions: Human rotavirus vaccine significantly reduced the incidence of severe rotavirus gastroenteritis among African infants during the first year of life. (ClinicalTrials.gov number, NCT00241644.), (2010 Massachusetts Medical Society)

Objective: To examine caregivers' perceptions and practices related to food and personal hygiene and its association with diarrhea in children 6 to 36 months of age who suffered recurrent diarrhea., Design: This qualitative study, conducted in March and April 2006, used both in-depth interviews and direct observation data., Setting: Urban Tangerang, near Jakarta, Indonesia., Participants: Twenty-four mothers whose monthly household income was less than $160 US and had latrines in their homes., Phenomenon of Interest: To examine the relationship between mothers' perceptions and behaviors related to diarrhea, food hygiene, and personal hygiene., Analysis: Interview transcripts were analyzed based on the phenomenon of interest and coded for common themes., Results: Mothers differentiated diarrhea episodes as either disease or nondisease. Most mothers associated the importance of food hygiene with disease prevention, contaminating agents, and health. Mothers commonly wiped cutting boards with a kitchen towel after slicing vegetables, whereas they washed the board with soap and water after cutting raw meat. Mothers perceived that the importance of personal hygiene was for maintaining health and cleanliness. The majority of mothers washed their hands without soap after performing housework and cooking., Conclusions and Implications: Improving mothers' knowledge while incorporating existing perceptions might lead to positive changes.

In the province of Salta, in the Northwest region of Argentina, almost two-thirds of the population live in absolute poverty, and diseases associated with poverty are rampant. Almost 12% of the total population of the province are children below 5 years of age; almost half of these infants are living in situations where the basic necessities are not available. Primitive sanitary conditions, including widespread contamination of available water supplies with pathogens, contribute to a major public health problem. Infant mortality was 17% higher for Salta than for Argentina as a whole in 2001. A major cause of death for these children is infectious disease, especially respiratory and intestinal diseases. In Salta, more than half of the total population of infants is affected by diarrhoea annually. The infectious pathogens are diverse: bacteria (predominantly in spring and summer), viruses (especially in the winter) and parasites (endemic in some situations). This paper evaluates current methods used to test for the presence of pathogens in drinking water; discusses why these methods are less than adequate; documents an episode of contamination in a local water supply source; and suggests appropriate methods that can be used to better address this major public health issue effectively.

This paper analyses the Indian National Family Health Survey (2005-2006) data to present certain broad descriptive features of child health inequalities in India and their distribution across well-defined socio-economic groups classified by gender and sector-of-origin, and their dispersal across space. This study finds that poorer sections of the population are beleaguered with ill health whether in the quest for child survival or due to anxieties pertaining to child nutrition. The concentration index value for the indicators of under-five mortality, full immunisation and underweight outcomes at the national level is calculated to be -0.159, 0.204 and -0.158, respectively. The other disturbing finding here is that there are reigning regional and gender disadvantages irrespective of the developmental status of the State. This study would not only help policymakers to recognise these persistent inequalities but also would help understand health performance at the state and regional levels thus facilitating targeting intervention.

The diversity and capacity of human rotaviruses for rapid evolution and genetic reassortment suggests that rotavirus vaccine should be designed to provide heterotypic protection. The objective of the present study was to provide information on the circulating genotypes of rotavirus and allied baseline epidemiology in Lucknow, India. In a cross-sectional study, the prevalence of rotavirus G-P types was studied in patients aged 1-36 months with acute watery diarrhoea. Various sociodemographic, environmental and clinical factors were assessed as potential predictors of rotavirus infection; 412 patients with acute watery diarrhoea were recruited into the study from September 2004 to April 2008 and rotavirus was identified in 19.2% (79/412) cases using ELISA and PAGE. The genotypes identified were G1 (38.0%), G2 (15.2%), G3 (16.5%), G9 (10.9%), G4 (5.1%) and mixed G types (10.1%). The most common G-P combinations were G1P[8], G3P[6], G1P[6] and G2P[8]. Rotavirus diarrhoea was found to occur throughout the year with a single peak in winter months (November-January). Rotavirus diarrhoea was found to be associated with children not currently breast fed (adjusted OR 2.2, 95% CI 1.3-3.7, p 0.004), children < or =7 months of age (adjusted OR 1.1, 95% CI 1.0-1.1, p 0.002) and children with severe dehydration (adjusted OR 1.8, 95% CI 1.1-3.0, p 0.03) using multivariate logistic regression. A high degree of strain diversity of rotavirus G and P types was detected. Rotavirus was found to be associated with dehydrating diarrhoea, particularly in children aged 0-7 months, placing them at increased risk of mortality.

In a study conducted in João Pessoa, northeast of Brazil, 2344 Escherichia coli isolated from 290 infants with diarrhea and 290 healthy matched controls were analyzed for virulence traits. Enteroaggregative E. coli (EAEC) was the most prevalent pathogen associated to acute diarrhea. Based on the results of colony blot hybridization, serotyping, and HEp-2 cell adherence assays, strains were separated in categories as typical enteropathogenic E. coli (EPEC) (1.7%), atypical EPEC (a-EPEC) (9.3%), EAEC (25%), enterotoxigenic E. coli (10%), and enteroinvasive E. coli (EIEC) (1.4%). No enterohemorrhagic E. coli strains were isolated. Other enteropathogens were found, including Salmonella (7.9%), Shigella spp. (4.1%), thermophilic Campylobacter spp. (2.4%), Giardia lamblia (9.3%), and Entamoeba histolytica (5.8%). All enteropathogens were associated with diarrhea (P < 0.01). However, the association was lower for EPEC and EIEC (P < 0.03). Different pathogens associated with diarrhea may have been changing in Brazil where EAEC and a-EPEC seem to be the most prevalent pathogens among them.

Objective: Gastroenteritis is a major cause of childhood morbidity and mortality worldwide. Adenovirus AdV is recognized to be one of the most important pathogens associated with severe dehydrating gastroenteritis. Studies reported elsewhere have shown that about 8%-10% of cases with infantile diarrhea are caused by AdV and in some areas AdV diarrhea even occurred in the form of outbreaks. Studies have confirmed that AdV infections are also very common in infants and young children in China. This study aimed to investigate the molecular epidemiologic characteristics of human adenovirus diarrhea among infants and children with acute diarrhea in Lanzhou, Gansu province, China., Method: Stool specimen and case information were collected from both outpatients and inpatients with acute diarrhea in Lanzhou. Polymerase chain reaction was used to detect AdV in stool specimens. The subjects included 709 urban children and 180 rural children, their age ranged from 19 d to 60 months., Result: Of the 889 cases, 43 (4.8%) were found positive for AdV. AdV was detected in 14 of 257 (5.4%) cases seen from July 2005 to June 2006, in 4 of 286 cases (1.4%) seen from July 2006 to June 2007. During the period of July 2007 to June 2008, adenovirus was detected in 346 specimens, the positive rate was 7.2% (25/346). AdV detection rates of the three-year period were significantly different. The major AdV subtypes detected were adenovirus (subgenus F) Ad40, Ad41 with a positive rate of 3.8% (34/889), followed by non-enteric adenovirus (Ad12, Ad18, Ad31, Ad2, Ad5, Ad6, Ad7) with a positive rate of 1.0% (9/889) in Lanzhou during the 3 years. Most of the AdV-positive specimens showed Ad41 group F (67.4%, 29/43) as the major epidemic strains, and Ade infection mainly occurred in children under one year of age and no seasonal cluster was found., Conclusion: Adenovirus was one of the major etiological agent of viral diarrhea among infants and children in Lanzhou between 2005 and 2008. Ad41 was the prodomiment serotype.

Background: Infantile exposure to macrolides has been associated with hypertrophic pyloric stenosis causing projectile vomiting, dehydration, electrolyte abnormalities, and in rare cases death possibly via macrolide interaction with gastric motilin receptors. Large population-based cohorts have suggested that exposure to macrolides via breastmilk may be associated with pyloric stenosis., Methods: In this prospective, controlled observational study designed to assess the safety of macrolides during lactation, we followed infants whose mothers contacted our Drug Consultation Center at the Assaf Harofeh Medical Center (Zerrifin, Israel) inquiring about safety of macrolides during lactation and compared them to a cohort of infants exposed to amoxicillin during breastfeeding., Results: Fifty-five infants exposed to macrolide antibiotics were compared to a control cohort of 36 infants exposed to amoxicillin via lactation. The infants in the macrolide group were all exposed to erythromycin and the newer macrolides: azithromycin, clarithromycin, and roxithromycin. The rate of adverse reactions the infant experienced while being exposed to both antibiotics was comparable. Seven (12.7%) infants in the macrolide group experienced adverse reactions versus three infants (8.3%) in the amoxicillin group (odds ratio = 1.6, 95% confidence interval, 0.38-6.65, p = 0.73). The adverse reactions in the infants exposed to macrolides were rash, diarrhea, loss of appetite, and somnolence, whereas the infants exposed to amoxicillin experienced rashes and somnolence. Factors such as gestational age, age and weight at exposure, maternal age, or type of macrolide were not associated with the infant's adverse reaction in multivariate regression analysis., Conclusions: Rates and types of minor adverse reactions in breastfed infants exposed to a macrolide or amoxicillin in breastmilk were comparable. Macrolide exposure during breastfeeding was not associated with pyloric stenosis, although larger prospective studies are required to confirm our observation.

Background: Diarrheagenic Escherichia coli strains are being recognized as important pediatric enteropathogens worldwide. However, it is unclear whether there are differences in age-related susceptibility to specific strains, especially among infants., Methods: We conducted a passive surveillance cohort study of diarrhea that involved 1034 children aged 2-12 months in Lima, Peru. Control stool samples were collected from randomly selected children without diarrhea. All samples were analyzed for common enteric pathogens and for diarrheagenic E. coli with use of multiplex real-time polymerase chain reaction., Results: The most frequently isolated pathogens in 1065 diarrheal episodes were diarrheagenic E. coli strains (31%), including enteroaggregative (15.1%) and enteropathogenic E. coli (7.6%). Diarrheagenic E. coli, Campylobacter species, and rotavirus were more frequently isolated from infants aged >or=6 months. Among older infants, diffusely adherent E. coli and enterotoxigenic E. coli were more frequently isolated from diarrheal samples than from control samples (P <.05). Children aged >or=6 months who were infected with enterotoxigenic E. coli had a 4.56-fold increased risk of diarrhea (95% confidence interval, 1.20-17.28), compared with younger children. Persistent diarrhea was more common in infants aged <6 months (13.5% vs 3.6%; P <.001). Among children with diarrheagenic E. coli-positive samples, coinfections with other pathogens were more common in children with diarrhea than in control children (40.1% vs 15.6%; P <.001)., Conclusions: Diarrheagenic E. coli strains were more frequently isolated in samples from older infants. In this setting with high frequency of pathogen exposure and high frequency of breastfeeding, we hypothesize that the major age-related differences result from decreased exposure to milk-related protective factors and from increased exposure to contaminated food and water.

Background: A licensed rotavirus vaccine was withdrawn from use because of an increased risk of intussusception. The association of rotavirus vaccination with intussusception raised concerns about a potential link between natural rotavirus disease and intussusception. The objectives of the present study were to determine whether an epidemiological association with natural rotavirus infection existed., Methods: From 1984 to 2003, all children younger than 5 years with intussusception were retrospectively identified by medical charts, and from 1995 to 2003, a prospective surveillance study of rotavirus infection in children younger than 5 years was independently conducted. Epidemiological characteristics of intussusception and rotavirus infection were then compared., Results: A total of 533 cases of intussusception and 146 cases of rotavirus infection were identified. The incidence of intussusception for infants younger than 1 year was 62/100,000 child-years. The age distributions of intussusception and rotavirus gastroenteritis overlapped, and a masculine predominance was noted in both cases. No significant association was observed between the monthly distribution of intussusception and rotavirus infection., Conclusion: The present study has not convincingly shown that rotavirus diarrhea plays a major role in intussusception. However, data about age and sex distributions supported the biologic plausibility of such an association.

Objective: To explore whether different forms of violence against women were associated with increased incidence rates of diarrhea and respiratory tract infections among infants., Design: A 12-month follow-up study embedded in a food and micronutrient supplementation trial., Setting: Rural Bangladesh., Participants: Pregnant women and their 3132 live-born children., Main Exposure: Maternal exposure to physical, sexual, and emotional violence and level of controlling behavior in the family., Main Outcome Measures: Infants' risk of falling ill with diarrheal diseases and respiratory tract infections in relation to mothers' exposure to different forms of violence. Adjusted for household economic conditions, mother's education level, parity, and religion., Results: Fifty percent of the women reported lifetime experience of family violence. Infants of mothers exposed to different forms of family violence had 26% to 37% higher incidence of diarrhea. Any lifetime family violence was positively associated with increased incidence of diarrheal diseases (adjusted rate ratio, 1.20; 95% confidence interval, 1.10-1.30) and lower respiratory tract infections (adjusted rate ratio, 1.31; 95% confidence interval, 1.17-1.46). Further, all forms of family violence were also independently positively associated with infant illness, and the highest incidence rates were found among the daughters of severely physically abused mothers., Conclusion: Family violence against women was positively associated with an increased risk of falling ill with diarrheal and respiratory tract infections during infancy. The present findings add to increasing evidence of the magnitude of public health consequences of violence against women.

Aim: to determine the prevalence of rotavirus in acute diarrhea among children under 5 years and to describe the epidemiology, clinical trials of rotavirus diarrhea and compare them with those of other gastroenteritis., Methods: A Prospective study during 1 year (1 January 2007-31 December 2007) was conducted in the department of Pediatrics B of the Children's Hospital of Tunis. 117 children aged under than 5 years and admitted for acute community gastroenteritis were included in the study. A search of rotavirus in the stool, collected within 48 hours of admission, was performed by a rapid detection of viral antigens: proteins specific RV group A (VP6 protein of the capsid) using enzyme immunoassay technique: sandwich ELISA (IDEIA Rotavirus Dako)., Results: Rotavirus diarrhea accounted for 25% of acute gastroenteritis. The average age of rotavirus gastroenteritis was 11 months +/- 1.78. We have noted a male predominance with a sex ratio of 1.2. The seasonal distribution of rotavirus gastroenteritis showed three peaks of incidence (January, May and July). The respiratory signs were more frequently found in rotavirus gastroenteritis group. Rotavirus gastroenteritis had a higher severity score compared with other gastroenteritis (8.44 vs 6.75 P = 0.01). The duration of hospitalization was longer in rotavirus group with a difference close to significance p = 0.07., Conclusion: The seasonal distribution of rotavirus gastroenteritis has three peaks of incidence. The gastroenteritis Rotavirus affects very young infants and has more severe symptoms than other gastroenteritis and is significantly associated with respiratory signs.

In a prospective passive diarrhea surveillance cohort study of 1,034 infants of low socioeconomic communities in Lima, Peru, we determined the prevalence and antimicrobial drug susceptibility of the diarrheagenic Escherichia coli . The prevalence of diarrheagenic E. coli was 29% (161 of 557) in children with gastroenteritis and 30% (58 of 195) in the control group without diarrhea. The most common E. coli pathogens in diarrhea were enteroaggregative E. coli (EAEC) (14%), enteropathogenic E. coli (EPEC) (7%), diffusely adherent E. coli (DAEC) (4%), and enterotoxigenic E. coli (ETEC) (4%). Diarrheagenic E. coli as a group exhibited high levels of antimicrobial drug resistance in diarrheal cases to ampicillin (85%), cotrimoxazole (79%), tetracycline (65%), and nalidixic acid (28%). Among individual E. coli groups in patients with diarrhea, DAEC and EAEC exhibited significant higher frequencies of resistance to ampicillin, cotrimoxazole, tetracycline and nalidixic acid than EPEC and ETEC. Antimicrobial drug resistance to ampicillin and cotrimoxazole were more frequent in E. coli isolated from diarrheal samples than controls, which reflected greater antibiotic exposure in patients with gastroenteritis.

Background: Low-birth-weight infants may have impaired zinc status, but little is known about the effect of zinc supplementation., Objective: The objective was to investigate the effect of daily zinc supplementation on morbidity and anthropometric status in hospital-born, low-birth-weight infants., Design: In a double-blind, randomized, placebo-controlled trial, 2052 hospital-born term infants with a birth weight < or =2500 g were randomly assigned to receive zinc or placebo. The zinc group received elemental zinc: 5 mg/d for those infants between ages 2 wk and 6 mo and 10 mg/d for those infants aged >6 mo. All-cause hospitalizations, prevalence of diarrhea, acute lower respiratory tract infections, visits to health care providers, weights, and lengths were ascertained at 3, 6, 9, and 12 mo of age., Results: The supplement was consumed for >85% of the follow-up period. Mean plasma zinc at 12 mo of age was higher in the zinc group (100.2 microg/dL) than in the control group (73.3 microg/dL) (difference in means: 26.9; 95% CI: 19.6, 34.2). The 24-h and 7-d prevalence of diarrhea and acute lower respiratory tract infections was similar at 3, 6, 9, and 12 mo. Care-seeking for illness was significantly lower in the zinc group (difference in proportions: -5.7; 95% CI: -9.9, -1.4; P < 0.05) at 9 mo. The numbers of hospitalizations, weights, and lengths were all similar at all 4 assessments., Conclusion: Hospital-born, term, low-birth-weight infants do not seem to benefit substantially from zinc supplementation that meets the Recommended Dietary Allowance for zinc in terms of morbidity or physical growth during infancy in this setting. This trial was registered at www.clinicaltrials.gov as NCT00272142.

Background: In India, common morbidities among children under 3 years of age are fever, acute respiratory infections, diarrhea. Effective early management at the home level and health care-seeking behavior in case of appearance of danger signs are key strategies to prevent the occurrence of severe and life-threatening complications., Objectives: To find out the prevalence of acute child morbidities, their determinants and health-seeking behavior of the mothers of these children., Setting and Design: The cross-sectional study was carried out in Wardha district of central India., Material and Methods: We interviewed 990 mothers of children below 3 years of age using 30-cluster sampling method. Nutritional status was defined by National Center for Health Statistics (NCHS) reference. Composite index of anthropometric failure (CIAF) was constructed. Hemoglobin concentration in each child was estimated using the 'filter paper cyanm ethemoglobin method.' Using World Health Organization guidelines, anemia was defined as hemoglobin concentration less than 110 g/L. Post-survey focus group discussions (FGDs) were undertaken to bridge gaps in information obtained from the survey., Statistical Analysis: The data was analyzed by using SPSS 12.0.1 software package. Chi-square was used to test the association, while odds ratios were calculated to measure the strength of association. Multiple logistic regression analysis was applied to derive the final model., Results: Anemia was detected in 80.3% of children, and 59.6% of children were undernourished as indicated by CIAF. The overall prevalence of acute morbidity was 59.9%. Children with mild anemia, moderate anemia and severe anemia had 1.52, 1.61 and 9.21 times higher risk of being morbid, respectively. Similarly, children with single, 2 and 3 anthropometric failures had 1.16, 1.29 and 2.27 times higher risk of being morbid, respectively. Out of 594 (60%) children with at least one of the acute morbidities, 520 (87.5%) sought health care, where majority (66.1%) received treatment from private clinics. The final model suggested that anemia and mother's poor educational status are predictors of childhood morbidity., Conclusions: Nutritional anemia and mother's poor educational status are the most important risk factors of acute childhood morbidity. There is need to revitalize existing health care delivery and child health programs in rural India with emphasis on immediate correction of nutritional anemia.

The objective of this cross sectional prospective study was to determine rotavirus etiology and prevalence of the different rotavirus genotypes causing acute gastroenteritis in infants and children (

Research was conducted in rural Northeast Thailand to understand how mothers perceive children's acute illness episodes, and their resulting illness management strategies. Although diarrheal disease is one of the leading causes of illness among young children in Thailand, interviews revealed that mothers frequently do not classify infantile diarrhea as an "illness." Infantile diarrhea is commonly labeled thai su, a type of diarrhea believed necessary to "lighten the body" so that the infant can attain a new developmental stage, such as sitting up, standing, or walking. Consequently, mothers do not perceive infection-related diarrheal illness as common in infants, and therefore do not direct much attention to prevention, nor manage diarrheal cases in a manner consistent with biomedical recommendations. In this article I describe local explanatory models of diarrheal illness, and discuss the role of situational factors and elder authority in determining how illness episodes are assessed and managed.

Objectives: To identify risk factors for sporadic cases of Campylobacter infection in children aged 14 years., Methods: We performed an age-matched, case-control study. Cases were residents of Lleida Health Region aged 6 months to 14 years old with diarrhea and positive stool isolation for Campylobacter. Information was gathered by telephone using a structured questionnaire on individual susceptibility and food and non-food exposures. A multivariate conditional logistic regression model was used to estimate adjusted odds ratios (ORa) and their 95% confidence intervals (95%CI)., Results: Forty-five cases and 45 controls were included in the analysis. The median age of cases was 1.6 years. Factors independently associated with disease were consumption of cooked deli meat 2 times (ORa:4.2, 95%CI:1.2-14.7), chicken 3 times (ORa:3.6, 95%CI:1.1-11.1) in the week before symptom onset, and previous antibiotic intake (ORa:4.7, 95%CI:1.1-19.6)., Conclusions: Chicken meat was a risk factor for sporadic cases of campylobacteriosis in children, whether through consumption or through cross-contamination with other <> foods such as cooked deli meat.

Background/objective: The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children., Methods: We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6-24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting., Results: We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children., Conclusions: Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups.

Diarrhea remains an important cause of morbidity in Thailand, particularly for children below age five. This study identified the patterns of diarrhea incidence in children below age five in northeastern provinces of Thailand along the border with Lao PDR, based on the individual hospital case records of patients with diarrhea routinely reported from 1999 to 2004. Linear regression models containing the district, season and year as factors were fitted to the log-transformed disease incidences, with generalized estimating equations used to account for spatial correlation between districts. Low disease counts suggesting under-reporting were handled by imputation based on these models. This study found a seasonal pattern higher in January to March and April to June. Higher rates occurred in most districts of Loei and Amnat Chroen Provinces. Using a thematic map to display the level of diarrhea incidence by district can provide useful information for health authorities to direct their intervention plans more effectively and to set up health policies for prevention of disease.

Context: Pentavalent rotavirus vaccine (RV5), a live, oral attenuated vaccine, prevented 98% of severe rotavirus diarrhea in a trial conducted mainly in Finland and the United States. Nicaragua introduced RV5 in 2006, providing the first opportunity to assess the association between vaccination and rotavirus disease in a developing country., Objective: To assess the association between RV5 vaccination and subsequent rotavirus diarrhea requiring overnight admission or intravenous hydration., Design, Setting, and Participants: Case-control evaluation in 4 hospitals in Nicaragua from June 2007 to June 2008. Cases were children age-eligible to receive RV5 who were admitted or required intravenous hydration for laboratory-confirmed rotavirus diarrhea. For each case (n = 285), 1 to 3 neighborhood (n = 840) and hospital (n = 690) controls were selected., Main Outcome Measures: Primary outcome was the association of RV5 and rotavirus diarrhea requiring overnight admission or intravenous hydration in the emergency department. Secondary analysis further classified disease as severe and very severe. We computed the matched odds ratio of vaccination in cases vs controls. Vaccine effectiveness was estimated using the formula 1 - matched odds ratio x 100%., Results: Of the 285 rotavirus cases, 265 (93%) required hospitalization; 251 (88%) received intravenous hydration. A single rotavirus strain (G2P[4]) was identified in 88% of the cases. Among cases and controls, respectively, 18% and 12% were unvaccinated, 12% and 15% received 1 dose of RV5, 15% and 17% received 2 doses, and 55% and 57% received 3 doses. Vaccination with 3 doses was associated with a lower risk of rotavirus diarrhea requiring overnight admission or intravenous hydration (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.36-0.82). Of the 285 rotavirus cases, 191 (67%) were severe and 54 (19%) were very severe. A progressively lower risk of severe (OR, 0.42; 95% CI, 0.26-0.70) and very severe rotavirus diarrhea (OR, 0.23; 95% CI, 0.08-0.61) was observed after RV5 vaccination. Thus, effectiveness of 3 doses of RV5 against rotavirus disease requiring admission or treatment with intravenous hydration was 46% (95% CI, 18%-64%); against severe rotavirus diarrhea, 58% (95% CI, 30%-74%); and against very severe rotavirus diarrhea, 77% (95% CI, 39%-92%)., Conclusion: Vaccination with RV5 was associated with a lower risk of severe rotavirus diarrhea in children younger than 2 years in Nicaragua but to a lesser extent than that seen in clinical trials in industrialized countries.

The objective of this cohort study was to assess risk factors for child dysentery and watery diarrhoea. The study participants consisted of 254 children aged 12-24 months in rural South Africa and Zimbabwe in households where drinking water was collected from communal sources. The main outcome measure was the most severe diarrhoea episode: dysentery, watery diarrhoea or none. For dysentery, drinking water from sources other than standpipes had a relative risk ratio of 3.8 (95% CI 1.5-9.8). Poor source water quality, as indicated by Escherichia coli counts of 10 or more cfu 100 ml(-1), increased risk by 2.9 (1.5-5.7). There were no other significant risk factors for dysentery and none for watery diarrhoea. In this study, endemic dysentery is associated only with faecal contamination of source water. Sources other than standpipes, including improved groundwater, are of greater risk. Remediation of water quality by treatment at source or in the household will be required to achieve access to safe drinking water in accordance with the 7th Millennium Development Goal.

To determine the aetiology of diarrhoea in children younger than 5 years hospitalised for acute enteritis and to evidence the chief clinical aspects in correlation with different aetiological agents, a total of 402 children with acute diarrhoea were examined between February 2003 and December 2006 in the Paediatric Department of Sondrio Hospital. Faecal samples were collected and processed by routine microbiological and biochemical tests. For all patients the clinical signs and symptoms on admission were evidenced. Most of the patients (310/402, 77.1%) were infected by rotavirus, while of the remaining 82 (22.9%) 40 were infected by salmonella species. In 42 patients, no bacterial agent was evidenced by microbiological tests. Clinical signs of mild dehydration were observed in 13 children during the hospital stay (all infected by rotavirus), while no case of metabolic acidosis, hypoglycaemia or hypovolaemic shock was documented. Elevated serum levels of uric acid were evidenced in 13/302 (4.3%) of patients with rotavirus infection, while only 1/82 (1.2%) rotavirus-negative children presented a minimal increase in serum uric acid level. Our retrospective study confirms the epidemiological and clinical importance of rotavirus as the main aetiological agent in hospitalised children younger than 5 years affected by acute diarrhoea. There also emerged a possible correlation between rotavirus infection and hyperuricaemia, probably connected with dehydration.

Diarrhoeal diseases remain a major cause of morbidity and mortality in Brazilian children. However, from 1992 to 2001 there was a significant decline in hospitalizations for acute diarrhoea in children below 1 year of age in Brazil. A significant improvement in child health was also observed in the state of Rio Grande do Norte (RN), with a decrease in child mortality from 70 to 40 deaths per 1000. Using distributed lag analysis we analysed a number of factors possibly connected with decreased hospitalization in RN and found that hospitalization was correlated up to lag 3 with poverty (P<0.001) and inflation (P<0.001). Improvements in public health infrastructure such as better waste collection, presence of city water supply and increased sanitation, socio-economic variables such as education and literacy, and increased investment in health services were all important in reducing severe early childhood diarrhoeas and thus directly associated with the decrease in hospitalization. We also observed a positive seasonal correlation between rainfall and hospitalizations with an increased in rainfall impacting positively on hospitalization in all lags. The data suggests that increased buying power and reductions in poverty played a crucial role in reducing hospitalizations for acute diarrhoea in infants in RN.

Objectives: An effective vaccine is needed to protect against severe rotavirus disease, an important cause of gastroenteritis. Since there are no data on the incidence and antigenic diversity of rotavirus infection in Sierra Leone, we studied its epidemiology to enable an effective vaccine strategy to be designed., Methods: Children between the ages of 3 and 30 months presenting with gastroenteritis to the Ola During Children's Hospital in Freetown, Sierra Leone, were enrolled. Stool specimens were tested in South Africa using polyacrylamide gel electrophoresis to confirm rotavirus infection., Results: Over a 5-month period 143 children presenting with gastroenteritis were recruited. Stool samples obtained from 128 study subjects were tested for the presence of rotavirus; 45% were aged between 3 and 9 months (mean age 10.85 months), and 48 stool samples (37.5%) tested positive for rotavirus. The incidence of rotavirus infection was 20% higher in boys than in girls, a gender difference confirmed elsewhere in West Africa. The prevalence of rotavirus-positive stools peaked in August, coinciding with the rainy season. About 90% of the rotavirus-positive patients had severe diarrhoea, as opposed to only about two-thirds of the patients whose diarrhoea was not caused by rotavirus; this difference was statistically significant., Conclusions: There is a high incidence of rotavirus infection in Sierra Leone, with rotavirus causing 37.5% of the gastroenteritis in this study. Patients with rotavirus gastroenteritis almost all had severe diarrhoea. The high incidence of rotavirus infection and the severity of the disease presentation make the institution of a rotavirus vaccine programme in Sierra Leone imperative.

Aim: To evaluate the effective dose of Lactobacillus rhamnosus GG (LGG) as probiotic in acute watery diarrhea (AWD) in Indian children., Setting: Hospital-based study., Design: Randomized, controlled, blinded trial., Methods: All patients of AWD admitted over 1 year were included in the study. They were randomized into 3 groups to receive either only oral rehydration solution (ORS) (group A/control), ORS+LGG powder containing 10(10) colony forming units (CFU) (group B), or ORS+LGG powder containing 10(12) CFU (group C) twice daily for a minimum period of 7 days or until diarrhea stopped along with correction of dehydration. None of them received any other drug such as antibiotic or antidiarrheal medication. The duration and frequency of diarrhea and vomiting were studied. Data were analyzed by SPSS-10 software., Results: The study comprised of 559 patients, group A/controls (n=185), group B (n=188), and group C (n=186). All the groups were similar with respect to age, number of breastfed infants, presentation with dehydration, degree of protein energy malnutrition, and rotavirus infection. The frequency and duration of diarrhea, requirement for intravenous therapy, and hospital stay were significantly lower in both the intervention groups compared with the controls. There was no significant difference between the 2 intervention groups. No complication was observed from the doses of LGG used., Conclusions: Both the doses of LGG (10(10) and 10(12) CFU) were equally effective to decrease the frequency and duration of diarrhea and reduction in hospital stay in patients of AWD.