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Background: Rotavirus has a significant morbidity and mortality in children under two years. The burden of rotavirus diarrhea 4 years post introduction of rotavirus vaccine in Uganda is not well established. This study aimed to determine the prevalence, severity of dehydration and factors associated with rotavirus diarrhea among children aged 3 to 24 months after the introduction of the vaccine at Fort Portal Regional Referral hospital., Methods: This was a cross-sectional hospital-based study in which children with acute watery diarrhea were included. A rectal tube was used to collect a stool sample for those unable to provide samples. Stool was tested for rotavirus using rapid immunochromatographic assay. Data was analysed using SPSS version 22 with logistic regression done to determine the factors., Results: Out of 268 children with acute watery diarrhea, 133 (49.6%) were females. Rotavirus test was positive in 42 (15.7%), majority of whom had some dehydration 28(66.7%). The factors that were independently associated with rotavirus diarrhea were; age < 12 months (AOR = 8.87, P = 0.014), male gender (AOR = 0.08, P = 0.001), coming from a home with another person with diarrhea (AOR = 17.82, P = 0.001) or a home where the water source was a well (AOR = 50.17, P = 0.002)., Conclusion: The prevalence of rotavirus diarrhea was three times less in the post rotavirus vaccination period compared to pre-rota vaccination period. Majority of the participants with rotavirus diarrhea had some dehydration. There is need for provision of safe water sources to all homes. Surveillance to determine the cause of the non rota diarrhea should be done., (© 2024. The Author(s).)

Background: Diarrhoea still ranks among the top causes of the deaths of children under five years old in the world. In solving this important health problem, it is necessary and imperative to know the health-related knowledge levels of mothers who take care of the child individually and the traditional practices they perform when their children are sick, in order to provide effective health education., Aim: This study aims to examine the knowledge levels and traditional practices of mothers with children younger than 5   years old regarding diarrhoea in relation to their education levels., Methods: We conducted a cross-sectional web-based survey. The population of this cross-sectional study consisted of mothers with children under the age of 5 who lived in the metropolitan city Bursa in the South Marmara Region of Turkey. The survey was applied among the mothers of children under the age of 5 using the snowball sampling method via mobile platforms. The data were collected via Google Forms using a "Socio-Demographic Data Collection Form", an "Information Form on Measuring the Knowledge Level of Mothers on Diarrhoea" and a "Form on Main Traditional Practices Used When Children Have Diarrhoea in Turkey" prepared by the researchers after a review of the relevant literature., Results: In the study, the mean total diarrhoea knowledge score of the participating mothers was found to be 22.01   ±   3.72 (high). Multiple linear regression analysis was used to determine the relationship between the total diarrhoea knowledge scores of the participants and other variables. The difference in the knowledge scores based on education levels was statistically significant ( p   <   .001). The most prevalently preferred traditional practice in the case of children's diarrhoea was "feeding the child banana" (92.5%)., Conclusion: Maternal education level is determined to be a significant variable that positively affects diarrhoea knowledge levels.KEY MESSAGESDiarrhoea continues to be among the top five preventable causes of death in the world and Turkey among children under the age of 5.The knowledge level of mothers about diarrhoea plays an important role in diarrhoea management. The level of knowledge about diarrhoea differs according to the education level of mothers.Traditional practices have an important place in the management of diarrhoea by mothers.

Introduction: Diarrhoea is one of the leading causes of infant mortality and morbidity. Infants with low-birth weight (LBW) have a higher risk of diarrhoea due to their low immunity and nutritional status issues.This study aimed to analyze the factors associated with diarrhoea in infants with LBW in Indonesia., Materials and Methods: We used cross-sectional and secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS). A total of 142 infants under 1 year were selected as the respondents. Chi-square test and binary logistic regression were used to examine factors associated with diarrhoea in infants with LBW in Indonesia., Results: There are several factors more likely to increase the incidence of diarrhoea in infants with LBW, which are living in rural areas [OR = 5.65, 95% CI = 1.08-29.5] and having internet access less than the last 12 months (OR = 13.03, 95% CI = 1.48-114). Meanwhile, factors more likely to decrease the incidence of diarrhoea in infants with LBW, which are maternal age (20-24 years old) [odds ratio (OR) = 0.07, 95% CI = 0.01-0.98], cell phone ownership (OR = 0.08, 95% CI= 0.01-0.45), and the use of feeding bottles (OR = 0.22, 95% CI = 0.05-0.92)., Conclusion: This study highlights that maternal age, cell phone ownership, internet access, area of residence, and use of feeding bottles are significant factors associated with diarrhoea in infants with LBW. Health workers must enhance health education related to those factors through the Community Integrated Child Health Service (Posyandu) programs.

Objective: Studies involving less sensitive conventional microscopy and culture-based approaches have identified distinct differences in diarrhoeal aetiology in childhood malnutrition. Our study involved the use of an advanced molecular biology technique, the TaqMan Array Cards (TAC), to elucidate the diarrhoeal aetiology among young infants with severe acute malnutrition (SAM)., Method: A total of 113 faecal samples was collected from SAM infants, aged 2-6 months, upon admission to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) with complications of diarrhoea and related comorbidities. We used TAC for the detection of 29 different diarrhoeal enteropathogens from a single faecal sample. For comparison, we also analysed 25 diarrhoeal samples from well-nourished infants of similar age., Results: Higher odds of detection of all bacterial enteropathogens were associated with diarrhoea among SAM infants. In particular, the detection of Aeromonas sp (aOR: 25.7, p = 0.011), Campylobacter sp (aOR: 9.6, p < 0.01) and ETEC (aOR: 5.2, p = 0.022) was significantly associated with diarrhoea among SAM infants in comparison to well-nourished infants. 80% higher odds of detection of rotavirus and norovirus GII were associated with diarrhoea among well-nourished infants in comparison to SAM infants (aOR: 0.2, p < 0.05)., Conclusion: Our study findings demonstrate a difference in diarrhoeal aetiology among SAM and well-nourished young infants, which may be useful in providing an evidence-based logic for possible revision of treatment guidelines for treatment of young diarrhoeal infants with SAM in the early management of the menace of antimicrobial resistance., (© 2021 John Wiley & Sons Ltd.)

Background: Childhood diarrhea remains a major public health problem in sub-Saharan Africa (SSA). Women empowerment reduces child mortality, and wife beating attitude is one of the indicators of women empowerment. There is a dearth of evidence about wife beating attitudes and childhood diarrhea in SSA. Therefore, the present study aimed to examine the association between attitude towards wife beating and diarrhea among under-five children., Methods: We used Demographic and Health Surveys from 25 countries in SSA that were conducted between 2010 and 2020. Using Stata version 14 software, we carried out the analysis on 153,864 children under five. Bivariate and multivariate logistic regression analyses were applied, and the results were presented using adjusted odd ratios (aOR) at 95% confidence interval (CI)., Results: The pooled results show that 71.4% of married women disagreed with wife beating. About 20.5% of under-five children of married women had diarrhea. Childhood diarrhea varied from highest prevalence in Chad (27.9%) to the lowest prevalence in Sierra-Leone (8.5%). The study showed lower odds of diarrhea among children of married women who disagreed with wife beating (aOR = 0.66 95% CI; 0.54-0.80) compared to children of married women who agreed with wife beating. Moreover, the study results show that women's age (35-39 years-aOR = 0.48, 95% CI; 0.31-0.74, 40-44 years-aOR = 0.57, 95% CI; 0.35-0.93, 45-49 years-aOR = 0.35, 95% CI; 0.16-0.79) was negatively associated with childhood diarrhea, while husband's education (primary school-aOR = 1.36, 95% CI; 1.05-1.77), parity (ever born 3-4 children-aOR = 1.36, 95% CI; 1.09-1.70, and 5+ children-aOR = 1.56, 95% CI; 1.14-2.12), and religion (Muslim-aOR = 3.56, 95% CI; 1.44-8.83) were positively associated with diarrhea among under-five children., Conclusions: The study shows association between women attitude towards wife beating and childhood diarrhea. Therefore, empowering women, especially young women by increasing awareness about domestic violence, their rights, and empowering them through education and economic advancement need to be considered in order to reduce childhood diarrhea. Moreover, fertility control or birth spacing and working closely with religious leaders are important factors to consider in reducing childhood diarrhea., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Betregiorgis Zegeye et al.)

Introduction: Breastfeeding has a protective effect against acute respiratory and diarrheal infections. There are psychological and social effects due to physical isolation in the population in the mother-child group., Objective: To assess the impact on infant mortality due to a decrease in the prevalence of breastfeeding during 2020 due to the physical isolation against the SARS CoV-2 (COVID-19) pandemic in Colombia., Materials and Methods: We used the population attributable risk approach taking into account the prevalence of breastfeeding and its potential decrease associated with the measures of physical isolation and the relative risk (RR) of the association between exclusive breastfeeding and the occurrence of acute infection consequences in the growth (weight for height) of children under the age of five through a mathematical modeling program., Results: We found an increase of 11.39% in the number of cases of growth arrest in the age group of 6 to 11 months with a 50% decrease in breastfeeding prevalence, as well as an increase in the number of diarrhea cases in children between 1 and 5 months of age from 5% (5.67%) on, and an increased number of deaths in children under 5 years (9.04%) with a 50% decrease in the prevalence of exclusive breastfeeding., Conclusions: A lower prevalence of breastfeeding has an impact on infant morbidity and mortality in the short and medium-term. As a public health policy, current maternal and childcare strategies must be kept in order to reduce risks in the pediatric population.

Background: Approximately one-third of pregnant and postnatal women in Ethiopia experience depression posing a substantial health burden for these women and their families. Although associations between postnatal depression and worse infant health have been observed, there have been no studies to date assessing the causal effects of perinatal depression on infant health in Ethiopia. We applied longitudinal data and recently developed causal inference methods that reduce the risk of bias to estimate associations between perinatal depression and infant diarrhea, Acute Respiratory Infection (ARI), and malnutrition in Gondar Town, Ethiopia., Methods: A cohort of 866 mother-infant dyads were followed from infant birth for 6 months and the cumulative incidence of ARI, diarrhea, and malnutrition were assessed. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the presence of maternal depression, the Integrated Management of Newborn and Childhood Illnesses (IMNCI) guidelines were used to identify infant ARI and diarrhea, and the mid upper arm circumference (MUAC) was used to identify infant malnutrition. The risk difference (RD) due to maternal depression for each outcome was estimated using targeted maximum likelihood estimation (TMLE), a doubly robust causal inference method used to reduce bias in observational studies., Results: The cumulative incidence of diarrhea, ARI and malnutrition during 6-month follow-up was 17.0% (95%CI: 14.5, 19.6), 21.6% (95%CI: 18.89, 24.49), and 14.4% (95%CI: 12.2, 16.9), respectively. There was no association between antenatal depression and ARI (RD = - 1.3%; 95%CI: - 21.0, 18.5), diarrhea (RD = 0.8%; 95%CI: - 9.2, 10.9), or malnutrition (RD = -7.3%; 95%CI: - 22.0, 21.8). Similarly, postnatal depression was not associated with diarrhea (RD = -2.4%; 95%CI: - 9.6, 4.9), ARI (RD = - 3.2%; 95%CI: - 12.4, 5.9), or malnutrition (RD = 0.9%; 95%CI: - 7.6, 9.5)., Conclusion: There was no evidence for an association between perinatal depression and the risk of infant diarrhea, ARI, and malnutrition amongst women in Gondar Town. Previous reports suggesting increased risks resulting from maternal depression may be due to unobserved confounding.

Aims: Appropriate rehydration has always been significant in treating diarrhoeal diseases in children. Irrational antibiotic use among diarrhoeal children has remained a major public health concern. Information regarding antibiotic use in young infants suffering from diarrhoea is very limited and a unique aspect of research. We aimed to investigate the prevalence of antibiotic use in the community among 2-6 months infants with diarrhoeal illnesses and having different nutritional status., Methods: We investigated a total of 5279 infants aged 2-6 months at Dhaka hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between September 2018 and June 2019. Among them, 257 infants were suffering from severe acute malnutrition (SAM). History of taking antibiotics was ascertained by direct observation of a prescription by a physician, the bottle of antibiotic or asking the caregiver about the name of antibiotic or its price that is very close to the usual market price of an antibiotic., Results: Overall, 52% of infants received antibiotics before hospital admission. Non-SAM infants had higher odds of receiving antibiotics (adjusted odds ratio [aOR] = 1.52, 95% confidence interval: 1.18, 1.97, P value = 0.003) compared to infants with SAM and use of antibiotics increased with age (aOR = 1.11, 95% confidence interval: 1.06, 1.17, P value<0.001). Commonly used antibiotics were azithromycin (13.3%), ciprofloxacin (7.7%), erythromycin (7.7%) and metronidazole (2.6%). The proportion of receiving ciprofloxacin was significantly lower in infants with SAM compared to their non-SAM counterparts (2.7% vs. 7.97%, P value = 0.004)., Conclusions: The study underscores the excessive use of antibiotics among diarrhoeal infants, which is already a major public health concern in low- and middle-income countries., (© 2020 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: In South Africa, 30.9% of children under five years with Severe Acute Malnutrition (SAM) died in 2018. We aimed to identify factors associated with mortality among children under five years hospitalized with SAM in Limpopo province, South Africa., Methods: We conducted a cross-sectional study including children under five years admitted with SAM from 2014 to 2018 in public hospitals of Limpopo province. We extracted socio-demographic and clinical data from hospital records. We used logistic regression to identify factors associated with mortality., Findings: We included 956 children, 50.2% (480/956) male and 49.8% (476/956) female. The median age was 13 months (inter quartile range: 9-19 months). The overall SAM mortality over the study period was 25.9% (248/956). The most common complications were diarrhea, 63.8% (610/956), and lower respiratory tract infections (LRTIs), 42.4% (405/956). Factors associated with mortality included herbal medication use (adjusted Odds Ratio (aOR): 2.2, 95% Confidence Interval (CI): 1.4-3.5, p = 0.001), poor appetite (aOR: 2.7, 95% CI: 1.4-5.2, p = 0.003), Mid-upper circumference (MUAC) <11.5 cm (aOR: 3.0, 95% CI: 1.9-4.7, p<0.001), lower respiratory tract infections (LRTIs) (aOR: 1.6, 95% CI: 1.2-2.0, p<0.001), anemia (aOR: 2.5, 95% CI: 1.1-5.3, p = 0.021), hypoglycemia (aOR: 12.4, 95% CI: 7.1-21.8, p<0.001) and human immunodeficiency virus (HIV) infection (aOR: 2.3, 95% CI: 1.6-3.3, p<0.001)., Interpretation: Herbal medication use, poor appetite, LRTIs, anemia, hypoglycemia, and HIV infection were associated with mortality among children with SAM. These factors should guide management of children with SAM., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Diarrhoeal illness is a leading cause of childhood morbidity and mortality and has long-term negative impacts on child development. Although flooring, water and sanitation have been identified as important routes of transmission of diarrhoeal pathogens, research examining variability in the association between flooring and diarrhoeal illness by water and sanitation is limited., Methods: We utilised cross-sectional data collected for the evaluation of Zimbabwe's Prevention of Mother-to-Child HIV transmission programme in 2014 and 2017-18. Mothers of infants 9-18 months of age self-reported the household's source of drinking water and type of sanitation facility, as well as infant diarrhoeal illness in the four weeks prior to the survey. Household flooring was assessed using interviewer observation, and households in which the main material of flooring was dirt/earthen were classified as having unimproved flooring, and those with solid flooring (e.g. cement) were classified as having improved flooring., Results: Mothers of infants living in households with improved flooring were less likely to report diarrhoeal illness in the last four weeks (PD a  = -4.8%, 95% CI: -8.6, -1.0). The association between flooring and diarrhoeal illness did not vary by the presence of improved/unimproved water (p RERI  = 0.91) or sanitation (p RERI  = 0.76)., Conclusions: Our findings support the hypothesis that household flooring is an important pathway for the transmission of diarrhoeal pathogens, even in settings where other aspects of sanitation are sub-optimal. Improvements to household flooring do not require behaviour change and may be an effective and expeditious strategy for reducing childhood diarrhoeal illness irrespective of household access to improved water and sanitation., (© 2020 John Wiley & Sons Ltd.)

HIV-exposed, uninfected (HEU) children are a growing population at particularly high risk of infection-related death in whom preventing diarrhea may significantly reduce under-5 morbidity and mortality in sub-Saharan Africa. A historic cohort (1999-2002) of Kenyan HEU infants followed from birth to 12 months was used. Maternal and infant morbidity were ascertained at monthly clinic visits and unscheduled sick visits. The Andersen-Gill Cox model was used to assess maternal, environmental, and infant correlates of diarrhea, moderate-to-severe diarrhea (MSD; diarrhea with dehydration, dysentery, or related hospital admission), and prolonged/persistent diarrhea (> 7 days) in infants. HIV-exposed, uninfected infants ( n = 373) experienced a mean 2.09 (95% CI: 1.93, 2.25) episodes of diarrhea, 0.47 (95% CI: 0.40, 0.55) episodes of MSD, and 0.34 (95% CI: 0.29, 0.42) episodes of prolonged/persistent diarrhea in their first year. Postpartum maternal diarrhea was associated with increased risk of infant diarrhea (Hazard ratio [HR]: 2.09; 95% CI: 1.43, 3.06) and MSD (HR: 2.89; 95% CI: 1.10, 7.59). Maternal antibiotic use was a risk factor for prolonged/persistent diarrhea (HR: 1.63; 95% CI: 1.04, 2.55). Infants living in households with a pit latrine were 1.44 (95% CI: 1.19, 1.74) and 1.49 (95% CI: 1.04, 2.14) times more likely to experience diarrhea and MSD, respectively, relative to those with a flush toilet. Current exclusive breastfeeding was protective against MSD (HR: 0.30; 95% CI: 0.15, 0.58) relative to infants receiving no breast milk. Reductions in maternal diarrhea may result in substantial reductions in diarrhea morbidity among HEU children, in addition to standard diarrhea prevention interventions.

Objective: This study aimed at examining the socio-demographic, environmental and behavioural determinants of diarrhoea in children under five years in Kenya., Methods: The study entailed an analysis of secondary data from the Kenya Demographic Health Survey (DHS) 2014 using STATA Corp 2010. A total of 19,889 children <5 years were in the study, out of whom 2,906 had diarrhoea in the last two weeks prior to the survey. Descriptive analysis of independent variables and logistic regression model was used to analyse risk factors associated with diarrhoea in children <5 years., Results: The most significant risk factors (p < 0.05) associated with diarrhoea morbidity in children <5 years were child age (AOR 2.26 95% CI 1.64, 3.11), low level of caregiver's education (AOR 1.45 95% CI 1.11, 1.90) and unsafe disposal of children's faeces (AOR 1.29 95% CI 1.03, 1.61). Wealthier households (AOR 0.83 95% CI 0.68, 1) were protective for diarrhoea in children <5 years., Conclusion: Increasing caregiver education, wealthier households and promoting hygienic behaviours in poor households were associated with reducing diarrhoea. Programmes aimed at reducing diarrhoea may achieve better results in targeting caregivers with children in high risk age cohorts of 6-23 months., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Zinc deficiency has been associated with increased incidence, severity and duration of childhood diarrhoea., Objective: The objective of the study was to determine the prevalence of zinc deficiency among under-five children with acute diarrhoea., Methods: The study was a comparative cross-sectional study in which serum zinc levels were determined using atomic absorption spectrometry in under-five children with acute diarrhoea and in apparently healthy contols. Two hundred and fifty children with acute diarrhoea and 250 controls were studied at the Wesley Guild Hospital, Ilesa, Nigeria., Results: The diarrhoea patients had a mean ± SD serum zinc level of 78.8 ± 35.6 µg/dl, while the controls had a mean of 107.3 ± 46.8 µg/dl. The mean serum zinc level was significantly lower in the patients than the controls (t = -7.66; p < 0.001). Furthermore, the prevalence of zinc deficiency was significantly higher among the patients (30.4% versus 12.4% in the controls; OR = 3.09; 95% CI = 1.94 - 4.90; χ2 = 24.08; p < 0.001). Low social class was associated with a significantly higher prevalence of zinc deficiency among the patients (p = 0.013)., Conclusion: Zinc deficiency is significantly associated with diarrhoea among under-five children in the study community. Hence, routine zinc supplementation should be encouraged for the treatment of diarrhoea, and availability should be ensured., (© 2020 Abolurin OO et al.)

Objectives: To evaluate the effect of early breastfeeding cessation on incidence of diarrhea in a cohort of U.S. infants., Design, Sample, and Measurements: A secondary data analysis was conducted using data from 2,340 mother-infant dyads participating in the Infant Feeding Practices Study II. We examined associations between duration of feeding type (e.g., exclusive breastfeeding [EBF], any breastfeeding [BF], formula feeding) and incidence of diarrhea before one year., Results: The sample included mother-infant dyads that were 86.2% White, 3% Black, and 5% Hispanic. Interruption of EBF before 3 months was significantly associated with higher odds of having diarrhea at 6 months (OR = 1.80, p value ≤ 0.01) and between 6 and 12 months (OR = 1.45, p ≤ .01). Breastfeeding interruption before 6 months was associated with higher odds of having diarrhea at 6 months (OR = 3.19, p ≤ .01). Formula feeding for ≥3 months was associated with higher odds of diarrhea between 6 and 12 months., Conclusions: Exclusive breastfeeding for 3 months accompanied by any breastfeeding for 6 months provided the most protective effect against diarrhea. Public health interventions should address disparities in breastfeeding practices and provide support across clinical, workplace and community settings. Research should include more diverse population groups., (© 2019 Wiley Periodicals, Inc.)

Objective: To ascertain the relationship between prelacteal feeding, early formula feeding and adverse health outcomes, especially hospitalisation during the first year of life., Design: Multicentre prospective cohort study., Setting: Six hospitals across three cities in Vietnam., Patients: A total of 2030 pregnant women were recruited at 24-28 weeks of gestation and followed up at hospital discharge, 1, 3, 6 and 12 months post partum., Main Outcome Measures: Rates of infant hospitalisation, diarrhoea and lower respiratory tract infection during the first 12 months., Results: For the final complete sample (n=1709, 84%), about one-quarter of the infants experienced diarrhoea (25.5%) or were admitted to hospital with at least one episode (24.8%), and almost half (47.6%) the cohort contracted lower respiratory tract infection by 12 months. The prevalence of prelacteal feeding was high (56.5%) while formula feeding was common (79.5%) before hospital discharge, both of which increased the risks of adverse health outcomes particularly hospitalisation by approximately 1.5-fold, with adjusted OR (95% CI) 1.43 (1.09 to 1.88) and 1.48 (1.07 to 2.05), respectively for these infants by 12 months, when compared with others who were exclusively breast fed., Conclusions: Prelacteal feeding and early formula feeding before hospital discharge are associated with higher risks of infection and hospital admission in Vietnamese infants. Support for exclusive breast feeding should be provided to mothers to avoid the adverse consequences of giving formula milk and prelateal foods., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Childhood diarrheal disease causes significant morbidity and mortality in low and middle-income countries, yet our ability to accurately predict diarrhea incidence remains limited. El Niño-Southern Oscillation (ENSO) has been shown to affect diarrhea dynamics in South America and Asia. However, understanding of its effects in sub-Saharan Africa, where the burden of under-5 diarrhea is high, remains inadequate. Here we investigate the connections between ENSO, local environmental conditions, and childhood diarrheal disease in Chobe District, Botswana. Our results demonstrate that La Niña conditions are associated with cooler temperatures, increased rainfall, and higher flooding in the Chobe region during the rainy season. In turn, La Niña conditions lagged 0-5 months are associated with higher than average incidence of under-5 diarrhea in the early rainy season. These findings demonstrate the potential use of ENSO as a long-lead prediction tool for childhood diarrhea in southern Africa.

Objective: To investigate the occurrence of infectious morbidities according to day care attendance during the first year of life., Methods: This was a cross-sectional analysis of data from the 12-month follow-up of a medium-sized city birth cohort from children born in 2015, in the Southern Brazil. Main exposure variables were day care attendance from 0 to 11 months of age, type of day care center (public or private), and age at entering day care. Health outcomes were classified as follows: "non-specific respiratory symptoms," "upper respiratory tract infection," "lower respiratory tract infection," "flu/cold," "diarrhea," or "no health problem," considering the two weeks prior to the interview administered at 12 months of life. Associations were assessed using Poisson regression adjusted by demographic, behavioral, and socioeconomic variables., Results: The sample included 4018 children. Day care attendance was associated with all classifications of health outcomes mentioned above, except for flu/cold. These were stronger among children who entered day care at an age closer to the outcome time-point. An example are the results for lower respiratory tract infection and diarrhea, with adjusted prevalence ratios of 2.79 (95% CI: 1.67-4.64) and 2.04 (95% CI: 1.48-2.82), respectively, for those who entered day care after 8 months of age when compared with those who never attended day care., Conclusions: The present study consistently demonstrated the association between day care attendance and higher occurrence of infectious morbidities and symptoms at 12 months of life. Hence, measures to prevent infectious diseases should give special attention to children attending day care centers., (Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Diarrhea and acute respiratory infection (ARI) are major causes of child mortality. We aimed to identify risk factors associated with diarrhea and ARI among children under 2 years of age in rural northern Bangladesh., Method: We collected information on diarrhea and ARI in the previous 14 days and the previous 6 months at 6, 12, 18 and 24 months of age as part of a longitudinal, cluster randomized effectiveness trial, the Rang-Din Nutrition Study which enrolled 4011 pregnant women at ≤20 gestational weeks. Women and their children were followed up until 2 years postpartum. Information on household socioeconomic status, type of toilet, garbage disposal system, food insecurity, number of under-five children in the household, type of family, maternal characteristics and child characteristics was collected at baseline and/or at 6, 12, 18 and 24 months postpartum. Data on newborn health and feeding behaviors were collected within 72 h of delivery. Associations between potential risk factors and morbidity prevalence outcomes were assessed using logistic regression controlling for potential confounders., Results: Out of 3664 live born children, we collected information from ~ 3350 children at 6, 12, 18 and 24 months of age. Diarrhea in the previous 14 days, and in the previous 6 months, was associated with maternal depression score and food insecurity; diarrhea in the previous 6 months was also associated with family type (nuclear vs. joint). ARI in the previous 14 days was associated with maternal depression score, type of toilet and garbage disposal, household food insecurity and sex. Cough or nasal discharge in the past 6 months was associated with maternal depression score, type of toilet and garbage disposal, household food insecurity, sex and perceived overall physical condition of the infant after birth., Conclusion: Maternal depression and food insecurity appear to be important risk factors for diarrhea and respiratory infection among children under 2 years of age in this setting. These findings suggest that policies and programs that include strategies to address maternal mental health and household food insecurity may contribute to improved child health., Trial Registration: The trial was registered with the US National Institutes of Health at ClinicalTrials.gov, # NCT01715038 , with registration completed October 26, 2012.

Objectives: The determinants of gut microbiota composition and its effects on common childhood illnesses are only partly understood, especially in low-income settings. The aim of the present study was to investigate whether morbidity predicts gut microbiota composition in Malawian children and whether microbiota predicts subsequent morbidity. We tested the hypothesis that common infectious disease symptoms would be predictive of lower microbiota maturity and diversity., Methods: We used data from 631 participants in a randomized-controlled nutrition intervention trial, in which a small-quantity lipid-based nutrient supplement was provided to pregnant and lactating mothers and their children at 6 to 18 months of age. Fecal samples were collected from the children at 6, 12, 18, and 30 months of age and analyzed using 16S rRNA sequencing. Microbiota variables consisted of measures of microbiota diversity (Shannon Index), microbiota maturity (microbiota-for-age z score), and the relative abundances of taxa. Morbidity variables included gastrointestinal and respiratory symptoms and fever., Results: Diarrhea and respiratory symptoms from 11 to 12 months were predictive of lower microbiota-for-age z score and higher Shannon Index, respectively (P = 0.035 and P = 0.023). Morbidity preceding sample collection was predictive of the relative abundances of several bacterial taxa at all time points. Higher microbiota maturity and diversity at 6 months were predictive of a lower incidence rate of fever in the subsequent 6 months (P = 0.007 and P = 0.031)., Conclusions: Our findings generally do not support the hypothesis that morbidity prevalence predicts a subsequent decrease in gut microbiota maturity or diversity in rural Malawian children. Certain morbidity symptoms may be predictive of microbiota maturity and diversity and relative abundances of several bacterial taxa. Furthermore, microbiota diversity and maturity may be associated with the subsequent incidence of fever.

Background: Rotavirus A (RVA) is one of the leading causes of acute gastroenteritis worldwide; however, few studies assessed RVA genetics with community surveillance., Objectives: This study aimed to investigate clinical data, genetic diversity, and coinfection patterns of RVA infections in children from 2 to 36 months old with or without community childhood diarrhea in the Brazilian semiarid region during postvaccination era., Methods: We enrolled and collected socioeconomic/clinical information using a standardized questionnaire and fecal samples from 291 children. Viral RNA samples were extracted and analyzed using quantitative reverse transcription polymerase chain reaction to establish the diagnosis of RVA. Sequencing of VP7 and VP4 (VP8*) regions and phylogenetic analysis were performed., Results: RVA-negative diagnosis was associated with children 24 to 36 months old with complete vaccination schedule. Genotype G1P[8] was the most prevalent (57%), whereas unusual genotypes including G1P[4], G2P[8], and G3P[9] were also detected. G1- and P[8]-positive samples showed high degrees of similarity with the vaccine strain. RVA coinfections were frequently observed, and enteroaggregative Escherichia coli was the most prevalent copathogen., Conclusions: These results demonstrate that genotype G1P[8] is the most prevalent strain. VP7 and/or VP8* gene segments arising from RV1 vaccine strain were documented in these children, suggesting shedding or herd vaccination. Moreover, our study indicates full vaccination is important for protection against RVA infections.

Background: Pediatric diarrhea can be caused by a wide variety of pathogens, from bacteria to viruses to protozoa. Pathogen prevalence is often described as seasonal, peaking annually and associated with specific weather conditions. Although many studies have described the seasonality of diarrheal disease, these studies have occurred predominantly in temperate regions. In tropical and resource-constrained settings, where nearly all diarrhea-associated mortality occurs, the seasonality of many diarrheal pathogens has not been well characterized. As a retrospective study, we analyze the seasonal prevalence of diarrheal pathogens among children with moderate-to-severe diarrhea (MSD) over three years from the seven sites of the Global Enteric Multicenter Study (GEMS), a case-control study. Using data from this expansive study on diarrheal disease, we characterize the seasonality of different pathogens, their association with site-specific weather patterns, and consistency across study sites., Methodology/principal Findings: Using traditional methodologies from signal processing, we found that certain pathogens peaked at the same time every year, but not at all sites. We also found associations between pathogen prevalence and weather or "seasons," which are defined by applying modern machine-learning methodologies to site-specific weather data. In general, rotavirus was most prevalent during the drier "winter" months and out of phase with bacterial pathogens, which peaked during hotter and rainier times of year corresponding to "monsoon," "rainy," or "summer" seasons., Conclusions/significance: Identifying the seasonally-dependent prevalence for diarrheal pathogens helps characterize the local epidemiology and inform the clinical diagnosis of symptomatic children. Our multi-site, multi-continent study indicates a complex epidemiology of pathogens that does not reveal an easy generalization that is consistent across all sites. Instead, our study indicates the necessity of local data to characterizing the epidemiology of diarrheal disease. Recognition of the local associations between weather conditions and pathogen prevalence suggests transmission pathways and could inform control strategies in these settings., Competing Interests: The authors have declared that no competing interests exist.

Background: Diarrhea is a leading cause of childhood mortality globally as well as in Nepal. Data all around the world has shown the highest prevalence of diarrheal disease amongst 6-12 months old children. This paper aims to assess the existing diarrhea preventive practices carried out by caretakers of children from 6-12 months of age and their predicting factors in Chitwan district of Nepal., Methods: A cross -sectional survey was conducted among 384 caretakers of children aged 6-12 months from four different MCH clinics of Chitwan district, Nepal. Data were collected by using face- to-face interviews with structured questionnaires from April 15 to May 30, 2018. Univariate analysis, chi square, Pearson correlation and stepwise multiple regression analysis were the statistics used for data analysis., Results: The findings showed that only around one-fourth (22.7%) of the caretakers followed good diarrhea preventive practices. Stepwise multiple regression showed that age, monthly family income, knowledge, attitude and accessibility to WASH (water, sanitation and hygiene), could predict the diarrhea preventive practices of caretakers by only 20.5%. Accessibility to WASH (beta= 0.246) had the highest predictive power and age (beta= 0.015) had the least predictive power of diarrhea preventive practices amongst them., Conclusions: The findings of this study suggest that there is a definite need to promote diarrhea preventive practices. Local government and non-government organizations should establish activities to improve accessibility to WASH, caretaker's attitude and caretaker's knowledge in order to ultimately improve their preventive practices.

Background: Cryptosporidium is a major pathogen associated with diarrheal disease in young children. We studied Cryptosporidium diarrhea in children enrolled in the Global Enteric Multicenter Study (GEMS) in rural Gambia., Methods: We recruited children <5 years of age with moderate-to-severe diarrhea (MSD) for 3 years (2008-2010), and children with either MSD or less severe diarrhea (LSD) for one year (November 2011-November 2012) at sentinel health centers. One or more randomly selected controls were matched to each case. Stool samples were tested to identify Cryptosporidium by immunoassay. A subset of randomly selected case-controls pairs were tested for Cryptosporidium species. We investigated the epidemiology of, and evaluated possible risk factors for, Cryptosporidium-positive diarrhea., Results: We enrolled 1938 cases (1381 MSD, 557 LSD) and 2969 matched controls; 231/1929 (12.0%) of diarrhea cases and 141/2962 (4.8%) of controls were positive for Cryptosporidium. Most Cryptosporidium diarrhea cases (85.7%, 198/231) were aged 6-23 months, and most (81.4%, 188/231) occurred during the rainy season. Cryptosporidium hominis (C. hominis) was the predominant (82.6%) species. We found associations between increased risk of Cryptosporidium-positive MSD or LSD, or both, with consumption of stored drinking water and certain animals living in the compound-cow, cat (MSD only) and rodents (LSD only). Larger households, fowl living in the compound, and the presence of Giardia infection were associated with decreased risk of Cryptosporidium MSD and LSD., Conclusion: Cryptosporidium-positive diarrhea is prevalent in this setting, especially at 6-23 months of age. The preponderance of Cryptosporidium infection in the rainy season and increased risk of Cryptosporidium-positive diarrhea with consumption of stored drinking water suggest water-borne transmission. Further investigation is needed to clarify the role of animals and contamination of stored drinking water in Cryptosporidium transmission., Competing Interests: DS is currently affiliated with a company. DS is a Director, Epidemiology and Health Economics at GlaxoSmithKline (GSK) Vaccines, Wavre, Belgium. RA is retired from GSK and RA was a Global Director, Scientific Affairs of GSK Vaccines, Wavre, Belgium. Both of them were with MRC Unit The Gambia at LSHTM during the study period. The current work of DS does not involve research on Cryptosporidium vaccine. The other authors have declared that no competing interests exist.

Background: There has been a growing interest in the non-skeletal roles of vitamin D particularly its immune-modulatory properties which has been shown to influence the susceptibility and severity to infections. There is insufficient data globally on the association between Vitamin D levels and Diarrhoea in children. The objective of the study was to determine the association between vitamin D levels and diarrhoea in children aged less than five years., Methods: Hospital based unmatched case-control study was carried out at MNH between September 2015 and January 2016. Cases were defined as patients with diarrhoea, Sick controls were patients who did not have diarrhoea but were admitted for other illnesses and Healthy controls were children who had neither diarrhoea nor other co-morbid conditions. Structured questionnaires were used to capture the demographic data and anthropometric measurements. Blood samples of study participants were tested for serum vitamin D levels and grouped as vitamin D sufficient, insufficient or deficient (VDD). SPSSv.20 was used to carry out the Statistical analysis. Binary logistic regression, Mann-Whitney and Kruskal-Wallis tests were used, a p-value≤ 0.05 was considered to be statistically significant., Results: A total of 188 children under five were recruited in the study at the ratio of 1 case: 3 controls, of these 47 were Cases, 94 were Sick controls and remaining 47 were Healthy controls. The mean age was 17.01 ± 14.8 months. The mean vitamin D level was 51.18 ± 21.97 nmol/l. Majority of the participants 101 (53.7%) were vitamin D deficient, 64 (34%) were insufficient and 23 (12.2%) had sufficient vitamin D levels. Sick controls were 3.2 times more likely to be VDD compared to cases [95% CI 0.14-0.69; p = 0.0015] and 5.03 times when compared to Healthy controls [95% CI 2.22-11.55; p = 0.000]. Severe acute malnutrition (SAM) was independently associated with diarrhoea (95% CI: 1.26-5.39, p 0.01)., Conclusions: High prevalence of vitamin D deficiency was found in the children under five years studied. Vitamin D levels was not found to be specifically associated with diarrhoea in children under five years of age.

Background: Diarrhea remains the leading cause of morbidity and mortality among under 5 children in low- and middle-income countries. In Tanzania, diarrhea remains one of the major public health problems. This study aimed to investigate spatial variations and the factors correlated with diarrhea in under five children., Methods: This is a secondary data analysis using data from the population-based cross section Tanzanian Demographic and Health Survey 2015-16 data. Spatial analysis was done using the Bernoulli model from SaTScan™ software, and a generalized linear mixed model was used to identify the factors associated with childhood diarrhea., Results: The overall reported prevalence of childhood diarrhea for the under five children in Tanzania was 12.1% (95%CI 11.3%-12.9%). The SaTScan spatial statics analysis revealed that diarrhea in children was not random. The odds of diarrhea were 7.35 times higher (AOR= 7.35; 95%CI: 5.29, 10.22) among children in the 6-11 months age group compared to children within the 48-59 months of age. As mother's age increased, the risk of diarrhea for the under five children decreased whereas the highest risk of diarrhea was observed in the two rich income brackets richer (AOR=1.70, 95%CI=1.30, 2.22), and richest (AOR= 1.05, 95%CI=1, 1.09). The odds of diarrhea were 1.25 times higher (AOR=1.25, 95%CI=1.06, 1.46) among children with unsafe stool disposal compared to those with safe disposal., Conclusion: The socio-demographic factors associated with diarrhea among children were mother's age in years, current age of the child, wealth index and child stool disposal.

Introduction: Improved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia., Methods: Community oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms. Community councils were strengthened/established in all study sites. Using household surveys, information on mother's handwashing practices and diarrhea incidence of children 2 weeks preceding the study was obtained., Results and Conclusion: Access to safe drinking water was reportedly higher for communities in Guatemala and Zambia (> 80%), than those in Cambodia and Kenya (< 63%), with significantly higher levels in intervention sites for Guatemala and Kenya. Improved sanitation was low (< 10%), for Kenya and Zambia, compared to Cambodia and Guatemala (> 40%); intervention sites reporting significantly higher levels, except for Zambia. Hand washing index; hand washing before food preparation, after defecation, attending to a child after defecation, and before feeding children was significantly higher for intervention sites in Cambodia, Guatemala and Kenya (Cambodia, 2.4 vs 2.2, p < 0.001, Guatemala, 3.0 vs 2.5, p < 0.001, Kenya, 2.6 vs 2.3, p < 0.001). Factors significantly associated with lower odds of diarrhea were; mother's marital status, higher educational status, one or more handwashing practices, wealthier quintiles, older (> 24 m), and female children. The findings suggest that caretaker handwashing with soap or ash has a protective effect on prevalence of diarrhea in children.

Background: Diarrheal diseases remain a leading cause of illness and death among children younger than 5 years in low-income and middle-income countries. The Global Enteric Multicenter Study (GEMS) has described the incidence, aetiology, and sequelae of medically attended moderate-to-severe diarrhoea (MSD) among children aged 0-59 months residing in censused populations in sub-Saharan Africa and south Asia, where most child deaths occur. To further characterise this disease burden and guide interventions, we extended this study to include children with episodes of less-severe diarrhoea (LSD) seeking care at health centres serving six GEMS sites., Methods: We report a 1-year, multisite, age-stratified, matched case-control study following on to the GEMS study. Six sites (Bamako, Mali; Manhiça, Mozambique; Basse, The Gambia; Mirzapur, Bangladesh; Kolkata, India; and Bin Qasim Town, Karachi, Pakistan) participated in this study. Children aged 0-59 months at each site who sought care at a sentinel hospital or health centre during a 12-month period were screened for diarrhoea. New (onset after ≥7 diarrhoea-free days) and acute (onset within the previous 7 days) episodes of diarrhoea in children who had sunken eyes, whose skin lost turgor, who received intravenous hydration, who had dysentery, or who were hospitalised were eligible for inclusion as MSD. The remaining new and acute diarrhoea episodes among children who sought care at the same health centres were considered LSD. We aimed to enrol the first eight or nine eligible children with MSD and LSD at each site during each fortnight in three age strata: infants (aged 0-11 months), toddlers (aged 12-23 months), and young children (aged 24-59 months). For each included case of MSD or LSD, we enrolled one to three community control children without diarrhoea during the previous 7 days. From patients and controls we collected clinical and epidemiological data, anthropometric measurements, and faecal samples to identify enteropathogens at enrolment, and we performed a follow-up home visit about 60 days later to ascertain vital status, clinical outcome, and interval growth. Primary outcomes were to characterise, for MSD and LSD, the pathogen-specific attributable risk and population-based incidence values, and to assess the frequency of adverse clinical consequences associated with these two diarrhoeal syndromes., Findings: From Oct 31, 2011, to Nov 14, 2012, we recruited 2368 children with MSD, 3174 with LSD, and one to three randomly selected community control children without diarrhoea matched to cases with MSD (n=3597) or LSD (n=4236). Weighted adjusted population attributable fractions showed that most attributable cases of MSD and LSD were due to rotavirus, Cryptosporidium spp, enterotoxigenic Escherichia coli encoding heat-stable toxin (with or without genes encoding heat-labile enterotoxin), and Shigella spp. The attributable incidence per 100 child-years for LSD versus MSD, by age stratum, for rotavirus was 22·3 versus 5·5 (0-11 months), 9·8 versus 2·9 (12-23 months), and 0·5 versus 0·2 (24-59 months); for Cryptosporidium spp was 3·6 versus 2·3 (0-11 months), 4·3 versus 0·6 (12-23 months), and 0·3 versus 0·1 (24-59 months); for enterotoxigenic E coli encoding heat-stable toxin was 4·2 versus 0·1 (0-11 months), 5·2 versus 0·0 (12-23 months), and 1·1 versus 0·2 (24-59 months); and for Shigella spp was 1·0 versus 1·3 (0-11 months), 3·1 versus 2·4 (12-23 months), and 0·8 versus 0·7 (24-59 months). Participants with both MSD and LSD had significantly more linear growth faltering than controls at follow-up., Interpretation: Inclusion of participants with LSD markedly expands the population of children who experience adverse clinical and nutritional outcomes from acute diarrhoeal diseases. Since MSD and LSD have similar aetiologies, interventions targeting rotavirus, Shigella spp, enterotoxigenic E coli producing heat-stable toxin, and Cryptosporidium spp might substantially reduce the diarrhoeal disease burden and its associated nutritional faltering., Funding: Bill & Melinda Gates Foundation., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas., Methods: We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour., Results: In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers., Conclusions: Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain., (© The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Pediatric diarrheal disease is a significant source of morbidity and mortality in the developing world. While several studies have demonstrated an increased incidence of diarrheal illness in boys compared with girls in low- and middle-income countries (LMIC), the reasons for this difference are unclear. This secondary analysis of the dehydration: assessing kids accurately (DHAKA) derivation and validation studies included children aged <5 years old with acute diarrhea in Dhaka, Bangladesh. The dehydration status was established by percentage weight change with rehydration. Multivariable regression was used to compare percent dehydration, while controlling for differences in age and nutritional status. In this cohort, a total of 1396 children were analyzed; 785 were male (56.2%) and 611 were female (43.8%). Girls presenting with diarrhea were older than boys (median age 17 months vs. 15 months, p = 0.02) and had significantly more malnutrition than boys, even when controlled for age (mean 134.2 mm vs. 136.4 mm, p < 0.01). The mean percent dehydration did not differ between boys and girls after controlling for age and nutrition status ( p = 0.25). Although girls did have higher rates of malnutrition than boys, measures of diarrhea severity were similar between the two groups, arguing against a cultural bias in care-seeking behavior that favors boys., Competing Interests: None of the authors have any conflicts of interest to report. All authors had full access to all the study data and had final responsibility for the decision to submit for publication., (© Atlantis Press International B.V.)

Background: The impacts of climate change on surface water, waterborne disease, and human health remain a growing area of concern, particularly in Africa, where diarrheal disease is one of the most important health threats to children under 5 years of age. Little is known about the role of surface water and annual flood dynamics (flood pulse) on waterborne disease and human health nor about the expected impact of climate change on surface-water-dependent populations., Methods and Findings: Using the Chobe River in northern Botswana, a flood pulse river-floodplain system, we applied multimodel inference approaches assessing the influence of river height, water quality (bimonthly counts of Escherichia coli and total suspended solids [TSS], 2011-2017), and meteorological variability on weekly diarrheal case reports among children under 5 presenting to health facilities (n = 10 health facilities, January 2007-June 2017). We assessed diarrheal cases by clinical characteristics and season across age groups using monthly outpatient data (January 1998-June 2017). A strong seasonal pattern was identified, with 2 outbreaks occurring regularly in the wet and dry seasons. The timing of outbreaks diverged from that at the level of the country, where surface water is largely absent. Across age groups, the number of diarrheal cases was greater, on average, during the dry season. Demographic and clinical characteristics varied by season, underscoring the importance of environmental drivers. In the wet season, rainfall (8-week lag) had a significant influence on under-5 diarrhea, with a 10-mm increase in rainfall associated with an estimated 6.5% rise in the number of cases. Rainfall, minimum temperature, and river height were predictive of E. coli concentration, and increases in E. coli in the river were positively associated with diarrheal cases. In the dry season, river height (1-week lag) and maximum temperature (1- and 4-week lag) were significantly associated with diarrheal cases. During this period, a 1-meter drop in river height corresponded to an estimated 16.7% and 16.1% increase in reported diarrhea with a 1- and 4-week lag, respectively. In this region, as floodwaters receded from the surrounding floodplains, TSS levels increased and were positively associated with diarrheal cases (0- and 3-week lag). Populations living in this region utilized improved water sources, suggesting that hydrological variability and rapid water quality shifts in surface waters may compromise water treatment processes. Limitations include the potential influence of health beliefs and health seeking behaviors on data obtained through passive surveillance., Conclusions: In flood pulse river-floodplain systems, hydrology and water quality dynamics can be highly variable, potentially impacting conventional water treatment facilities and the production of safe drinking water. In Southern Africa, climate change is predicted to intensify hydrological variability and the frequency of extreme weather events, amplifying the public health threat of waterborne disease in surface-water-dependent populations. Water sector development should be prioritized with urgency, incorporating technologies that are robust to local environmental conditions and expected climate-driven impacts. In populations with high HIV burdens, expansion of diarrheal disease surveillance and intervention strategies may also be needed. As annual flood pulse processes are predominantly influenced by climate controls in distant regions, country-level data may be inadequate to refine predictions of climate-health interactions in these systems., Competing Interests: The authors have declared that no competing interests exist.

Background: Previous studies have found a relationship between cesarean section delivery and adverse outcomes in the offspring, partially attributing these findings to differential development of immunity in infants delivered by cesarean compared to vaginal delivery. The purpose of this study is to determine whether cesarean section delivery is associated with higher reports of adverse short-term infant health outcomes in a peri-urban Indian population., Methods: Data from a prospective pregnancy cohort study in a peri-urban region of Telangana State, India, were analyzed to assess the association between mode of delivery, cesarean section or vaginal, and maternal report of recent infant diarrhea and/or respiratory symptoms at a 6 month follow-up visit. Inverse probability weights were applied to log-binomial regression models to account for maternal pre-pregnancy, prenatal, and labor and delivery factors., Results: Of the 851 singleton infants delivered between 2010 and 2015, 46.7% were delivered by cesarean. Cesarean delivery was not associated with an increased report of infants having one or more of the outcomes (diarrhea, respiratory infection, or difficulty breathing) at 6 months (adjusted risk ratio 0.89, 95% confidence interval 0.76-1.03), nor was it associated with infants having a more severe outcome of comorbid diarrhea and respiratory infection (adjusted risk ratio 1.08, 95% confidence interval 0.58-2.04)., Conclusion: Unlike findings in Western populations, in this peri-urban Indian population, cesarean delivery was not associated with higher reports of short-term adverse gastrointestinal or respiratory infant outcomes after accounting for pre-delivery maternal factors. Future research in this cohort could elucidate whether mode of delivery is associated with other adverse outcomes later in childhood.

Pediatric urolithiasis remains endemic in low-resource countries where infants constitute 17-40% of all children with urolithiasis. This study reports socio-economic factors, medical history and chemical composition of urinary stones in 976 infants of up to 2 years of age. Between 1992 and 2016, 976 infants presented to our institute with 1038 stones. Chemical composition of stones was analyzed by Fourier transformation infrared spectroscopy (FTIR). The mean age of infants was 19.5 ± 5.74 months with a M:F ratio of 5.5:1. Half (50%) of the infants were rural dwellers, 90% belonged to low socio-economic class and 70% were malnourished. A history of chronic diarrhoea was reported in 13% and urinary tract infections in 5%. The anatomic location was bladder in 487 (46.9%), kidney in 246 (23.6%), ureter in 142 (13.6%), urethra in 2 (0.2%) and 161 (15.5%) were passed spontaneously. Overall frequency of compounds in stones showed ammonium acid urate (AAU) in 772 (74.37%), calcium oxalate (CaOx) in 410 (39.5%). Uric acid (UA) in 119 (11.46%), calcium phosphate apatite (CaP) in 96 (9.25%), magnesium ammonium phosphate (Struvite) in 45 (4.34%), cystine in 12 (1.16%) and xanthine in 40 (3.85%). Frequency of compounds was similar in genders. Infants of age 0-6 months had higher frequency of UA (28%), CaOx (50%) and low AAU (61%) as compared to 11, 39 and 75%, respectively, in 7-24 months (p < 0.049) (p < 0.002) (p < 0.001). Nucleus of stones showed pure AAU in 63 and 43% on the surface due to addition of CaOx, struvite and CaP. Our study has shown that AAU is a major component of stones in infants where the main risk factors are poverty, malnutrition, diarrheal diseases and dehydration.

Diarrhea is a major cause of morbidity and mortality among children in West Africa. To determine whether there are areas of heightened risk and if so, how they may be influenced by household and climatic variables, we describe the geo-spatial distribution of childhood diarrhea in ten countries of West Africa for the period 2008-2013 using data from Demographic and Health Surveys. The purely spatial scan statistic was applied, where the observed diarrhea cases were modeled as a Poisson variable and were compared to expected cases predicted from non-spatial logistic regression. Covariate-adjusted cluster analysis detected statistically significant clusters (p < 0.05) in ten cities and thirteen largely rural areas. Areas with particularly high relative risk included Cotonou, Benin (7.16), and Kaduna, Nigeria (7.21). The study demonstrates the importance of development and adaptation measures to protect child health, and that these interventions should be tailored to meet the needs of specific populations., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: Rotaviruses are the most common cause of severe diarrhoeal disease in young children. However, little is known about the epidemiological and clinical profile of rotavirus A (RVA) in diarrhoeal children or the efficacy of Lanzhou lamb rotavirus vaccine (LLR) in Chengdu, China. This study aimed to determine the prevalence and clinical profile of RVA in diarrhoeal children and provide gene analysis information for RVA vaccination programmes., Methods: A total of 1121 faecal samples were collected from outpatient children with diarrhoea between 2009 and 2014. RT-PCR was performed to detect RVA infection and other gastroenteritis viruses. VP4 and VP7 genes of 13 RVA strains were sequenced to compare their similarity with vaccine strains., Results: The overall RVA infection rate was 17.48%. G1 (54.72%) and G3 (18.87%) were the predominant G genotypes; P[8] (72.36%) and P[4] (11.38%) were the main P genotypes. Sixteen genotypes were identified; G1P[8] (57.33%) and G9P[8] (12.00%) were the most prevalent. The proportion of coinfection with RVA and other gastroenteritis viruses was 18.88%. RVA was mostly detected in winter and in diarrhoeal children 1-2 years of age. The genotypes of Rotarix and RotaTeq vaccines were consistent with RVA strains prevalent in Sichuan and shared high identity., Conclusions: RVA was one of the major aetiological agents of diarrhoeal children in Chengdu. Genotype distribution differed within each year and the gene analysis implied low efficacy of LLR. Continuous epidemiological monitoring of RVA is essential for the national vaccination programme., (© 2018 John Wiley & Sons Ltd.)

The effect of a targeted training intervention on uptake of recommended hygiene practices by caregivers of children 6-23 months was assessed. A sub-sample of 40 mothers from 303 households was used for a detailed study of hygiene practices during preparation of complementary foods after training. Mothers and caregivers were observed for 6 months and evaluated using a questionnaire. Data were analyzed using SPSS and Chi-square test was used to determine the differences in proportions of mothers and caregivers who adopted recommended practices. Results showed significant increase in the proportions of mothers and caregivers who followed recommended hygiene practices after training. There was significant decrease in prevalence of diarrhea among the children (45% to 8.6%). It can be concluded that targeted training on practical hands-on activities such as hand washing, cleaning of cooking and serving utensils, covering of food and water increase adoption of recommended hygiene and sanitation practices.

Objective: To systematically review the evidence for an association between maternal depression and the risk of diarrheal illness in infants., Study Design: This study is a meta-analysis., Methods: Nine databases were searched systematically for studies that investigated the risk of diarrheal illness in infants born to mothers with depression., Results: Our search strategy yielded 10 studies of the association between maternal depression and the risk of diarrheal illness in infants: eight studies of postnatal depression, two studies of antenatal depression, and one study of perinatal depression. Our meta-analysis showed that infants born to mothers with postnatal depression were more likely to develop diarrheal illness (odds ratio [OR] = 1.902, 95% confidence interval [95% CI] = 1.385-2.612, P < 0.001, n = 18,585). A similar trend was noted for antenatal depression (OR = 2.703, 95% CI = 0.920-7.942, P = 0.071, n = 583). Only one study reported an association between perinatal depression and risk of diarrhea in infants (OR = 1.848, log OR = 0.614, standard error = 0.093, n = 107,587)., Conclusions: Only a few studies so far have identified an association between maternal depression and risk of diarrhea in infants. The evidence available to date suggests that infants born to mothers with depression are more likely to develop diarrhea than infants whose mothers do not have depression., (Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Diarrhea is a waterborne disease that affects children, especially those under 5 years of age. The objective of this study was to identify the spatial patterns of distribution of diarrheal disease in under 5-year-old children in the State of Tocantins, Brazil, from 2008 to 2013., Methods: Geoprocessing tools were used to carry out an epidemiological study, to prepare thematic maps in the TerraView 4.2.2 software based on secondary data. General indicators of the disease, presence of spatial dependence through the Global Moran's Index (I) and the Spatial Association Index (LISA) were described., Results: There were 3,015 cases of under 5-year-old children hospitalized for diarrhea, with an average annual rate (AAR) of 4.10/1,000 inhabitants (inhab.). Among the main characteristics were: increasing rates in under 1-year-old children (6.16 to 9.66/1,000 inhabitants); children aged 1 to 4 full years (63%); males (55%); 8 deaths of under one-year-old children (75%); county of Araguaína (67%); incidence in the county of Nazaré (63.97/1,000 inhab.); prevalence and incidence in the Araguaína microregion (45%, AAR 9.38/1,000 inhab.). The presence of a cluster with spatial autocorrelation was found in the Araguaína microregion, which was statistically significant (I = 0.11, p-value < 0.03), with priority of intervention (Moran Map)., Conclusions: There was an increase in the number of hospitalizations for diarrhea in under 5-year-old children in the state of Tocantins. The spatial analysis identified clusters of priority areas for measures of maintenance and control of diarrheal diseases.

Introduction: Diarrhoea among children under-five is a serious public health problem in many developing countries, including Nepal. This study aimed to examine the association between health service utilization and diarrhoea management approaches among children under-five years in Nepal., Methods: The combined 2001, 2006 and 2011 Nepal Demographic and Health Survey (NDHS) data sets were examined and the sample included 2,655 children aged 0-59 months who had diarrhoea 2-weeks prior to the each survey. Multilevel logistic regression analyses that adjust for clustering and sampling weight were used to examine the association between health service utilization and diarrhoea management approaches (Oral Rehydration Solution, increased fluids and/or continued feeding)., Results: The prevalence of extra fluids decreased significantly from 27% in 2001 to 15% in 2011 while that of ORS increased significantly from 32% in 2001 to 40% in 2011. The prevalence of continued feeding fluctuated between 83-89%. Multivariate analysis revealed that caregivers whose children received treatment or advice from health care providers during diarrhoea were 5.78 times more likely to treat diarrhoea with Oral Rehydration Solution (ORS) [adjusted Odds Ratio (aOR) 5.78, 95% confidence interval (CI) 4.50, 7.44], 1.56 (aOR 1.56, 95% CI 1.19, 2.05) times more likely to offer extra fluids, and 2.25 (aOR 2.25, 95% CI 1.50, 3.39) times more likely to use continued feeding than those who did not seek advice., Conclusions: Our findings indicate that health service utilization significantly improves diarrhoea management among under-five children. However, a broader national diarrhoeal disease control program to further reduce diarrhoea related morbidity and mortality in Nepal should focus on educating caregivers about the importance of the use of ORS as well as increase fluid intake to children under-five years with diarrhoea.

Diarrhea is one of the world's leading killers of children, and globally, rotavirus is the most common cause of severe diarrhea among under 5 children. In Bangladesh, rotavirus kills nearly 6,000 under 5 children in each year. To reduce the burden of childhood rotavirus diseases, universal rotavirus vaccination is recommended by World Health Organization. The objective of this study is to assess the cost-effectiveness of introducing universal childhood rotavirus vaccination with the newly developed ROTAVAC vaccine in national Expanded Programme of Immunization in Bangladesh. We developed a decision model to examine the potential impact of vaccination in Bangladesh and to examine the effect if the vaccination is applied in the nationwide immunization program schedule. Introduction of childhood universal rotavirus vaccination in Bangladesh scenario appears as highly cost-effective and would offer substantial future benefits for the young population if vaccinated today. The cost per DALY averted of introducing the rotavirus vaccine compared with status quo is approximately US$ 740.27 and US$ 728.67 per DALY averted from the health system and societal perspective respectively which is "very cost-effective" using GDP threshold level according to World Health Organization definition. The results of this analysis seek to contribute to an evidence-based recommendation about the introduction of universal rotavirus vaccination in national Expanded Programme of Immunization (EPI) in Bangladesh.

Objectives: This study aimed to examine the previously unknown long-term spatio-temporal patterns in diarrheal morbidity and mortality across age groups and geography in Brazil under the light of evolving socioeconomic factors and interventions., Methods: Nationwide mortality (1979-2014) and hospitalization (1998-2014) data were obtained from the Brazilian Ministry of Health. Analyses of long-term secular trends and seasonality of diarrheal morbidity and mortality were performed in EPIPOI (www.epipoi.info)., Results: For most states, the primary peak in mortality risk among children under 5 years occurred from December-April (summer/early autumn) from 1979-1988. From 2000-2005 (before the 2006 implementation of rotavirus vaccination), the pattern switched to June-October (winter/early spring). By 2007-2014, the peak in mortality shifted back towards summer/early autumn. A similar pattern was observed for hospitalizations. These patterns were particularly apparent in non-equatorial regions of the country. In contrast, the risk of diarrhea-related death among older children (5-19 years) did not demonstrate well-defined seasonality or spatial patterns., Conclusions: Rotavirus vaccination policies were associated with a shift in the timing of seasonal peaks in children under 5, reminiscent of the summer diarrhea period common decades prior. Additionally, young children were shown to have distinct disease patterns compared to other age groups, suggesting different etiologies., (Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Background: Implementing rigorous epidemiologic studies in low-resource settings involves challenges in participant recruitment and follow-up (e.g., mobile populations, distrust), biological sample collection (e.g., cold-chain, laboratory equipment scarcity) and data collection (e.g., literacy, staff training, and infrastructure). This article describes the use of a monitoring and evaluation (M&E) framework to improve study efficiency and quality during participant engagement, and biological sample and data collection in a longitudinal cohort study of Bolivian infants., Methods: The study occurred between 2013 and 2015 in El Alto, Bolivia, a high-altitude, urban, low-resource community. The study's M&E framework included indicators for participant engagement (e.g., recruitment, retention, safety), biological sample (e.g., stool and blood), and data (e.g., anthropometry, questionnaires) collection and quality. Monitoring indicators were measured regularly throughout the study and used for course correction, communication, and staff retraining., Results: Participant engagement indicators suggested that enrollment objectives were met (461 infants), but 15% loss-to-follow-up resulted in only 364 infants completing the study. Over the course of the study, there were four study-related adverse events (minor swelling and bruising related to a blood draw) and five severe adverse events (infant deaths) not related to study participation. Biological sample indicators demonstrated two blood samples collected from 95% (333 of 350 required) infants and stool collected for 61% of reported infant diarrhea episodes. Anthropometry data quality indicators were extremely high (median SDs for weight-for-length, length-for-age and weight-for-age z-scores 1.01, 0.98, and 1.03, respectively), likely due to extensive training, standardization, and monitoring efforts., Conclusions: Conducting human subjects research studies in low-resource settings often presents unique logistical difficulties, and collecting high-quality data is often a challenge. Investing in comprehensive M&E is important to improve participant recruitment, retention and safety, and sample and data quality. The M&E framework from this study can be applied to other longitudinal studies.

Introduction: Despite efforts toward the prevention and management of diarrhoea, associated mortality among infants has remained high in Northern Nigeria. This study was designed to determine the prevalence and identify determinants of diarrhoea among infants in Kaduna North Local Government Area (KNLGA), Nigeria., Methods: In a cross-sectional survey 630 mothers of infants attending three primary health care centers were interviewed. Data was collected on socio-demo graphic characteristics, infant care practices, infant diarrhoea history and mothers knowledge of causes, symptoms and management of diarrhea. Data were analyzed using descriptive statistics, Chi-square, and logistic regression tests at 5% level of significance., Results: Mothers' mean age was 27±5.5 years and 46.1% had secondary education. Infants' mean age was 22.4± 12.8 weeks and 50% were females. Prevalence of diarrhoea in the two weeks preceding the study was 21.1%. Only 11.7% of mothers had poor knowledge of diarrhoea. About 76.3% of mothers always washed their hands with soap after cleaning infants' perineum. Majority of infants (84.6%) completed age appropriate immunization while 31.6% were exclusively breastfed. Infants whose mothers sometimes (OR=2.32; 95% CI: 1.4-3.87) or never washed (OR=2.64; 95% CI: 1.19-5.82) their hands with soap after cleaning the infants perineumand those with incomplete age appropriate immunization (OR=1.87, 95% CI: 1.2-2.896) were more likely to have diarrhoea., Conclusion: Promotion of hygiene and nutrition education for mothers particularly on proper infant feeding practices, hand washing practices and complete immunization of infants is needed to address the diarrhea determinants.

Background: Maternal mental health prior to and during pregnancy has been shown to be associated with inflammatory diseases and gastrointestinal complaints in the offspring. Unfortunately, many studies merely focused on perinatal distress without consideration of lifetime anxiety and depressive disorders., Aims: To prospectively investigate associations of anxiety and depressive disorders prior to and during pregnancy as well as perinatal distress with infants' inflammatory diseases, gastrointestinal complaints and corresponding drug administration., Study Design: Prospective-longitudinal study initiated in 2009/2010., Subjects: N=306 (expectant) mothers with and without DSM-IV lifetime anxiety and depressive disorders (Composite International Diagnostic Interview for Women) and low vs. high severity of psychopathological symptoms during pregnancy (Brief Symptom Inventory) enrolled in early pregnancy and repeatedly assessed during peripartum period., Outcome Measures: Infant inflammatory diseases, gastrointestinal complaints and drug administration assessed via questionnaire (maternal report) at four months postpartum (n=279)., Results: Severe psychopathological symptoms during pregnancy were associated with inflammatory diseases and anti-infective medication, whereas anxiety and depressive disorders prior to and during pregnancy were related to gastrointestinal complaints (diarrhea, colic complaints) and corresponding medication., Conclusions: These results have to be discussed with caution, because information on infants' diseases were based exclusively on maternal self-reports. However, they suggest promising directions regarding our current knowledge about the relevance of maternal perinatal distress for infant inflammatory diseases (e.g. fetal programming). Moreover, the association between maternal anxiety and depressive disorders and infant gastrointestinal complaints may be explained by an anxious misinterpretation of 'normal' infant signals or a transmission of adverse gut microbiota, respectively., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background & Objectives: Multidrug-resistant enteropathogenic Escherichia coli (EPEC) is responsible for a large number of cases of infantile diarrhoea in developing countries, causing failure in treatment with consequent health burden and resulting in a large number of deaths every year. This study was undertaken to determine the proportion of typical and atypical EPEC in under five children with diarrhoea and controls, their function as a carriage and to identify virulent genes associated with them., Methods: During the study period, 120 stool samples including 80 from controls children were collected and analyzed for the presence of EPEC using standard bacteriological methods. Isolates were subjected to antimicrobial testing by disc diffusion method. Isolates confirmed as E. coli by phenotypic method were further tested for the presence of attaching and effacing (eae) and bundle-forming pilus (bfpA) genes by real-time SYBR Green-based polymerase chain reaction., Results: All isolates were tested for the presence of EPEC. The frequency of typical EPEC was 20 and 16.25 per cent whereas the frequency of atypical EPEC strains was 5 and 23.75 per cent in patients and controls, respectively (PbfpA was seen in 45 and 18.75 per cent isolates of diarrhoeal patients and controls, respectively., Interpretation & Conclusions: Our results showed that typical EPEC was a common cause of diarrhoea, but at the same time, atypical EPEC was emerging as colonizers in the intestine of children with and without diarrhoea in and around Delhi. Children can be considered asymptomatic carriers of these pathogens and can transmit them to other susceptible children. Adequate steps need to be taken to stop these strains from developing and spreading further.

Background: Environmental enteropathy (EE) is a common intestinal condition among children living in low- and middle-income countries and is associated with diminished enteric immunity to gastrointestinal pathogens, and possibly to oral vaccine antigens. The goal of this study was to examine associations between biomarkers of EE and immunogenicity to the pentavalent rotavirus vaccine (RV5)., Methods: Infants were recruited 1 day before their first RV5 immunization in León, Nicaragua, from public health rosters. Infants provided a preimmunization blood and stool sample, and a second blood sample 1 month after receipt of RV5. We measured immunoglobin A (IgA) seroconversion to the first dose of RV5 and concentrations of 4 previously identified fecal biomarkers of EE (alpha-1 antitrypsin, neopterin, myeloperoxidase and calprotectin). We then assessed associations between concentrations of these biomarkers, both individually and as combined scores, and seroconversion to the first dose of RV5., Results: Of the 43 enrolled infants, 24 (56%) seroconverted after the first dose of RV5. As compared with infants who seroconverted, those who did not seroconvert had higher median concentrations of both myeloperoxidase (3.1 vs. 1.1 µg/mL, P = 0.002) and calprotectin (199.1 vs. 156.2 µg/mL, P = 0.03). Further, those who did not seroconvert had a higher median combined score of the 4 biomarkers as compared with those who seroconverted (6.5 vs. 4.5, P = 0.017)., Conclusions: We found an association between biomarkers of EE and seroconversion to the first dose of RV5. It is possible that interventions that prevent or ameliorate EE may also improve oral rotavirus vaccine response.

Background: Drawing attention to home birth conditions and subsequent neonatal infections is a key starting point to reducing neonatal morbidity which are a main cause of mortality in sub-Saharan Africa., Objectives: To determine the proportion of respiratory, ophthalmic, and diarrhoeal infections in neonates; the proportion of mothers of neonates, following clean delivery practices; and to explore existing community practices during delivery and the neonatal period., Methods: A descriptive, cross-sectional, exploratory study, including 10 questionnaires and five Key-Informant interviews, in rural Karamoja, Uganda., Results: Post-delivery razor blade and string use was 90%, but clean delivery surface use only 30%, while 90% obtained bathing water for neonates from boreholes. No mothers washed hands after latrine-related activities compared with 83% for food-related activities. None delivered in health centres or with skilled birth attendants. Respiratory infections occurred in eight neonates, compared to two ophthalmic infections, and no diarrhoea., Conclusion: Use of clean delivery surfaces needs to be improved as well as washing after latrine-related activities. Diarrhoea was far less common than expected. Since rural Mother-Infant pairs spend the majority of their post-delivery time around the homestead, hygiene impacts neonatal infections to a large degree, possibly even more so than delivery practices.

Background: Cryptosporidium is a leading cause of moderate to severe childhood diarrhea in resource-poor settings. Understanding the natural history of cryptosporidiosis and the correlates of protection are essential to develop effective and sustainable approaches to disease control and prevention., Methods: Children (N = 497) were recruited at birth in semiurban slums in Vellore, India, and followed for 3 years with twice-weekly home visits. Stool samples were collected every 2 weeks and during diarrheal episodes were tested for Cryptosporidium species by polymerase chain reaction (PCR). Serum samples obtained every 6 months were evaluated for seroconversion, defined as a 4-fold increase in immunoglobulin G directed against Cryptosporidium gp15 and/or Cp23 antigens between consecutive sera., Results: Of 410 children completing follow-up, 397 (97%) acquired cryptosporidiosis by 3 years of age. PCR identified 1053 episodes of cryptosporidiosis, with an overall incidence of 0.86 infections per child-year by stool and serology. The median age for the first infection was 9 (interquartile range, 4-17) months, indicating early exposure. Although infections were mainly asymptomatic (693 [66%]), Cryptosporidium was identified in 9.4% of diarrheal episodes. The proportion of reinfected children was high (81%) and there was clustering of asymptomatic and symptomatic infections (P < .0001 for both). Protection against infection increased with the order of infection but was only 69% after 4 infections. Cryptosporidium hominis (73.3%) was the predominant Cryptosporidium species, and there was no species-specific protection., Conclusions: There is a high burden of endemic cryptosporidiosis in southern India. Clustering of infection is suggestive of host susceptibility. Multiple reinfections conferred some protection against subsequent infection., (© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.)

Background: Children's stool disposal is often overlooked in sanitation programs of any country. Unsafe disposal of children's stool makes children susceptible to many diseases that transmit through faecal-oral route. Therefore, the study aims to examine the magnitude of unsafe disposal of children's stools in India, the factors associated with it and finally its association with childhood diarrhea., Methods: Data from the third round of the National Family Health Survey (NFHS-3) conducted in 2005-06 is used to carry out the analysis. The binary logistic regression model is used to examine the factors associated with unsafe disposal of children's stool. Binary logistic regression is also used to examine the association between unsafe disposal of children's stool and childhood diarrhea., Result: Overall, stools of 79% of children in India were disposed of unsafely. The urban-rural gap in the unsafe disposal of children's stool was wide. Mother's illiteracy and lack of exposure to media, the age of the child, religion and caste/tribe of the household head, wealth index, access to toilet facility and urban-rural residence were statistically associated with unsafe disposal of stool. The odds of diarrhea in children whose stools were disposed of unsafely was estimated to be 11% higher (95% CI: 1.01-1.21) than that of children whose stools were disposed of safely. An increase in the unsafe disposal of children's stool in the community also increased the risk of diarrhea in children., Conclusion: We found significant statistical association between children's stool disposal and diarrhea. Therefore, gains in reduction of childhood diarrhea can be achieved in India through the complete elimination of unsafe disposal of children's stools. The sanitation programmes currently being run in India must also focus on safe disposal of children's stool.

The objective of this study was to analyze the nutritional and morbidity patterns of children aged 7-24 months in relationship to household socioeconomic and demographic characteristics. Structured questionnaires and repeated 24-hour recalls were used to collect data. Maternal education and age influenced timing of complementary foods, dietary diversity score, meal frequency, and diarrhea incidences (p < .05). This resulted in 53%, 59%, 48%, 43%, and 22% of the study children having inadequate intake of energy, protein, vitamin A, iron, and zinc, respectively. Households need to be empowered to utilize available resources for improving nutrient intake and health among their children.