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Epidemiology of persistent diarrhea and etiologic agents in Mirzapur, Bangladesh
Insights
Persistent diarrhea in Bangladeshi children is common, peaking in infants 6-11 months old. While Aggregative adherent Escherichia coli was linked to persistent cases, other factors likely contribute more significantly to prolonged diarrhea.
Area of Science:
- Pediatric infectious diseases
- Epidemiology of childhood diarrhea
- Microbial pathogenesis
Background:
- Persistent diarrhea (PD) is a major cause of childhood mortality and morbidity in developing countries.
- Understanding the epidemiology and causative agents of PD is crucial for effective intervention strategies.
- Previous studies have focused on specific pathogens, but the multifactorial nature of PD requires further investigation.
Purpose of the Study:
- To investigate the epidemiological patterns of acute and persistent diarrhea in young children in rural Bangladesh.
- To identify the etiologic agents associated with acute and persistent diarrhea episodes.
- To explore factors influencing the duration of diarrheal episodes.
Main Methods:
- Intensive diarrhea surveillance was conducted on 363 children under six years old in rural Bangladesh from March 1987 to February 1989.
- Diarrhea recall interviews were performed, and stool samples from all diarrhea cases were analyzed for potential pathogens.
- Episodes were classified as acute (<14 days) or persistent (>=14 days).
Main Results:
- Children experienced an average of two diarrhea episodes per year, with incidence rates varying by age.
- The peak incidence for both acute (2.8 episodes/child/year) and persistent diarrhea (0.8 episodes/child/year) occurred in the 6-11 months age group.
- Aggregative adherent Escherichia coli was more frequent in persistent diarrhea, while Shigella, Aeromonas, Giardia, and toxigenic E. coli were less common compared to acute episodes. Loose/mucoid or bloody stools at onset were associated with prolonged episodes.
Conclusions:
- Persistent diarrhea is a significant issue in young Bangladeshi children, particularly in infants.
- While certain pathogens like Aggregative adherent Escherichia coli may play a role, they do not fully explain the burden of persistent diarrhea.
- The findings suggest that non-pathogen-related factors are likely more critical in the development and persistence of diarrhea in this population.
Abstract:
To determine the epidemiology and etiologic agents of persistent diarrhea we carried out an intensive diarrhea surveillance on children less than six years old in rural Bangladesh. From March 1987 to February 1989 we examined 363 children through diarrhea recall interviews and analyzed stool samples of all diarrhea cases for potential pathogens. Results showed that children had an average of two episodes per year and the incidence rate of diarrheal episodes defined as acute (< 14 d) and persistent (> or = 14 d) varied similarly with age. The peak incidence (episodes/child/year) of acute diarrhea (2.8) and persistent diarrhea (0.8) occurred in the 6-11 months age group. The data showed that an episode tended to be prolonged if the stool was loose/mucoid or bloody at onset. Aggregative adherent Escherichia coli was found significantly more often at onset in persistent than in acute episodes, whereas Shigella, Aeromonas, Giardia and toxigenic E. coli were isolated with less frequency in persistent than acute episodes. This suggests that other factors might be more important in the development of persistent diarrhea than specific pathogens.