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Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries
S Huilan1, L G Zhen, M M Mathan
1Shanghai Hygiene and Anti-epidemic Centre, China.
Insights
This study identified rotavirus, Shigella spp., and enterotoxigenic Escherichia coli as key causes of acute diarrhea in young children across five countries. Targeted interventions against these pathogens are crucial for controlling childhood diarrheal diseases in developing nations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute diarrhea remains a major cause of childhood morbidity and mortality globally.
- Identifying causative pathogens is essential for developing effective control strategies.
Purpose of the Study:
- To conduct a 2-year etiological survey of acute diarrhea in children aged 0-35 months across five countries.
- To identify the primary enteric pathogens associated with childhood diarrhea and their age-specific prevalence.
Main Methods:
- A standardized protocol was used in five hospitals in China, India, Mexico, Myanmar, and Pakistan.
- 3640 cases of diarrhea and 3279 age- and sex-matched controls were analyzed.
- Enteric pathogens were detected using laboratory methods.
Main Results:
- Enteric pathogens were detected in 68% of cases versus 30% of controls.
- Rotavirus, Shigella spp., and enterotoxigenic Escherichia coli were the most strongly associated pathogens.
- Pathogen prevalence varied by age, with rotavirus dominant in infants and Shigella spp. in older children.
Conclusions:
- Rotavirus, Shigella spp., and enterotoxigenic E. coli are critical targets for diarrheal disease control in young children.
- Microbe-specific interventions should be prioritized for public health strategies in developing countries.
- Age-specific pathogen data informs targeted prevention and treatment approaches.
Abstract:
A 2-year etiological survey of acute diarrhoea in children aged 0-35 months who were attending treatment facilities was carried out using a standardized protocol in five hospitals in China, India, Mexico, Myanmar, and Pakistan. A total of 3640 cases of diarrhoea and 3279 age- and sex-matched controls were studied; about 60% of the patients were aged less than 1 year and 60% were male. An enteric pathogen was detected in 68% of the cases and in 30% of the controls. In all the study centres, the pathogens most strongly associated with disease were rotavirus (16% of cases, 2% of controls), Shigella spp. (11% of cases, 1% of controls) and enterotoxigenic Escherichia coli (16% of cases, 5% of controls). Rotavirus was commonest among 6-11-month-olds, accounting for 20% of all cases in this age group; 71% of all rotavirus episodes occurred during the first year of life. Shigella spp. were commonest among those aged 12-23 months and 24-35 months, accounting for 22% and 27% of the cases, respectively. The proportion of cases that yielded no pathogen was inversely related to age, being highest (41%) among infants below 6 months of age and lowest (19%) among those aged 24-35 months. These results suggest that microbe-specific intervention strategies for the control of childhood diarrhoeal diseases in developing countries should focus on rotavirus, Shigella spp. and enterotoxigenic E. coli.