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Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED)
James A Platts-Mills1, Sudhir Babji2, Ladaporn Bodhidatta3
1Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
The Lancet. Global Health
|July 24, 2015
Summary
This study investigated diarrhea causes in young children across South America, Africa, and Asia. Norovirus, rotavirus, and Campylobacter were common causes, highlighting the need for multifaceted prevention strategies beyond single-pathogen approaches.
Area of Science:
- Infectious Diseases
- Pediatrics
- Global Health
Background:
- Limited data exists on community-level diarrhea causes in low- and middle-income countries, with most research focusing on severe cases.
- Understanding pathogen-specific burdens is crucial for effective public health interventions.
Purpose of the Study:
- To estimate the pathogen-specific burden of diarrhea in young children within a community setting.
- To identify key determinants of diarrhea incidence and etiology.
Main Methods:
- A birth cohort study was conducted in South America, Africa, and Asia with intensive community surveillance for diarrhea.
- Stool samples from 2145 children (aged 0-24 months) were analyzed for enteropathogens using culture, immunoassay, and PCR.
- The adjusted attributable fraction (AF) was used to quantify pathogen-specific diarrhea burdens.
Main Results:
- Norovirus GII, rotavirus, Campylobacter spp., astrovirus, and Cryptosporidium spp. were leading causes of diarrhea in the first year of life.
- In the second year, Campylobacter spp., norovirus GII, rotavirus, astrovirus, and Shigella spp. were most prevalent.
- Pathogen prevalence varied significantly by age, geography, season, and rotavirus vaccination status.
Conclusions:
- Diarrhea etiology is heterogeneous, influenced by age, location, season, vaccination, and symptoms.
- While single-pathogen strategies reduce severe disease, their impact on overall community diarrhea incidence may be limited.
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