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Descriptive epidemiology of persistent diarrhoea among young children in rural northern India
Insights
Persistent diarrhea is a significant health issue in young children in rural northern India, particularly in infants under one year old. Aggregative adherence E. coli (EAEC-A) was more frequently found in persistent diarrhea cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Persistent diarrhea poses a significant health burden in children, especially in resource-limited settings.
- Understanding the epidemiological characteristics and etiological agents of persistent diarrhea is crucial for effective public health interventions.
Purpose of the Study:
- To determine the descriptive epidemiology of persistent diarrhea in children aged 0-71 months in rural northern India.
- To identify risk factors and associated pathogens contributing to the persistence of diarrheal episodes.
Main Methods:
- A prospective cohort study involving 963 children aged 0-71 months followed for 12 months with weekly household visits.
- Data collected included incidence rates, demographic factors, clinical symptoms (stool frequency, blood in stool), and pathogen isolation from stool samples.
- Enteric pathogens were identified using standard microbiological techniques, with specific attention to Escherichia coli (E. coli) pathotypes.
Main Results:
- The incidence of persistent diarrhea was 6.3 per 100 child-years, highest in infants aged 0-11 months (31 per 100 child-years).
- Higher initial stool frequency and presence of gross blood in stools were significantly correlated with diarrhea persistence.
- Enterotoxigenic E. coli (ETEC) and Salmonella spp. were common pathogens, but aggregative adherent E. coli (EAEC-A) was significantly more prevalent in persistent diarrhea (34.9%) compared to acute diarrhea (12.3%).
Conclusions:
- Persistent diarrhea is a major concern in the first two years of life in this population.
- While common enteric pathogens are implicated, EAEC-A appears to play a more significant role in the persistence of diarrheal episodes.
- Further research into the specific mechanisms of EAEC-A in persistent diarrhea is warranted.
Abstract:
In order to determine the descriptive epidemiology of persistent diarrhoea in rural northern India, a cohort of 963 children aged 0-71 months was followed prospectively for 12 months through weekly household visits. The incidence of persistent diarrhoea was 6.3 per 100 child-years among those aged 0-71 months, and was highest (31 per 100 child-years) among those aged 0-11 months. There were no significant sex-related differences in the incidence of the disease, and the overall seasonal distribution of acute and persistent diarrhoea was similar. The persistence of diarrhoeal symptoms was significantly correlated with a higher initial mean stool frequency (P less than 0.01) and passage of gross blood with stools (P less than 0.001). Persistent diarrhoea was an important problem among children during the first 2 years of life. Established enteric pathogens were isolated during the initial illness in 46.4% of persistent and 55.4% of acute episodes. Pathogens isolated during persistent episodes included enterotoxigenic Escherichia coli (ETEC 9.3%), Salmonella spp. (4.7%), as well as campylobacter (4.7%), Shigella spp. (2.3%), Entamoeba histolytica (2.3%), and rotavirus (2.3%). Similar proportions of these pathogens were isolated also during episodes of acute diarrhoea. Multiple pathogens were isolated in 7% of the persistent and 5% of the acute episodes. E. coli that manifested aggregative adherence (EAEC-A) was more common (34.9% versus 12.3%) in persistent than acute episodes (P less than 0.01), and initial faecal excretion of EAEC-A was significantly associated with the persistence of a diarrhoeal episode.