Share This Article:

Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

Abstract Full-Text HTML Download Download as PDF (Size:157KB) PP. 233-239
DOI: 10.4236/fns.2013.43031    4,998 Downloads   7,922 Views   Citations

ABSTRACT

There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score < ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%; urban—15%), Shigella (16%; 9%), Salmonella (1%; 2%) and Campylobacter (3%; 4%); and less likely to have rotavirus (25%; 20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%; 13%) than those of MM (5%; 10%) and WN (2%; 8%) and lower for rotavirus (30%; 31%), (34%; 43%), (35%; 47%) respectively (p < 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p < 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%; p = 0.72) but significantly higher than that in WN (1%; p < 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. Das, M. Chisti, S. Huq, M. Malek, M. Salam, T. Ahmed and A. Faruque, "Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh," Food and Nutrition Sciences, Vol. 4 No. 3, 2013, pp. 233-239. doi: 10.4236/fns.2013.43031.

References

[1] L. Liu, H. L. Johnson, S. Cousens, J. Perin, S. Scott, J. E. Lawn, I. Rudan, H. Campbell, R. Cibulskis, M. Li, C. Mathers and R. E. Black, “Global, Regional, and National Causes of Child Mortality: An Updated Systematic Analysis for 2010 with Time Trends since 2000,” Lancet, Vol. 379, No. 9832, 2012, pp. 2151-2161. doi:10.1016/S0140-6736(12)60560-1
[2] F. Alkizim, D. Matheka and A. Muriithi, “Childhood Diarrhoea: Failing Conventional Measures, What Next?” Pan African Medical Journal, Vol. 8, No. 51, 2011, p. 47. doi:10.4314/pamj.v8i1.71164
[3] S. R. Pasricha and B. A. Biggs, “Undernutrition among Children in South and South-East Asia,” Journal of Paediatrics and Child Health, Vol. 46, No. 9, 2010, pp. 497-503. doi:10.1111/j.1440-1754.2010.01839.x
[4] World Health Organization (WHO), “Severe Acute Malnutrition,” WHO, Geneva, 2004.
[5] World Health Organization (WHO), “Maternal, Newborn, Child and Adolescent Health: Serious Childhood Problems in Countries with Limited Resources,” WHO, Geneva, 2004.
[6] R. E. Black, L. H. Allen, Z. A. Bhutta, L. E. Caulfield, M. de Onis, M. Ezzati, C. Mathers and J. Rivera, “Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences,” Lancet, Vol. 371, No. 9608, 2008, pp. 243-260. doi:10.1016/S0140-6736(07)61690-0
[7] A. Talbert, N. Thuo, J. Karisa, C. Chesaro, E. Ohuma, J. Ignas, J. A. Berkley, C. Toromo, S. Atkinson and K. Maitland, “Diarrhoea Complicating Severe Acute Malnutrition in Kenyan Children: A Prospective Descriptive Study of Risk Factors and Outcome,” PLoS One, Vol. 7, No. 6, 2012, p. e38321. doi:10.1371/journal.pone.0038321
[8] A. H. Irena, M. Mwambazi and V. Mulenga, “Diarrhea is a Major Killer of Children with Severe Acute Malnutrition Admitted to Inpatient Set-Up in Lusaka, Zambia,” Nutrition Journal, Vol. 10, 2011, p. 110. doi:10.1186/1475-2891-10-110
[9] “Bangladesh Demographic and Health Survey,” 2011. www.measuredhs.com/pubs/pdf/PR15/PR15.pdf
[10] M. J. Chisti, M. I. Hossain, M. A. Malek, A. S. Faruque, T. Ahmed and M. A. Salam, “Characteristics of Severely Malnourished Under-Five Children Hospitalized with Diarrhoea, and Their Policy Implications,” Acta Paediatrica, Vol. 96, No. 5, 2007, pp. 693-696. doi:10.1111/j.1651-2227.2007.00192.x
[11] B. Nahar, M. I. Hossain, J. D. Hamadani, T. Ahmed, S. N. Huda, S. M. Grantham-McGregor and L. A. Persson, “Effects of a Community-Based Approach of Food and Psychosocial Stimulation on Growth and Development of Severely Malnourished Children in Bangladesh: A Randomised Trial,” European Journal of Clinical Nutrition, Vol. 66, No. 6, pp. 701-709. doi:10.1038/ejcn.2012.13
[12] B. Nahar, T. Ahmed, K. H. Brown and M. I. Hossain, “Risk Factors Associated with Severe Underweight among Young Children Reporting to a Diarrhoea Treatment Facility in Bangladesh,” Joyrnal of Health, Population, and Nutrition, Vol. 28, No. 5, pp. 476-483.
[13] D. M. Denno, N. Shaikh, J. R. Stapp, X. Qin, C. M. Hutter, V. Hoffman, J. C. Mooney, K. M. Wood, H. J. Stevens, R. Jones, P. I. Tarr and E. J. Klein, “Diarrhea Etiology in a Pediatric Emergency Department: A Case Control Study,” Clinical Infectious Diseases, Vol. 55, No. 7, 2012, pp. 897-904. doi:10.1093/cid/cis553
[14] J. L. Deen, L. von Seidlein, D. Sur, M. Agtini, M. E. Lucas, A. L. Lopez, D. R. Kim, M. Ali and J. D. Clemens, “The High Burden of Cholera in Children: Comparison of Incidence from Endemic Areas in Asia and Africa,” PLoS Neglected Tropical Diseases, Vol. 2, No. 2, 2008, p. e173. doi:10.1371/journal.pntd.0000173
[15] R. B. Sack, A. K. Siddique, I. M. Longini, Jr., A. Nizam, M. Yunus, M. S. Islam, J. G. Morris, Jr., A. Ali, A. Huq, G. B. Nair, F. Qadri, S. M. Faruque, D. A. Sack and R. R. Colwell, “A 4-Year Study of the Epidemiology of Vibrio Cholerae in Four Rural Areas of Bangladesh,” The Journal of Infectious Diseases, Vol. 187, No. 1, 2003, pp. 96-101. doi:10.1086/345865
[16] D. Legros, M. McCormick, C. Mugero, M. Skinnider, D. D. Bek’Obita and S. I. Okware, “Epidemiology of Cholera Outbreak in Kampala, Uganda,” East African Medical Journal, Vol. 77, No. 7, 2000, pp. 347-349.
[17] M. A. Luque Fernandez, P. R. Mason, H. Gray, A. Bauernfeind, J. F. Fesselet and P. Maes, “Descriptive Spatial Analysis of the Cholera Epidemic 2008-2009 in Harare, Zimbabwe: A Secondary Data Analysis,” Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 105, No. 1, 2011, pp. 38-45. doi:10.1016/j.trstmh.2010.10.001
[18] D. T. Leung, F. Chowdhury, S. B. Calderwood, F. Qadri and E. T. Ryan, “Immune Responses to Cholera in Children,” Expert Review of Anti-Infective Therapy, Vol. 10, No. 4, 2012, pp. 435-444. doi:10.1586/eri.12.23
[19] R. N. Mazumder, H. Ashraf, S. S. Hoque, I. Kabir, N. Majid, M. A. Wahed, G. J. Fuchs and D. Mahalanabis, “Effect of an Energy-Dense Diet on the Clinical Course of Acute Shigellosis in Undernourished Children,” The British Journal of Nutrition, Vol. 84, No. 5, 2000, pp. 775-779.
[20] W. Savino, “The Thymus Gland Is a Target in Malnutrition,” European Journal of Clinical Nutrition, Vol. 56, Suppl. 3, 2002, pp. S46-S49. doi:10.1038/sj.ejcn.1601485
[21] W. Savino and M. Dardenne, “Nutritional Imbalances and Infections Affect the Thymus: Consequences on T-Cell-Mediated Immune Responses,” Proceedings of the Nutrition Society, Vol. 69, No. 4, 2010, pp. 636-643. doi:10.1017/S0029665110002545
[22] R. H. Gilman, R. Partanen, K. H. Brown, W. M. Spira, S. Khanam, B. Greenberg, S. R. Bloom and A. Ali, “Decreased Gastric Acid Secretion and Bacterial Colonization of the Stomach in Severely Malnourished Bangladeshi Children,” Gastroenterology, Vol. 94, No. 6, 1988, pp. 1308-1314.
[23] M. E. Conner and R. F. Ramig, “Viral Enteric Diseases,” Lippincott-Raven Publishers, Philadelphia, 1997.
[24] O. Lundgren and L. Svensson, “The Enteric Nervous System and Infectious Diarrhea,” Elsevier Science BV, Amsterdam, 2003.
[25] E. Guiraldes and J. R. Hamilton, “Effect of Chronic Malnutrition on Intestinal Structure, Epithelial Renewal, and Enzymes in Suckling Rats,” Pediatric Research, Vol. 15, No. 6, 1981, pp. 930-934. doi:10.1203/00006450-198106000-00010
[26] K. Zaman, M. Yunus, S. El Arifeen, T. Azim, A. S. Faruque, E. Huq, I. Hossain, S. P. Luby, J. C. Victor, M. J. Dallas, K. D. Lewis, S. B. Rivers, A. D. Steele, K. M. Neuzil, M. Ciarlet and D. A. Sack, “Methodology and Lessons-Learned from the Efficacy Clinical Trial of the Pentavalent Rotavirus Vaccine in Bangladesh,” Vaccine, Vol. 30, Suppl. 1, 2012, pp. A94-A100. doi:10.1016/j.vaccine.2011.07.117
[27] B. Nahar, T. Ahmed, K. H. Brown and M. I. Hossain, “Risk Factors Associated with Severe Underweight among Young Children Reporting to a Diarrhoea Treatment Facility in Bangladesh,” Joyrnal of Health, Population, and Nutrition, Vol. 28, No. 5, 2010, pp. 476-483.
[28] B. S. Schwartz, J. B. Harris, A. I. Khan, R. C. Larocque, D. A. Sack, M. A. Malek, A. S. Faruque, F. Qadri, S. B. Calderwood, S. P. Luby and E. T. Ryan, “Diarrheal Epidemics in Dhaka, Bangladesh, during Three Consecutive Floods: 1988, 1998, and 2004,” The American Journal of Tropical Medicine and Hygiene, Vol. 74, No. 6, 2006, pp. 1067-1073.
[29] P. Sanchez, M. S. Swaminathan, P. Dobie and N. Yuksel, “Un Millennium Project 2005. Halving Hunger: It Can Be Donetask Force on Hunger,” Earthscan, London and Sterling, 2005.
[30] J. Picot, D. Hartwell, P. Harris, D. Mendes, A. J. Clegg and A. Takeda, “The Effectiveness of Interventions to Treat Severe Acute Malnutrition in Young Children: A Systematic Review,” Health Technology Assessment, Vol. 16, No. 19, 2012, pp. 1-316. doi:10.3310/hta16190
[31] M. J. Chisti, T. Duke, C. F. Robertson, T. Ahmed, A. S. Faruque, P. K. Bardhan, S. La Vincente and M. A. Salam, “Co-Morbidity: Exploring the Clinical Overlap between Pneumonia and Diarrhoea in a Hospital in Dhaka, Bangladesh,” Annals of Tropical Paediatrics, Vol. 31, No. 4, 2011, pp. 311-319. doi:10.1179/1465328111Y.0000000033
[32] M. J. Chisti, T. Ahmed, A. S. Faruque and M. Abdus Salam, “Clinical and Laboratory Features of Radiologic Pneumonia in Severely Malnourished Infants Attending an Urban Diarrhea Treatment Center in Bangladesh,” Pediatric Infectious Disease Journal, Vol. 29, No. 2, 2010, pp. 174-177. doi:10.1097/INF.0b013e3181b9a4d5
[33] Y. Motarjemi, F. Kaferstein, G. Moy and F. Quevedo, “Contaminated Weaning Food: A Major Risk Factor for Diarrhoea and Associated Malnutrition,” Bulletin of the World Health Organization, Vol. 71, No. 1, 1993, pp. 79-92.
[34] T. Ahmed, M. Ali, M. M. Ullah, I. A. Choudhury, M. E. Haque, M. A. Salam, G. H. Rabbani, R. M. Suskind and G. J. Fuchs, “Mortality in Severely Malnourished Children with Diarrhoea and Use of a Standardised Management Protocol,” Lancet, Vol. 353, No. 9168, 1999, pp. 1919-1922. doi:10.1016/S0140-6736(98)07499-6
[35] T. Ahmed, B. Begum, Badiuzzaman, M. Ali and G. Fuchs, “Management of Severe Malnutrition and Diarrhea,” The Indian Journal of Pediatrics, Vol. 68, No. 1, 2001, pp. 45-51. doi:10.1007/BF02728857

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.