Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries.
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.
Huilan
S
S
Shanghai Hygiene and Anti-epidemic Centre, China.
Zhen
L G
LG
Mathan
M M
MM
Mathew
M M
MM
Olarte
J
J
Espejo
R
R
Khin Maung
U
U
Ghafoor
M A
MA
Khan
M A
MA
Sami
Z
Z
D002675:Child, Preschool; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012401:Rotavirus / Q000302:isolation & purification; D012760:Shigella / Q000302:isolation & purification