title: Case-control study of the etiology of infant diarrheal disease in 14 districts in Madagascar.
abstract: BACKGROUND
  Acute diarrhea is a major cause of childhood morbidity and mortality worldwide. Its microbiological causes and clinico-epidemiological aspects were examined during the rainy seasons from 2008 to 2009 in 14 districts in Madagascar.
  
  
  METHODS
  Stool specimens of 2196 children with acute diarrhea and 496 healthy children were collected in a community setting. Intestinal parasites were diagnosed by microscopy and bacteria by culturing methods. Rota-, astro and adenoviruses were identified using commercially available ELISA kits and rotaviruses were confirmed using reverse transcriptase polymerase chain reaction (RT-PCR).
  
  
  RESULTS
  Intestinal microorganisms were isolated from 54.6% of diarrheal patients and 45.9% of healthy subjects (p = <0.01). The most common pathogens in diarrheic patients were intestinal parasites (36.5%). Campylobacter spp. and Rotavirus were detected in 9.7% and 6.7% of diarrheic patients. The detection rates of Entamoeba histolytica, Trichomonas intestinalis and Giardia lamblia were much greater in diarrheal patients than in non diarrheal subjects (odds ratios of 5.1, 3.2, 1.7 respectively). The abundance of other enteropathogens among the non diarrheal group may indicate prolonged excretion or limited pathogenicity.
  
  
  CONCLUSIONS
  In developing countries, where the lack of laboratory capacities is great, cross sectional studies of enteropathogens and their spatial distribution, including diarrheal and non diarrheal subjects, are interesting tools in order to advise regional policies on treatment and diarrheic patient management.
authors.affiliation: Epidemiologic Unit, Institut Pasteur in Madagascar, Antananarivo, Madagascar.
authors.forename: Rindra
authors.initials: R
authors.lastname: Randremanana
authors.forename: Frédérique
authors.initials: F
authors.lastname: Randrianirina
authors.forename: Marie
authors.initials: M
authors.lastname: Gousseff
authors.forename: Natasha
authors.initials: N
authors.lastname: Dubois
authors.forename: Richter
authors.initials: R
authors.lastname: Razafindratsimandresy
authors.forename: Elisoa Ratsima
authors.initials: ER
authors.lastname: Hariniana
authors.forename: Benoit
authors.initials: B
authors.lastname: Garin
authors.forename: Arthur
authors.initials: A
authors.lastname: Randriamanantena
authors.forename: Hanitra Clara
authors.initials: HC
authors.lastname: Rakotonirina
authors.forename: Lovasoa
authors.initials: L
authors.lastname: Ramparany
authors.forename: Charles Emile
authors.initials: CE
authors.lastname: Ramarokoto
authors.forename: Fanjasoa
authors.initials: F
authors.lastname: Rakotomanana
authors.forename: Maherisoa
authors.initials: M
authors.lastname: Ratsitorahina
authors.forename: Soatiana
authors.initials: S
authors.lastname: Rajatonirina
authors.forename: Antoine
authors.initials: A
authors.lastname: Talarmin
authors.forename: Vincent
authors.initials: V
authors.lastname: Richard
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D020133:Reverse Transcriptase Polymerase Chain Reaction