title: Etiology and Epidemiology of Diarrhea in Hospitalized Children from Low Income Country: A Matched Case-Control Study in Central African Republic.
abstract: BACKGROUND
  In Sub-Saharan Africa, infectious diarrhea is a major cause of morbidity and mortality. A case-control study was conducted to identify the etiology of diarrhea and to describe its main epidemiologic risk factors among hospitalized children under five years old in Bangui, Central African Republic.
  
  
  METHODS
  All consecutive children under five years old hospitalized for diarrhea in the Pediatric Complex of Bangui for whom a parent's written consent was provided were included. Controls matched by age, sex and neighborhood of residence of each case were included. For both cases and controls, demographic, socio-economic and anthropometric data were recorded. Stool samples were collected to identify enteropathogens at enrollment. Clinical examination data and blood samples were collected only for cases.
  
  
  RESULTS
  A total of 333 cases and 333 controls was recruited between December 2011 and November 2013. The mean age of cases was 12.9 months, and 56% were male. The mean delay between the onset of first symptoms and hospital admission was 3.7 days. Blood was detected in 5% of stool samples from cases. Cases were significantly more severely or moderately malnourished than controls. One of the sought-for pathogens was identified in 78% and 40% of cases and controls, respectively. Most attributable cases of hospitalized diarrhea were due to rotavirus, with an attributable fraction of 39%. Four other pathogens were associated with hospitalized diarrhea: Shigella/EIEC, Cryptosporidium parvum/hominis, astrovirus and norovirus with attributable fraction of 9%, 10%, 7% and 7% respectively. Giardia intestinalis was found in more controls than cases, with a protective fraction of 6%.
  
  
  CONCLUSIONS
  Rotavirus, norovirus, astrovirus, Shigella/EIEC, Cryptosporidium parvum/hominis were found to be positively associated with severe diarrhea: while Giardia intestinalis was found negatively associated. Most attributable episodes of severe diarrhea were associated with rotavirus, highlighting the urgent need to introduce the rotavirus vaccine within the CAR's Expanded Program on Immunization. The development of new medicines, vaccines and rapid diagnostic tests that can be conducted at the bedside should be high priority for low-resource countries.
authors.affiliation: Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine.|Laboratoire de Microbiologie Clinique et Environnementale, Centre Hospitalo-Universitaire, Pointe-à-Pitre/Les Abymes, Guadeloupe, France.|Université des Antilles, Faculté de Médecine, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Breurec
authors.affiliation: Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France.
authors.forename: Noémie
authors.initials: N
authors.lastname: Vanel
authors.affiliation: Complexe Pédiatrique de Bangui, Bangui, République Centrafricaine.
authors.forename: Petulla
authors.initials: P
authors.lastname: Bata
authors.affiliation: Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Chartier
authors.affiliation: Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine.
authors.forename: Alain
authors.initials: A
authors.lastname: Farra
authors.affiliation: Faculté de Médecine et de Pharmacie, Université de Rouen, Rouen, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Favennec
authors.affiliation: Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine.
authors.forename: Thierry
authors.initials: T
authors.lastname: Franck
authors.affiliation: Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France.
authors.forename: Tamara
authors.initials: T
authors.lastname: Giles-Vernick
authors.affiliation: Complexe Pédiatrique de Bangui, Bangui, République Centrafricaine.
authors.forename: Jean-Chrysostome
authors.initials: JC
authors.lastname: Gody
authors.affiliation: Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France.
authors.forename: Liem Binh
authors.initials: LB
authors.lastname: Luong Nguyen
authors.affiliation: Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine.
authors.forename: Manuella
authors.initials: M
authors.lastname: Onambélé
authors.affiliation: Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine.
authors.forename: Clotaire
authors.initials: C
authors.lastname: Rafaï
authors.affiliation: Faculté de Médecine et de Pharmacie, Université de Rouen, Rouen, France.
authors.forename: Romy
authors.initials: R
authors.lastname: Razakandrainibe
authors.affiliation: Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Tondeur
authors.affiliation: Laboratoire de Virologie, Institut Pasteur de Bangui, Bangui, République Centrafricaine.
authors.forename: Vianney
authors.initials: V
authors.lastname: Tricou
authors.affiliation: Unité de pathogénie microbienne moléculaire, Institut Pasteur, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Sansonetti
authors.affiliation: Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Vray
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D016022:Case-Control Studies; D002488:Central African Republic / Q000453:epidemiology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011528:Protozoan Infections / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors; D014777:Virus Diseases / Q000453:epidemiology / Q000821:virology