Diarrheal Disease in Rural Mozambique: Burden, Risk Factors and Etiology of Diarrheal Disease among Children Aged 0–59 Months Seeking Care at Health Facilities

Abstract

BackgroundDiarrheal disease remains a leading cause of illness and death, particularly in low-income countries. Its burden, microbiological causes and risk factors were examined in children aged 0–59 months living in Manhiça, rural southern Mozambique.MethodsTrends of diarrhea-related burden of disease were estimated during the period 2001–2012. A prospective, age-stratified and matched (by age, gender and geographical origin), case-control study was conducted during 2007–2011. Clinical, epidemiology, anthropometric measurement and fecal samples obtained from recruited children were used to estimate moderate-to-severe diarrhea (MSD) weighted attributable fractions.ResultsOver the last decade the incidence of acute diarrhea has dropped by about 80%. Incidence of MSD per 100 child years at risk for the period 2007–2011 was 9.85, 7.73 and 2.10 for children aged 0–11, 12–23 and 24–59 months respectively. By adjusted population attributable fractions, most cases of MSD were due to rotavirus, Cryptosporidium, ETEC ST (ST only or ST/LT), Shigella and Adenovirus 40/41. Washing hands and having facilities to dispose child’s stools were associated with a reduced risk of MSD, while giving stored water to the child was associated with an increased risk of MSD.ConclusionsDespite the predominantly decreasing trends observed throughout the last decade, diarrheal diseases remain today a major cause of morbidity among children aged 0–59 months living in this rural Mozambican area. Rotavirus, cryptosporidium, Shigella, ETEC ST and Adenovirus 40/41 were the most important aetiologies of MSD. Thus, well-known preventive strategies such as washing hands, improving the treatment of stored water, having facilities to dispose children stools, and accelerating the introduction of the rotavirus vaccine should be promoted on a wider scale to reduce the current burden of diarrheal diseases.

Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018

“…Among intestinal parasites, Cryptosporidium spp. is most common in children with diarrhea, followed by Giardia lamblia and Entamoeba histolytica [2][3][4][5][6].…”

Enteric Pathogen Diversity in Infant Foods in Low-income Neighborhoods Of Kisumu, Kenya

“…Even though pediatric diarrheal diseases are declining worldwide, they remain the 2nd most common cause of preventable illness and death among children under the age of five [(1)]; responsible for approximately 800 million illnesses and 800,000 deaths in 2010. Approximately 90% of this disease burden is concentrated in children under the age of 5 in low- and middle-income countries (LMICs) [(2, 3)].…”

Prevalence and hospitalization rates due to diarrhoea in infants: the 2006 Brazilian National Demographic Health Survey

“…Common outcomes are dehydration and malnutrition, which hinder weight and height gain in children, and affect intellect development in infants. [5][6][7] Recent research has estimated that more than 2.5 billion cases of diarrhea occur annually among children under five, especially in the first two years of life, and of the 10 million children that die each year, approximately 1.5 million die due to diarrhea. [4,8] Gastroenteritis, like diarrhea, is one of the most frequent causes of hospitalization in children under the age of nine.…”

“…[8,9] However, the etiological agents and risk factors for diarrhea vary depending on the location, which makes knowledge of these aspects essential to developing prevention and control programs. [7] Studies evaluating the prevalence of childhood diarrhea frequently analyze samples from children under five years of age. [10][11][12] However, children under two are more vulnerable to gastrointestinal infections, [2,[13][14][15] because they have a maturing immune system and because of specific conditions related to physical growth and neuropsychomotor development that result in a physiological vulnerability to illness.…”