Diarrheal Morbidity and Mortality in Children in the Central African Republic

Abstract

Diarrheal morbidity and mortality in children less than 5 years old were studied in Bangui, Central African Republic, by a cluster survey. We found a high prevalence of diarrheal disease with an estimated annual incidence of 7 episodes of diarrhea per child per year. The estimated annual mortality rate for children less than 5 years old was 28.6 per 1,000 and 85.8 per 1,000 for infants; 51.6% of deaths were reported to be associated with diarrhea. During the survey, stool specimens were collected from 133 children with current diarrhea and 117 control children to study the etiologic agents of diarrheal disease in the community. An enteric pathogen was identified in 58% of diarrheal children's stools and 48% of stools of well children. A statistically significant association between diarrhea and rotavirus was found, with it being isolated from 8 of 33 (24%) of stools of infants with diarrhea compared to 0 of 25 (0%) of control infants. Isolation rates for Campylobacter jejuni, Entamoeba histolytica, pathogenic Escherichia coli, and other bacterial enteropathogens did not differ significantly between children with diarrhea and control children.

Prevalence of shigellosis diarrhoea in a paediatrics population: hospital based survey in Bangui, Central African Republic

“…Shigella is a major cause, as reported in Senegal, Djibouti and Zambia, where it represents respectively 11%, 15% and 10.2% of enteropathogenic agents [6][7][8]. A previous study in Bangui in 1983 found only 2.2% of diarrhoea attributable to Shigella (9). Such an increase in prevalence is supported by World Health Organization data, which demonstrates a regular increasing trend of Shigella in sub-Saharan countries in the last ten years [10].…”

A Systematic Review and Meta-analysis of the Association Between Giardia lamblia and Endemic Pediatric Diarrhea in Developing Countries

“…Children comprised the target population in the majority of the studies [6, 7, 12, 13, 25, 26, 28, 67, 68, 70–74, 76, 78, 79, 81, 82, 84–86, 88–91, 93–104], although some studies included adults with or without children [69, 75, 77, 80, 83, 87, 92, 105]. …”

“…Case ascertainment was performed in the community [78, 96], outpatient clinics [6, 25, 28, 69, 73, 76, 81, 82, 91, 97, 102, 103], emergency rooms [83, 90, 95], or hospitals [7, 12, 13, 26, 68, 70–72, 75, 77, 80, 84, 86, 87, 93, 100, 104, 105]. The control subjects without diarrhea were outpatients [6, 13, 25, 28, 67, 69, 72, 73, 76, 80, 81, 89, 91, 95, 97, 101–103] emergency room patients [83], or hospitalized patients [7, 12, 13, 26, 70, 71, 75, 77, 84, 86, 87, 100, 104, 105], but some studies enrolled community controls [68, 78, 82, 93, 96].…”

“…The control subjects without diarrhea were outpatients [6, 13, 25, 28, 67, 69, 72, 73, 76, 80, 81, 89, 91, 95, 97, 101–103] emergency room patients [83], or hospitalized patients [7, 12, 13, 26, 70, 71, 75, 77, 84, 86, 87, 100, 104, 105], but some studies enrolled community controls [68, 78, 82, 93, 96]. Both inpatient and outpatient settings comprised the sampling frame for some studies [67, 74, 79, 85, 92, 98, 101].…”

“…Matching (or adjustment for confounders) between cases and controls by age, sex, and other variables was done in only a fraction of the studies [12, 13, 25, 28, 67, 68, 70, 72, 73, 75, 76, 78–80, 82, 83, 85, 86, 88, 90, 91, 93, 96–98, 102, 103, 105]. In others, neither matching nor adjustment for confounding effects in multivariate analyses was performed [6, 7, 26, 71, 74, 77, 81, 84, 87, 89, 92, 94, 95, 99–101, 104].…”