Rotavirus A infection in children under five years old with a double health problem: undernutrition and diarrhoea – a cross-sectional study in four provinces of Mozambique

Abstract

Background Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique. Methods The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR). Results Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3–30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0–47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4–15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24–59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed. Conclusions The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children’s development.

Characterizing Undernourished Children Under-Five Years Old with Diarrhoea in Mozambique: A Hospital Based Cross-Sectional Study, 2015–2019

“…Children from 0 to 59 months admitted as inpatients or outpatients with diarrhoea disease were invited to the surveillance through their caregiver. Diarrhoeal disease was defined as the passage of three or more loose or liquid stools in the last 24 h [ 22 , 25 , 26 ].…”

“…In Mozambique, diarrhoea and undernutrition in children are major public health problems [ 14 , 20 ]; however, most of the studies conducted in the country estimated the occurrence of diarrhoea and undernutrition in the south of the country, or only reported an association between undernutrition and diarrhoea caused by a specific pathogen [ 14 , 20 , 22 , 24 , 25 ].…”

Rotavirus A infection in pre- and post-vaccine period: Risk factors, genotypes distribution by vaccination status and age of children in Nampula Province, Northern Mozambique (2015-2019)

“…ViNaDia methodology has been previously described elsewhere [16,17,23,24]. Briefly, a single stool specimen (10 ml) was collected from each child in a polyester container and stored at -20˚C until shipment, once a week, to the INS laboratory in Maputo for diagnosis.…”

“…Data used in the present analysis are from a hospital-based surveillance program (ViNaDia), whose primary aim is to monitor diarrhea and RVA cases before and after Rotarix 1 vaccine introduction [17]. Since ViNaDia is an ongoing surveillance system, the sample size calculation was not estimated for the present analysis.…”

“…ViNaDia data indicated a high diversity of RVA genotypes across the country, were uncommon combinations such as G3P [4], G9P [4], G9P [6], G2P [6], and non-typeable genotypes in Nampula province were seen [16]. ViNaDia also reported a high proportion of undernourished children with the double burden of RVA and HIV [17]. An independent analysis of RVA in Nampula is relevant because recurrent reports of poorer health indicators in children are described, including a high burden of conditions such as undernourishment, malaria, diarrhea and successive cholera outbreaks [18,19].…”