Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study

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Background:
Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya.

Methods and Findings:
We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours) at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9%) children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118), Campylobacter in 5% (57), and Shigella in 4% (42) of 1,137 stool samples; rotavirus was detected in 19% (196) of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6·8; 95% CI 3·1–14·9), and children <5 years to have Shigella (aOR = 5·5; 95% CI 2·2–14·0) identified than children who survived. Children who died were less likely to be infected with rotavirus (OR = 0·4; 95% CI 0·2–0·8). Further risk factors for death included being malnourished (aOR = 4·2; 95% CI 2·1–8·7); having oral thrush on physical exam (aOR = 2·3; 95% CI 1·4–3·8); having previously sought care at a hospital for the illness (aOR = 2·2; 95% CI 1·2–3·8); and being dehydrated as diagnosed at discharge/death (aOR = 2·5; 95% CI 1·5–4·1). A clinical diagnosis of malaria, and malaria parasites seen on blood smear, were not associated with increased risk of death. This study only captured in-hospital childhood deaths, and likely missed a substantial number of additional deaths that occurred at home.

Conclusion:
Nontyphoidal Salmonella and Shigella are associated with mortality among rural Kenyan children with diarrhea who access a hospital. Improved prevention and treatment of diarrheal disease is necessary. Enhanced surveillance and simplified laboratory diagnostics in Africa may assist clinicians in appropriately treating potentially fatal diarrheal illness.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study. PLoS Med 9(7): e32767. doi:10.1371/journal.pmed.1001256
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001256

Souhrn

Zdroje

1. Boschi-PintoCYoungMBlackRE 2010 The Child Health Epidemiology Reference Group reviews of the effectiveness of interventions to reduce maternal, neonatal and child mortality. Int J Epidemiol 39 Suppl 1 i3 i6

2. UNICEF/WHO 2009 Diarrhea: Why children are still dying and what can be done Geneva The United Nations Children's Fund/World Health Organization 1 58

3. BlackRECousensSJohnsonHLLawnJERudanI 2010 Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375 1969 1987

4. BryceJBoschi-PintoCShibuyaKBlackRE 2005 WHO estimates of the causes of death in children. Lancet 365 1147 1152

5. MadhiSACunliffeNASteeleDWitteDKirstenM 2010 Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med 362 289 298

6. SantoshamM 2010 Rotavirus vaccine–a powerful tool to combat deaths from diarrhea. N Engl J Med 362 358 360

7. ArmahGESowSOBreimanRFDallasMJTapiaMD 2010 Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial. Lancet 376 606 614

8. World Health Organization 2009 Meeting of the Immunization Strategic Advisory Group of Experts, April 2009 — conclusions and recommendations. Wkly Epidemiol Rec 84 220 236

9. WHO/UNICEF 2004 Joint Statement on clinical management of acute diarrhea Geneva WHO/UNICEF

10. Boschi-PintoCBahlRMartinesJ 2009 Limited progress in increasing coverage of neonatal and child-health interventions in Africa and Asia. J Health Popul Nutr 27 755 762

11. Fischer WalkerCLFontaineOYoungMWBlackRE 2009 Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. Bull World Health Organ 87 780 786

12. RamPKChoiMBlumLSWamaeAWMintzED 2008 Declines in case management of diarrhoea among children less than five years old. Bull World Health Organ 86 E F

13. Boschi-PintoCLanataCFMendozaWHabteD 2006 Diarrheal disease. JamisonDTFeachemRGMakgobaMWBosERBainganaFK Disease and mortality in sub-Saharan Africa Washington (D.C.) World Bank 107 234

14. MogesTHaidarJ 2009 Management and outcome of severely malnourished children admitted to Zewditu Memorial Hospital, Ethiopia. East Afr J Public Health 6 162 167

15. SunguyaBFKoolaJIAtkinsonS 2006 Infections associated with severe malnutrition among hospitalised children in East Africa. Tanzan Health Res Bull 8 189 192

16. MoisiJCGatakaaHBerkeleyJAMaitlandKMturiN 2011 Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis. Bull World Health Organ 89 725 732A

17. GriffinPMRyanCANyaphisiMHargrett-BeanNWaldmanRJ 1988 Risk factors for fatal diarrhea: a case-control study of African children. Am J Epidemiol 128 1322 1329

18. IrenaAHWambaziMLengaV 2011 Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia. Nutr J 10 110

19. GirmaBBerhaneY 2011 Children who were vaccinated, breast fed and from low parity mothers live longer: a community based case-control study in Jimma, Ethiopia. BMC Public Health 11 197 203

20. ZanoniBCPhungulaTZanoniHMFranceHFeeneyME 2011 Risk factors associated with increased mortality among HIV infected children initiating antiretroviral therapy (ART) in South Africa. PLoS One 6 e22706 doi:10.1371/journal.pone.0022706

21. Kenya National Bureau of Statistics 2010 Population and Housing Statistics, Population Projections by Province, 1999–2010 Nairobi, Kenya Kenya National Bureau of Statistics

22. Kenya National Bureau of Statistics 2004 Kenya Demographic and Health Survey 2003 Calverton (Maryland) Kenya National Bureau of Statistics, Kenya Ministry of Health and ORC Macro

23. AdazuKLindbladeKARosenDHOdhiamboFOfwareP 2005 Health and demographic surveillance in rural western Kenya: a platform for evaluating interventions to reduce morbidity and mortality from infectious diseases. Am J Trop Med Hyg 73 1151 1158

24. World Health Organization 1995 The management of acute respiratory infections in children: practical guidelines for outpatient care Geneva World Health Organization

25. World Health Organization 2010 WHO child growth standards, SAS macros Geneva World Health Organization

26. World Health Organization 2006 WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development Geneva World Health Organization

27. EwingWH 1986 Identification of enterobacteriaciae. 4th ed New York Elsevier Science

28. Clinical Laboratory Standards Institute (CLSI) 2005 Performance standards for antimicrobial susceptibility testing: 15th informational supplement. CLSI document M100-S15 Wayne (Pennsylvania) CLSI

29. FieldsPIPopovicTWachsmuthKOlsvikO 1992 Use of polymerase chain reaction for detection of toxigenic Vibrio cholerae O1 strains from the Latin American cholera epidemic. J Clin Microbiol 30 2118 2121

30. KeaslerSPHallRH 1993 Detecting and biotyping Vibrio cholerae O1 with multiplex polymerase chain reaction. Lancet 341 1661

31. GhoshCNandyRKDasguptaSKNairGBHallRH 1997 A search for cholera toxin (CT), toxin coregulated pilus (TCP), the regulatory element ToxR and other virulence factors in non-01/non-0139 Vibrio cholerae. Microb Pathog 22 199 208

32. NandiBNandyRKMukhopadhyaySNairGBShimadaT 2000 Rapid method for species-specific identification of Vibrio cholerae using primers targeted to the gene of outer membrane protein OmpW. J Clin Microbiol 38 4145 4151

33. HullJJTeelENKerinTKFreemanMMEsonaMD 2011 United States rotavirus strain surveillance from 2005 to 2008: genotype prevalence before and after vaccine introduction. Pediatr Infect Dis J 30 S42 S47

34. SchmidtHKnopCFrankeSAleksicSHeesemannJ 1995 Development of PCR for screening of enteroaggregative Escherichia coli. J Clin Microbiol 33 701 705

35. GunzburgSTTornieporthNGRileyLW 1995 Identification of enteropathogenic Escherichia coli by PCR-based detection of the bundle-forming pilus gene. J Clin Microbiol 33 1375 1377

36. PatonAWPatonJC 1998 Detection and characterization of Shiga toxigenic Escherichia coli by using multiplex PCR assays for stx1, stx2, eaeA, enterohemorrhagic E. coli hlyA, rfbO111, and rfbO157. J Clin Microbiol 36 598 602

37. SchultszCPoolGJvan KetelRde WeverBSpeelmanP 1994 Detection of enterotoxigenic Escherichia coli in stool samples by using nonradioactively labeled oligonucleotide DNA probes and PCR. J Clin Microbiol 32 2393 2397

38. SethabutrOVenkatesanMMurphyGSEampokalapBHogeCW 1993 Detection of Shigellae and enteroinvasive Escherichia coli by amplification of the invasion plasmid antigen H DNA sequence in patients with dysentery. J Infect Dis 167 458 461

39. VegaEBarclayLGregoricusNWilliamsKLeeD 2011 CaliciNet: A novel surveillance network for norovirus gastroenteritis outbreaks in the United States. Emerg Infect Diseases 17 1389 1395

40. OkaTKatayamaKHansmanGSKageyamaTOgawaS 2006 Detection of human sapovirus by real-time reverse transcription-polymerase chain reaction. J Med Virol 78 1347 1353

41. FurnivalGMWilsonRW 1974 Regressions by leaps and bounds. Technometrics 16 499 511

42. HarrisJRGreeneSKThomasTKNdivoROkandaJ 2009 Effect of a point-of-use water treatment and safe water storage intervention on diarrhea in infants of HIV-infected mothers. J Infect Dis 200 1186 1193

43. LanataCFBlackRE 2008 Diarrheal diseases. Semba RD, Bloem MW, editors. Nutrition and Health in Developing Countries. 2nd ed New York Humana Press 139 178

44. MacLennanCAGondweENMsefulaCLKingsleyRAThomsonNR 2008 The neglected role of antibody in protection against bacteremia caused by nontyphoidal strains of Salmonella in African children. J Clin Invest 118 1553 1562

45. Kenya National Bureau of Statistics 2009 Kenya Demographic and Health Survey 2008–2009 Preliminary Report Calverton (Maryland) Kenya National Bureau of Statistics, ORC Macro

46. BrooksJTOchiengJBKumarLOkothGShapiroRL 2006 Surveillance for bacterial diarrhea and antimicrobial resistance in rural western Kenya, 1997–2003. Clin Infect Dis 43 393 401

47. BolasSOlsonCKinneryNMathingauAOdidiB 2008 Availability of oral rehydration solution packets at small shops in two areas of Kenya, 2007. Am J Trop Med Hyg 79 30

48. RamPOlsonCKinneryNBlumLBooreA 2008 Recommendation of oral rehydration solution for diarrhea case management by pharmacy workers in Kenya, 2007. Am J Trop Med Hyg 79 30

49. BerkeleyJARossAMwangiIOsierFHAMohammedM 2003 Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. Br Med J 326 1 6

50. Kenya Ministry of Public Health and Sanitation 2010 Policy guidelines on control and management of diarrhoeal diseases in children below five years in Kenya. 1–11 Nairobi Kenya Ministry of Public Health and Sanitation