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    Maternal diarrhea and antibiotic use are associated with increased risk of diarrhea among HIV-exposed, uninfected infants in Kenya

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    Author
    Deichsel, E.L.
    Pavlinac, P.B.
    Mbori-Ngacha, D.
    Date
    2020
    Journal
    American Journal of Tropical Medicine and Hygiene
    Publisher
    American Society of Tropical Medicine and Hygiene
    Type
    Article
    
    Metadata
    Show full item record
    See at
    http://doi.org/10.4269/AJTMH.19-0705
    Abstract
    HIV-exposed, uninfected (HEU) children are a growing population at particularly high risk of infection-related death in whom preventing diarrhea may significantly reduce under-5 morbidity and mortality in sub-Saharan Africa. A historic cohort (1999-2002) of Kenyan HEU infants followed from birth to 12 months was used. Maternal and infant morbidity were ascertained at monthly clinic visits and unscheduled sick visits. The Andersen-Gill Cox model was used to assess maternal, environmental, and infant correlates of diarrhea, moderate-to-severe diarrhea (MSD; diarrhea with dehydration, dysentery, or related hospital admission), and prolonged/persistent diarrhea (> 7 days) in infants. HIV-exposed, uninfected infants (n = 373) experienced a mean 2.09 (95% CI: 1.93, 2.25) episodes of diarrhea, 0.47 (95% CI: 0.40, 0.55) episodes of MSD, and 0.34 (95% CI: 0.29, 0.42) episodes of prolonged/persistent diarrhea in their first year. Postpartum maternal diarrhea was associated with increased risk of infant diarrhea (Hazard ratio [HR]: 2.09; 95% CI: 1.43, 3.06) and MSD (HR: 2.89; 95% CI: 1.10, 7.59). Maternal antibiotic use was a risk factor for prolonged/persistent diarrhea (HR: 1.63; 95% CI: 1.04, 2.55). Infants living in households with a pit latrine were 1.44 (95% CI: 1.19, 1.74) and 1.49 (95% CI: 1.04, 2.14) times more likely to experience diarrhea and MSD, respectively, relative to those with a flush toilet. Current exclusive breastfeeding was protective against MSD (HR: 0.30; 95% CI: 0.15, 0.58) relative to infants receiving no breast milk. Reductions in maternal diarrhea may result in substantial reductions in diarrhea morbidity among HEU children, in addition to standard diarrhea prevention interventions.
    Sponsors
    This work was supported by Eunice Kennedy Shriver National Institute of Child Health and the Human Development of the National Institutes of Health (grant numbers R01 HD-23412, 1F31 HD-089507 to ELD). ELD reports funding from Center for Vaccine Development and Global Health T32 Vaccinology fellowship T32AI007524.
    Keyword
    Diarrhea
    Diarrhea, Infantile--mortality
    HIV Infections
    Infant
    Kenya
    Mothers
    Risk Factors
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85085295973&doi=10.4269%2fAJTMH.19-0705&partnerID=40&md5=66f0aecd2e7b325d50d7e3f81b509b24; http://hdl.handle.net/10713/12999
    ae974a485f413a2113503eed53cd6c53
    10.4269/AJTMH.19-0705
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