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dc.contributor.authorDeichsel, E.L.
dc.contributor.authorPavlinac, P.B.
dc.contributor.authorMbori-Ngacha, D.
dc.date.accessioned2020-06-08T20:21:02Z
dc.date.available2020-06-08T20:21:02Z
dc.date.issued2020
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85085295973&doi=10.4269%2fAJTMH.19-0705&partnerID=40&md5=66f0aecd2e7b325d50d7e3f81b509b24
dc.identifier.urihttp://hdl.handle.net/10713/12999
dc.description.abstractHIV-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.en_US
dc.description.sponsorshipThis 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.en_US
dc.description.urihttp://doi.org/10.4269/AJTMH.19-0705en_US
dc.language.isoen_USen_US
dc.publisherAmerican Society of Tropical Medicine and Hygieneen_US
dc.relation.ispartofAmerican Journal of Tropical Medicine and Hygiene
dc.subject.meshDiarrheaen_US
dc.subject.meshDiarrhea, Infantile--mortalityen_US
dc.subject.meshHIV Infectionsen_US
dc.subject.meshInfanten_US
dc.subject.meshKenyaen_US
dc.subject.meshMothersen_US
dc.subject.meshRisk Factorsen_US
dc.titleMaternal diarrhea and antibiotic use are associated with increased risk of diarrhea among HIV-exposed, uninfected infants in Kenyaen_US
dc.typeArticleen_US
dc.identifier.doi10.4269/AJTMH.19-0705
dc.identifier.pmid32100682


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