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    Clinical features, risk factors, and impact of antibiotic treatment of diarrhea caused by Shigella in children less than 5 years in Manhiça district, rural Mozambique

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    Author
    Vubil, Delfino
    Acácio, Sozinho
    Levine, Myron M.
    Kotloff, Karen L.
    Date
    2018-01-01
    Journal
    Infection and Drug Resistance
    Publisher
    Dove Medical Press Ltd.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://www.doi.org/10.2147/IDR.S177579
    Abstract
    Objectives: During the period from December 2007 to November 2012, the epidemiology of diarrhea caused by Shigella was studied among children <5 years of age residing in Manhiça District, Southern Mozambique. Materials and methods: Children from 0 to 5 years with moderate-to-severe diarrhea (MSD) and less severe diarrhea (LSD) were enrolled along with matched controls (by age, gender, and neighborhood). Age-stratified logistic regression analyses were conducted to identify clinical features and risk factors associated with Shigella positivity in cases of diarrhea. The impact of antibiotic treatment was assessed for patients with known outcome. Results: A total of 916 cases of MSD and 1979 matched controls, and 431 cases of LSD with equal number of controls were enrolled. Shigella was identified as significant pathogen in both cases of MSD and LSD compared to their respective controls. Shigella was detected in 3.9% (17/431) of LSD compared to 0.5% (2/431) in controls (P=0.001) and in 6.1% (56/916) of MSD cases compared to 0.2% (4/1979) in controls (P<0.0001), with an attributable fraction of 8.55% (95% CI: 7.86–9.24) among children aged 12–23 months. Clinical symptoms associated to Shigella among MSD cases included dysentery, fever, and rectal prolapse. Water availability, giving stored water to child, washing hands before preparing baby’s food, and mother as caretaker were the protective factors against acquiring diarrhea caused by Shigella. Antibiotic treatment on admission was associated with a positive children outcome. Conclusion: Shigella remains a common pathogen associated with childhood diarrhea in Mozambique, with dysentery being a significant clinical feature of shigellosis. Adherence to the basic hygiene rules and the use of antibiotic treatment could contribute to the prevention of most of diarrhea due to Shigella. © 2018 Vubil et al.
    Sponsors
    This study was part the GEMS study funded by the Bill and Melinda Gates Foundation. CISM receives core funds from Spanish Agency for International Cooperation and Development (AECID). Delfino Vubil received a fellowship from Fundação Calouste Gulbenkian – Programa Gulbenkian Parcerias para o Desenvolvimento (www.gulbenkian.pt).
    Keyword
    Epidemiology
    Less severe diarrhea
    Moderate-to-severe diarrhea
    Shigella
    Epidemiology
    Less severe diarrhea
    Moderate-to-severe diarrhea
    Shigella
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85057607455&origin=inward; http://hdl.handle.net/10713/9843
    ae974a485f413a2113503eed53cd6c53
    10.2147/IDR.S177579
    Scopus Count
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    UMB Open Access Articles 2018

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      Household costs of diarrhea by etiology in 7 countries, the Global Enterics Mulitcenter Study (GEMS)

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      Background. Although there are many overlapping features, pediatric diarrheal diseases can vary in severity, duration, clinical manifestations, and sequelae according to the causal pathogen, which in turn can impact the economic burden on patients and their families. We aimed to evaluate the household costs of diarrheal disease by pathogen in 7 countries. Methods. We analyzed data from the Global Enteric Multicenter Study (GEMS), a prospective, age-stratified, matched case- control study of moderate to severe diarrheal disease among children aged 0-59 months in 7 low-income countries; 4 in Africa (Kenya, Mali, Mozambique, The Gambia) and 3 in Asia (Bangladesh, India, Pakistan). Demographic, epidemiological, economic, and clinical data were collected, and a stool sample was obtained for microbiological analysis at enrollment. We used a multivariate generalized linear model to assess the effect of rotavirus, Cryptosporidium, heat-stable toxin (ST)-producing enterotoxigenic Escherichia coli (ETEC [ST only or LT plus ST]), Shigella, Campylobacter jejuni, norovirus GII, Vibrio cholerae O1, age, gender, in/ outpatient, and country on total costs to the patient/family. Results. Household out-of-pocket costs were higher in Mali than any other country. Within countries, household cost differences between pathogens were minimal and not statistically significantly different. Conclusions. We found no significant differences in household costs by pathogen. Despite data limitations, understanding pathogen-specific household costs (or lack thereof) is useful, as decision-makers could consider broader illness cost information and its relevance to a particular pathogen's economic burden and contribution to poverty when deciding which pathogens to target for interventions. © The Author(s) 2019.
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