Prevalence of Diarrhoea and Associated Factors among Under-Five Children in Jigjiga District, Somali Region, Eastern Ethiopia

Background: Diarrheal disease is a major cause of morbidity and mortality among children in many developing countries, including Ethiopia and is a leading cause of morbidity in Pastoralist Ethiopian-Somali region. Diarrheal disease is not purely medical, but huge part of this should be traced back to the social, economic, environmental and behavioural aspects of the family. Determining these interactions is relevant to prevent and control diarrhoea. Objective: The objective of this study was to measure the prevalence of diarrhoea and describe associated factors relating to diarrheal disease among under-five children in Jigjiga district. Methods: A cross-sectional study was conducted in Jigjiga district from June 12 to 26 in 2014 using a structured and pretested questionnaire. A total of 1807 primary care takers were interviewed. Proportionate to size allocation was done and simple random selection was used to select sample units. Diarrheal morbidity occurred in the under-five children in the past 14 days were registered to determine prevalence. Data were entered using Epi Info version 3.5.3 and analysed in SPSS version 20. Odds ratio with 95% CI in a multivariate logistic regression was employed to control confounding factors. Results: The findings of this study showed that the overall two-week period prevalence of diarrhoea in under-five children was 27.3%: 95% CI (26.9%, 27.4%). Education of the primary caretaker, occupation of the father, birth order of the child, maternal diarrhoea, and hand washing during critical times, water source, type of water storage container, latrine availability, frequency of household solid waste water disposal, availability of liquid waste water drainage system and the type of the kitchen floor material showed as independent predictors of under-five child hood diarrhoea. Conclusion: This study revealed that diarrhoea morbidity was relatively high among children under-five years of age residing in Somali region. Efforts to reduce childhood diarrhoea should focus mainly on water, sanitation and hygiene interventions including health education.

Knowledge and practice of care-givers who have under-five diarrhoeal children:a quantitative cross-sectional study in Mataniko settlements in Honiara, Solomon Islands, 2016

Introduction:Diarrhoea remains the second most serious health problem among children below five years old in Solomon Islands and is one of the leading causes of infant mortality,which caused about one in every ten children dying before the age of five years.Globally,around 6 million children (＜5 years) suffer from diarrhoea each year.Because of lack of previous studies,this study aims to assess the predictors of knowledge and practice of caregivers towards diarrhoea among under-five children in Mataniko informal settlements in Honiara,Solomon Islands,2016.Methods:This quantitative study was conducted at three randomly selected settlements in Honiara,Solomon Islands from June to July 2016.This study was conducted among both male and female caregivers who had children under five years of age,were aged 18 and over,live in Solomon Islands and were willing to participate in the study.A validated structured questionnaire was used to collect the data based on a 2-week recall of diarrhoea episodes.To avoid double-counting,each surveyed household was geo-referenced using global positioning system (GPS).The collected data were entered and analysed using SPSS (version 23.0) and descriptive and analytical statistics.P＜0.05 was considered as statistically significant.This study was approved by relevant ethical committees.Results:A total of 205 caregivers with at least one child under-five years participated in the study.The mean ages of caregivers and the under-five children were (30.7+8.2) years and (2.6+1.5) years,respectively.Among 205 caregivers,94 of them had reported that their children (＜5 years) had suffered with at least one episode of diarrhoea within the last 2 weeks prior to the survey.This gave a prevalence rate of 45.9％.The caregiver's knowledge about the causes (99.0％) and prevention (98.0％) of under-five diarrhoea was extremely high.Nevertheless,less than half had regularly practiced essential hygiene habits.The factors which appeared to be significantly associated with under-five diarrhoea were irregular hand washing (odds ratio [OR] 2.07,95％ confidence interval [CI]:1.12-3.81,P=0.020),inappropriate methods of disposing of children's fecal waste (OR 1.88,95％ CIL 1.06-3.33,P=0.030),and using the river for bathing (OR 1.83,95％ CI:1.04-3.23,P=0.036),and laundry (OR 2.17,95％ CI:1.23-3.84,P=0.008).Conclusion:Diarrhoea is a major public health problem among children below five years in Mataniko informal settlements.To address these exposures,relevant programs and projects should be designed,especially in areas like family planning,household economic allocation and political commitment.Awareness and advocacy programs on birth spacing,food hygiene and potential health risks about the river should be ongoing at the community level.

Prevalence of diarrhoea and its associated factors in children under five years of age in Baghdad, Iraq

Introduction: Diarrhoeal disease is one of the principal causes of morbidity and mortality among children in developing countries. Poor nutrition leads to ill health and it contributes to further deterioration in nutritional status. Methodology: A cross-sectional study was conducted in Baghdad, Iraq. The study was conducted in three paediatric hospitals and from paediatric departments in other three general hospitals in Baghdad, Iraq. Sample was drawn conveniently, three paediatric hospitals from Baghdad hospital list. 150 respondents were chosen from these paediatric hospitals and 50 respondents were chosen from the paediatric departments in three general hospitals. Results: males had twice the risk of diarrhoea (OR 1.9, 95% CI 1.1;3.5). The risk of diarrhoea was 3 times higher among children with mothers who had lower level of education (OR 3.5 95% CI 1.3;10.1), 5 times higher with unemployed mothers (OR 4.7 95% CI 2.1;10.4) and 2 times higher with mothers who had poor nutritional knowledge (OR 2.5 95% CI 1.4;4.9). The risk of diarrhoea was three times higher among children with fathers who had lower level of education (OR 3.3 95% CI 1.7;6.6). The binomial logistics regression, Mothers’ level of education and employment status, fathers’ level of education, mothers’ nutritional knowledge were used as possible independent associated factors. Conclusion: Children in Baghdad remain at risk of frequent diarrhoea episodes and other complications which might affect their development status. It is becoming increasingly important to focus on improving the underlying factors by increasing the mother nutritional knowledge through special antenatal classes, and improving family economic status.

Adenovirus and Rotavirus Associated Diarrhoea in under 5 Children from Enugu Rural Communities, South East Nigeria

Globally, diarrhoea is the second commonest infectious cause of death in children less than 5 years old. It is estimated that more than one billion diarrhoea episodes occur every year causing up to 700,000 deaths among children younger than 5 years of age. Seventy-two percent of these deaths occur in children below two years and enteric viruses have been recognized as a major cause of childhood diarrhoea. This study was undertaken to determine the prevalence of enteric Adenoviruses and Rotaviruses in children with diarrhoea in rural Enugu communities of Enugu State South East Nigeria. Methods: Stool samples were collected from children less than 5 years with diarrhoea seen in any of the participating hospitals in Enugu State. Samples were collected between June 2015 and May 2017. Detection of rotavirus and enteric adenovirus antigens were performed using commercially available ELISA kit (Oxoid-ProspecT&#174;). Demographic data of the children were also collected. Results: Of the 290 stool samples that had sufficient materials for adenovirus and rotavirus ELISA, 14 (4.8%) and 89 (30.7%) were positive for enteric adenovirus and rotavirus respectively. 3 (1%) were co-infected with adenovirus and rotavirus. Rotavirus positive cases were more among hospitalized patients while enteric adenovirus was more among outpatients. Marked peaks of rotavirus positivity were seen in January of each year but no peak was seen among adenovirus positive cases. Higher vomiting frequencies and severe dehydration were more among rotavirus positive cases compared to adenovirus positive cases (p = 0.030 and 0.001 respectively). Conclusion: Many diarrhoea cases among children aged <5 in the population studied were associated with enteric adenoviruses and rotavirus. This finding suggests that enteric viral agents (adenovirus and rotavirus) are important aetiologies for childhood diarrhoea in Enugu state Nigeria. Appropriate preventive, diagnostic and treatment interventions should be instituted so as to reduce the mortality and morbidity associated with these viruses.

Use of Probiotic Yogurt in the Management of Acute Diarrhoea in Children. Randomized, Double-Blind, Controlled Study

Background: In Bolivia there are few probiotic preparations available in the market, practically without alternatives to the use of freeze-dried products. An alternative used as a good alternative in other parts of the world is yogurt with a probiotic strain added. In this study we report the use of a locally prepared yogurt with a lyophilized probiotic added. Methods: This is randomized, double-blind and controlled clinical trial in children hospitalized with acute diarrhoea carried out at the Paediatric Centre Albina Pati?o in Cochabamba, Bolivia with children 10 to 35 months participating. Children were randomly assigned to receive an oral rehydration solution and Saccharomyces boulardii (positive control) or the same solution plus yogurt preparation containing Lactobacillus rhamnosus (yogurt group). The primary outcome was the duration of diarrhoea. Secondary outcomes were the duration of fever, vomiting and hospitalization. Results: Of the 74 children incorporated 42 completed the protocol;baseline characteristics were similar in both groups. The median duration of diarrhoea was similar in children who received yogurt (71 hours) and controls (79 hours) (p = 0.3). The mean duration of fever was also similar in both groups: S. boulardii (24 hours) or yogurt (11 hours) (p = 1.02), as was the duration of vomiting: 17 hours vs. 32 hours in the control group (p = 0.37). A significant difference in the numbers of daily bowel movements was observed in the third day, the probiotic group was lower (p = 0.01). There was no effect on the duration of hospitalization (p = 0.26). Conclusions: The use of a yogurt containing L. rhamnosus has an effect comparable to S. boulardii. Introduction of yoghurt with a probiotic in the diet of patients hospitalized with acute diarrhoea may help reduce its duration, regardless of its aetiology.

Escherichia coli Pathotypes in Children with Acute Diarrhea in an Informal Settlement in Nairobi, Kenya

Diarrhea is among the leading causes of morbidity and mortality in children aged Escherichia coli (DEC) accounts for 30% - 40% of childhood diarrhea cases. To identify the pathotypes involved in diarrheal outbreaks in Kenya, we analyzed archived E. coli isolates from children E. coli confirmation and antimicrobial susceptibility testing were done using the VITEK®2 instrument. Pathotype identification was performed via conventional polymerase chain reaction. Of 175 E. coli isolates, 48 (27%) were DEC pathotypes, with enteroaggregative E. coli (EAEC) predominating (71%, 34/48). Enterohemorrhagic (EHEC) and enteropathogenic E. coli (EPEC) represented 19% and 10% of isolates, respectively. Enteroinvasive and enterotoxigenic pathotypes were not identified. All DEC isolates were susceptible to amikacin, ertapenem, imipenem, meropenem and tigecycline. Conversely, most (>80%) isolates were resistant to ampicillin, ampicillin-sulbactam and sulfamethoxazole-trimethoprim. Half of all EAEC and EPEC strains were resistant to cefazolin while half of EHEC isolates were resistant to ciprofloxacin and moxifloxacin. In total, 18 resistance phenotypes were identified with “ampicillin-cefazolin-ampicillin/ sulbactam-sulfamethoxazole/trimethoprim” predominating (33%, 16/48). The majority (81%) of DEC isolates were multidrug-resistant, with extended-spectrum beta-lactamase production identified in 8% of these isolates. This study highlights the predominance of Enteroaggregative E. coli and multidrug resistance of DEC pathotypes. Studying the epidemiology of diarrheal disease and antimicrobial resistance surveillance, will aid in identifying dominant etiological agents of diarrhea and newly emerging resistant strains in informal settlements.

中医药治疗小儿泄泻研究述评

目的:探讨小儿泄泻的病因病机、辨证分型及中医治疗方法。方法:总结、归纳、分析中医治疗小儿泄泻的相关文献。结果:小儿泄泻的病因病机主要包括:外感六淫、饮食所伤、脾肾虚弱、脾胃本虚。中医治疗小儿泄泻主要方法有脐部疗法、中药治疗、推拿治疗、针灸疗法,有效率均在90%以上。结论:中医治疗小儿泄泻的方法多样,不良反应小,疗效肯定。

2018~2020年西安地区儿童食源性腹泻病病原菌分布特征和耐药性及鼠伤寒沙门菌聚类分析

目的研究西安地区儿童食源性腹泻病流行病学特点、病原菌分布及耐药情况,为预防和治疗儿童食源性疾病提供依据。方法收集西安市儿童医院2018年8月~2020年8月门诊及住院食源性腹泻病患儿粪便标本进行细菌培养,分离的致病菌行基质辅助激光解吸/电离飞行时间质谱(matrix assisted laser desorption ionization-time of flight mass spectroscopy,MALDI-TOF MS)鉴定聚类分析、血清学鉴定及药物敏感性试验。结合临床病例对阳性结果患儿的年龄分布、患病季节性差异、病原菌血清学分布、耐药情况及同源性进行回顾性分析。结果食源性腹泻病患儿送检粪标本1435例,致病菌阳性标本117例,阳性分离率8.15%,其中检出较多的是沙门菌,占90.60%(106/117),鼠伤寒沙门菌50.43%(59/117),肠炎沙门菌27.35%(32/117);食源性腹泻病患儿发病主要集中于两个年龄段,其中2岁以下婴幼儿致病菌检出率5.92%(29/490),3~6岁学龄前期儿童致病菌检出率高达12.35%(61/494)。致病菌于夏季(7~9月份)检出率最高13.16%(55/418),其季节性分离率差异有统计学意义(χ^(2)=23.970,P<0.05);儿童分离的沙门菌对三、四代头孢菌素普遍敏感,其中头孢他啶、头孢噻肟、头孢吡肟的耐药率均<25.00%,喹诺酮类中环丙沙星多数表现为中介,比例高达91.55%,儿童常用氨苄西林(88.15%)及复方新诺明(71.36%)耐药率较高;采用质谱聚类分析59株鼠伤寒沙门菌同源情况,发现该院患儿食源性腹泻病分离的鼠伤寒沙门菌主要为两大簇(Ⅰ型和Ⅱ型)及3个亚小簇(Ⅰa,Ⅰb,Ⅱa)。结论儿童食源性腹泻病的主要致病菌为鼠伤寒沙门菌和肠炎沙门菌,夏季3~6岁学龄前期儿童病原菌分离率较高。沙门菌对三、四代头孢菌素敏感率均较高,可针对儿童食源性腹泻病行降阶梯治疗。聚类分析显示该地区的鼠伤寒沙门菌的同源性较低,亲缘关系相对分散。临床及感控部门应高度警惕儿童食源性腹泻病,加强对沙门菌流行病学监测力度。

低渗透压口服补液盐的配制处方在儿童急性腹泻病中的临床应用

目的推广应用WHO和UNICEF推荐的降低渗透压的新配方口服补液盐。方法通过减少氯化钠及葡萄糖含量而降低ORS的渗透压。结果能减少儿童急性腹泻病的病程和严重程度,避免可能发生的副作用。结论有必要使用低渗透压配方ORS控制腹泻病。

思密达保留灌肠治疗小儿急性腹泻病疗效分析

目的探讨应用思密达保留灌肠治疗小儿急性腹泻病的疗效。方法选择79例急性腹泻病患儿随机分成2组,均给予相同的常规治疗,治疗组给予思密达保留灌肠,对照组给予思密达口服。结果治疗组与对照组显效率和总有效率比较差异有统计学意义(P<0.05),排便次数及大便性状恢复正常时间与对照组比较差异有统计学意义(P<0.05)。结论使用思密达保留灌肠治疗小儿急性腹泻可缩短疗程,疗效明显优于对照组。

秋冬季腹泻病合并惊厥36例临床分析

目的:探讨小儿秋冬季腹泻合并惊厥的原因。方法:对36例秋冬季腹泻患儿的临床表现,实验室及相关辅助检查进行分析。结果:中枢感染、电介质紊乱、高热惊厥,维生素B_1、维生素K_1缺乏等均可引起秋冬季腹泻合并惊厥。结论:秋冬季腹泻合并惊厥由多种因素引起,临床应综合考虑,积极治疗。

推拿疗法治疗小儿泄泻的临床疗效观察

观察推拿治疗小儿泄泻的临床疗效,50例患儿得经过推拿治疗后,总有效率为96%。其中显效占86%,有效占10%,无效占4%。推拿疗法能促使脾胃等消化器官的兴奋性提高,增强消化吸收功能,尤其对小肠的吸收功能有一定的提高,以及能增加机体免疫力,从而起到健脾止泻的作用。

重庆市某儿童医院食源性疾病病原体检测及结果分析

目的了解重庆市儿童群体中食源性疾病流行病学特征及病原体检出情况,为预防儿童感染性腹泻提供科学依据。方法以2019-2021年重庆医科大学附属儿童医院采集的食源性疾病病例粪便标本进行沙门氏菌、副溶血性弧菌、志贺氏菌、致泻大肠埃希氏菌及诺如病毒的病原学检测,并对结果进行分析。结果2019-2021年共报告438例病例,采集标本354件,有126份标本检出阳性,检出率为35.59%,病原体检出情况为沙门氏菌103株(29.10%),致泻大肠埃希氏菌3株(0.85%),诺如病毒33株(9.32%),未分离出志贺氏菌和副溶血性弧菌,致病菌合并诺如病毒感染13例(3.67%);病例主要集中在小于或等于5岁年龄段,阳性标本多集中在小于或等于2岁年龄段,占阳性标本总数的82.08%(食源性致病菌)和84.85%(诺如病毒);可疑食品大部分来自家庭自制食品,占所有病例的71.92%。结论重庆地区儿童食源性疾病病原体以沙门氏菌和诺如病毒为主,应有针对性地加强食品安全宣教健康教育,开展食源性疾病防控知识宣传,以降低食源性疾病的发生。

儿童腹泻病的诊治策略

儿童腹泻病是儿童常见疾病,是儿童死亡的主要原因之一,也是营养不良的重要原因。本文阐述儿童腹泻病的病因、诊断要点、治疗建议和预防策略等。临床医师应及时更新和掌握小儿腹泻病的最新知识,以便于临床工作。

自拟止泻方联合推拿法治疗秋季小儿消化不良性腹泻

目的探讨自拟止泻方联合推拿法治疗秋季小儿消化不良性腹泻的临床疗效。方法选取我院2015年1月-2017年2月收治的208例秋季消化不良性腹泻患儿,按照随机数字表法分为对照组和观察组,各104例。对照组患儿则给予常规西医治疗,观察组患儿给予自拟止泻方和推拿法等中医综合治疗,观察比较2组患儿治疗前后的相关指标变化情况以及治疗效果。结果观察组痊愈率、总有效率分别为69.23%、91.35%,显著高于对照组的49.04%、84.62%(P <0.05)。2组患儿治疗后腹泻、腹痛、腹胀、大便性状以及HAMA评分等指标均较治疗前有明显改善(P <0.05),且观察组优于对照组(P <0.05)。观察组患儿治疗后大便次数恢复正常时间、体温恢复正常时间、大便性状恢复正常时间、住院时间均低于对照组(P <0.05)。结论自拟止泻方联合推拿法治疗秋季小儿消化不良性腹泻,以中药健脾渗湿,改善脾胃气虚之证,以推拿法充实脏腑促进气血运化和肠道蠕动,两者合用,可改善消化功能,达到标本兼治的效果。

综合性护理在腹泻患儿护理中的应用效果

目的分析综合性护理对腹泻患儿腹泻症状改善效果的影响。方法选取我院2017年4月~2018年4月收治的180例腹泻患儿作为研究对象,采用随机数字法将其分为对照组和实验组,每组各90例。对照组实施常规护理,实验组在对照组的基础上实施综合性护理干预。比较两组干预后的临床症状和体征改善情况、住院时间、住院费用及患儿家长满意度。结果干预后实验组的腹泻改善时间、呕吐改善时间、退热改善时间均短于对照组,大便次数少于对照组,差异均有统计学意义(P<0.05);实验组的住院时间明显短于对照组,住院费用明显低于对照组,差异均有统计学意义(P<0.05);实验组患儿家长的总满意度为88.89%,明显高于对照组的66.67%,差异有统计学意义(P<0.05)。结论对腹泻患儿行综合护理干预,能改善患儿的临床症状和体征,减少其住院时间和住院费用,且可提高患儿家长的满意度,值得临床进一步推广使用。

腹泻儿童A群轮状病毒及粪便常规检测的观察

目的探讨腹泻儿童A群轮状病毒及粪便常规检测结果。方法选取2016年6月—2020年6月浙江省永康市第一人民医院收治的134例腹泻儿童为研究对象。观察不同年龄、发病时间、性别的腹泻儿童A群轮状病毒抗原检测结果,比较A群轮状病毒抗原检测与粪便常规检测的一致性。结果A群轮状病毒抗原检测阳性为31例(23.1%),1、12月腹泻儿童A群轮状病毒抗原检测阳性率较高,男性、女性腹泻儿童A群轮状病毒感染阳性率相当。Kappa一致性检验显示,A群轮状病毒抗原检测阳性率与白细胞、红细胞、隐血检出率的一致性均较差,而与脂肪球检出阳性率的一致性较好。结论>6个月~2岁腹泻儿童是A群轮状病毒的易感染群,1、12月是A群轮状病毒感染的高发时期,粪便常规检测中脂肪球检出率和A群轮状病毒检测率可能有一定的相关性。

急性腹泻患儿应用布拉氏酵母菌散剂前后细胞免疫功能指标水平变化及意义

目的:通过急性腹泻患儿服用布拉式酵母散剂,观察服用前后细胞免疫功能指标水平的变化情况及意义。方法:选取笔者所在医院2012年7月-2013年7月收治的200例急性腹泻患儿作为研究对象,按照随机数字表法将其分为观察组126例和对照组74例。观察组患儿在服用抗生素、蒙脱石散剂口服及补液的基础上加用布拉式酵母散剂进行治疗,对照组患儿仅服用抗生素、蒙脱石散剂口服及补液进行治疗,对两组的治疗效果、平均止泻时间进行对比分析,观察对细胞免疫功能指标水平的影响。结果:观察组患儿治疗后1个月的CD3、CD4和CD4/CD8均明显高于治疗前,CD8明显低于治疗前,差异均有统计学意义(P<0.05),而对照组治疗前后比较差异均无统计学意义(P>0.05)。观察组的显效率66.67%和总有效率94.44%均明显高于对照组的33.78%和81.08%,差异均有统计学意义(P<0.05)。观察组的平均止泻时间(2.5±0.6)d明显短于对照组的(4.6±0.5)d,差异有统计学意义(t=25.3693,P=0.0000)。结论:在常规治疗的基础上加用布拉式酵母散剂对急性腹泻患儿进行治疗,可以增强小儿的细胞免疫功能,减少大便的次数,值得临床推广应用。

中西医结合治疗小儿迁延性及慢性腹泻的临床效果

目的 探讨中西医结合治疗小儿迁延性、慢性腹泻的临床效果。方法 选取2021年6月至2022年7月梅州市中医医院儿科诊断为迁延性、慢性腹泻的60例患儿作为研究对象,按随机数字表法将其分为治疗组和对照组,每组各30例。对照组患儿采用西医基础治疗,治疗组在对照组的基础上加用小儿推拿、火龙罐及中药治疗,两组均治疗3 d。比较两组患儿的脱水征缓解时间、酸碱电解质紊乱纠正时间、腹泻缓解时间及治疗总天数、治疗总有效率。结果 治疗组患儿的脱水征纠正时间、酸碱电解质紊乱纠正时间、腹泻缓解时间及治疗的总天数均短于对照组,差异有统计学意义(P<0.01)。治疗组患儿的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。结论中西医结合治疗小儿迁延性、慢性腹泻在改善临床症状及体征方面均有较明显的效果,能减少治疗天数。

粪便微生物检验在儿童腹泻诊断中的效果

目的分析粪便微生物检验在儿童腹泻诊断中的应用效果,并且观察这种检验方式在患儿疾病治疗中的指导作用。方法回顾性分析我疾控中心于2014年5月至2019年5月收到的腹泻样本,抽取80例儿童样本作为本次研究对象,所有样本均来自医院患儿,实施粪便微生物检验,进行细菌培养后利用全自动微生物鉴定仪进行鉴别,分析其中的致病菌株种类及占比。结果通过为80例腹泻儿童样本进行粪便微生物检验后,共检测出63例菌株,检出率为78.75%,致病菌株种类分别为志贺菌、沙门菌、致病性大肠埃希菌以及产毒性大肠杆菌等,其中以志贺菌占比最高,检出率为41.27%,差异有统计学意义(P<0.05)。结论粪便微生物检验在儿童腹泻诊断中应用效果较好,发现多种病原菌均可导致儿童发生细菌性腹泻,其中以志贺菌最为常见,其次则为致病性大肠埃希菌、沙门菌等,通过不同病原菌致病原因来实施针对性治疗,能够提高治疗效果,早日促进患儿疾病康复,值得运用。