Molecular Prevalence and Epidemiological Characteristics of Diarrheagenic <i>E. coli</i>in Children under 5 Years Old in the City of Koula-Moutou, East-Central Gabon

Background and Purpose: Diarrhoeagenic E. coli (DEC) is one of the germs responsible for childhood diarrhea in developing countries. This study aims at determining the prevalence of the five main pathotypes of DEC isolated from faeces of children under five years old with diarrhea or not, living in the city of Koula-Moutou. Methodology: Isolates of E. coli were phenotypically screened on chromIDTM agar and molecularly by multiplex PCR to detect the presence of enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enterohemorragic E. coli (EHEC) and enteroinvasive E. coli (EIEC). The evaluation of their sensitivity to 12 β-lactam antibiotic molecules was carried out by Kirby Bauer method. This method has also made it possible to characterize phenotypically the different β-lactamases produced. Results and Conclusion: Overall, at least one DEC pathovar was detected in the 63 E. coli strains with phenotypic and molecular frequencies of 63.5% and 68.5% respectively. Thus, ETEC (28.3%) and EHEC (28.3%) were the most frequent DEC in diarrheal isolates. ETEC/EHEC hybrid was recorded in both groups with rates of 7.5% in diarrheal cases and 10.0% for controls. The results showed produced carbapenemase type β-lactamases (31.7%), followed by ESBL (24.4%) and few produced high level penicillinases (4.9%). The DEC, in particular ETEC and EHEC are most likely the epidemiological agents responsible for childhood diarrhea in this study.

Nosocomial diarrhea in children:is astrovirus the leading pathogen?

Objective:To screen for the presence of mixed infection with rotavirus.Methods:The present study included 140 children aged less than 2 years with acute diarrhea.Fecal samples of all these patients were analyzed for the presence of astroviral antigen by enzyme immunoassay.Also 40 rotavirus positive fecal samples were screened for the presence of astrovirus.Results:In case of acute diarrhea in children the prevalence of astrovirus was around 34% (48/140).It was seen that even in rotavirus positive cases astrovirus co infection was 25% .Conclusions:Astrovirus is a growing problem which is often underrecognised.With the rotavirus vaccine licensure being imminent astrovirus will emerge out as the single most important cause of viral

History of Vitamin A Supplementation Reduces Severity of Diarrhea in Young Children Admitted to Hospital with Diarrhea and Pneumonia

Background: Although the role of vitamin A in childhood pneumonia in association with diarrhea is not fully proven, we did not find any published data demonstrating the impact of lack of vitamin A supplementation in under-five children who present with the co-morbidities of pneumonia and diarrhea. This study examined whether previous vitamin A supplementation was associated with reduced severity and duration of diarrhea and pneumonia for children presenting with both illnesses. Methods: All admitted children (n = 189) aged 0 - 59 months to the Special Care Ward of the Dhaka Hospital of icddr,b with diarrhea and radiological pneumonia from September-December 2007 were enrolled. We compared clinical features of the children who received (n = 96) and did not receive (n = 93) high potency capsule vitamin A supplementation during previous immunization according to EPI schedule. Results: In logistic regression analysis, after adjusting for potential confounders such as respiratory rate, lower chest wall in-drawing, severe wasting and systolic blood pressure, vitamin A non-supplemented children with pneumonia and diarrhea more often presented in their early infancy (95% CI 1.01 - 1.09), had duration of diarrhea for >4 days (95% CI 1.79 - 11.88), had clinical dehydration (95% CI 1.2 - 5.63), and more often required hospitalization for >7 days (95% CI 1.03 - 8.87). But, there was no significant difference in the clinical features of pneumonia, such as history of cough, respiratory rate, lower chest wall in-drawing, nasal flaring, head nodding, grunting respiration, cyanosis, and inability to drink between the groups. Conclusion: Lack of vitamin A supplementation in under-five children with radiological pneumonia and diarrhea is independently associated with young infancy, duration of diarrhea for >4 days, dehydration and hospitalization for >7 days which underscores the importance of routine supplementation of vitamin A in young infancy. However, lack of vitamin A supplementation did not influence any clinical signs of pneumonia.

Prevalence of diarrhea and associated risk factors among children under-five years of age in Eastern Ethiopia: A cross-sectional study

Diarrhea remains a major cause of mortality in children under 5 years of age in Sub-Saharan countries in Africa. Risk factors for diarrhea vary by context and have important implications for developing appropriate strategies to reduce the burden of the disease. The objective of this study was to assess the prevalence of diarrhea and associated risk factors among children un-der 5 years of age in Kersa district, located in Eastern Ethiopia. A community-based cross-sectional study was conducted among 1456 randomly selected households with at least one child under 5 years of age. A questionnaire and an observational check list were used for col-lecting information on socio-economic charac-teristics, environmental hygiene and behavioral practices, and occurrence of diarrhea among children under 5 years of age. Logistic regres-sion was used to calculate the adjusted odds ratio of 95% confidence interval. The two-week prevalence of diarrhea among children under 5 years of age was 22.5% (95% CI: 20.3-24.6). Improper refuse disposal practices (OR = 2.22, 95% CI: 1.20-4.03), lack of hand washing facilities (OR = 1.92, 95%CI: 1.29-2.86), living in rural area (OR = 1.81, 95% CI: 1.12-3.31), the presence of two or more siblings in a household (OR = 1.74, 95% CI: 1.33-2.28), and age of the child (OR= 2.25, 95% CI;1.5-3.36) were the major risk factors for diarrhea. This study demonstrated that diarrhea morbidity was relatively high among children under 5 years of age residing in Eastern Ethiopia. Efforts to reduce childhood diarrhea should focus on improving household sanitation, personal hygiene, and child birth spacing.

Norovirus Infection and Histo-blood Group Antigens in Children Hospitalized with Diarrhea in Lulong and Chenzhou in China

Norovirus （NOV） is a pathogen that commonly causes viral diarrhea in children. Studies indicate that NoV recognizes human histo-blood group antigens （HBGAs） as cell attachment factors. In order to explore the correlation between of NoV infection and HBGAs, a cross-sectional study was conducted in children less than five years old who were hospitalized with diarrhea in two areas of China between November 2014 and February 2015. Of the paired stool and saliva samples taken from 424 children,

Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%;urban—15%), Shigella (16%;9%), Salmonella (1%;2%) and Campylobacter (3%;4%);and less likely to have rotavirus (25%;20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%;13%) than those of MM (5%;10%) and WN (2%;8%) and lower for rotavirus (30%;31%), (34%;43%), (35%;47%) respectively (p 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%;p = 0.72) but significantly higher than that in WN (1%;p 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.

The Treatment of Children's Diarrhea with Massage and Acupunture in 58 cases

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Diarrhea Disease among Children under 5 Years of Age: A Global Systematic Review

Diarrhea diseases remain the second leading cause of death among children under five years globally. Nearly one in every five child deaths, about 1.6 million each year, are due to diarrhea. Further, diarrhea kills more young children than malaria, measles and Acquired Immunodeficiency Syndrome (AIDS) combined. As a result, better understanding of childhood diarrhea occurrence can perhaps help reduce associated morbidity and mortality rates. Therefore, this study conducted a global systematic review on occurrence of childhood diarrhea. The broad objective of this study was to review present and past researches on childhood diarrhea and most importantly for children under 5 years of age. The review focused on understanding the burden of diarrhea, causes of childhood diarrhea and solutions to the disease. A systematic literature review was conducted using the databases of PubMed, CINAHL, Web of Science and Google Scholar. Search key terms used were childhood diarrhea, risk factors and intervention practices. Journal articles and related reports were filtered and limited from 2005 to 2020. Sixty-one reports and articles that met inclusion criteria were used in this review. Review found that, childhood diarrhea imposes economic costs on the health system and families. Also, repeated bouts of diarrhea can lead to malnutrition, stunting and delayed brain growth later in life and can lead to stress and tension to the affected households. The dependence on open water sources which are often contaminated with fecal materials was found as the major cause of the rising prevalence of childhood diarrhea. Other important factors were poor hygienic practices and lack of sanitation facilities contribute to the spread of diarrhea diseases. Improvements in the quality of drinking water, sanitation facilities and hygiene practices especially in low and middle income countries have been suggested by many studies as an intervention to reduce childhood diarrhea.

Factors Influencing Preventive Behaviors of Mothers for Diarrhea in Children Aged 1-5 Years in Buol District, Indonesia

This study aims to determine the factors related with mothers＇ behaviors in preventing diarrhea in children aged 1-5 years inBuol District. This was a cross-sectional survey design with health belief model as the conceptual framework. A total of 300mothers were selected by using purposive sampling method based on criteria. Mothers were interviewed by using astructured questionnaire during October to November 2015. A chi-square （X^2） test was used to determine a significantassociation between independent variables and dependent variable. The finding showed that 68.3% of mothers hadgood behaviors in preventing diarrhea. The factors significantly related to mothers＇ behaviors included perceivedsusceptibility to diarrhea, perceived severity of diarrhea, perceived benefits of diarrhea prevention behaviors, and perceivedbarriers of diarrhea prevention behaviors CP 〈 .01, p 〈 .01, p 〈 .01, and p 〈 .01 respectively）. Further, mothers had highperception to comply with diarrhea prevention behaviors. Those who perceived that diarrhea prevention behaviors werehighly beneficial to their children had good behaviors in preventing diarrhea. However, taking certain actions must considernegative aspects.

Frequency of E.coli pathotypes in acute diarrhea of children and its related factorsat Beassat hospital,Sanandaj

Objective:Diarrhea is a leading cause of morbidity and mortality among children in developing countries.The bacterial pathogen most commonly associated with childhood diarrhea is Escherichia coli.A one-year prospective study was carried out in Sanandaj to determine the prevalence and roles of the different E.coli pathotypes in children less than five years of age with acute diarrhea.Methods:Rectal swab were collected prospectively from children with acute diarrhea and transported to the Department of Microbiology,School of Medicine, KUMS,Sanandaj during 2008.The study was approved by the institutional ethics committee.Results:During this study period,rectal swabs were investigated from a total of 466 children 1 to 144 months of age(mean, 29.97 months±S.D) with diarrhea.Among the children,191(41%,191/466) were girls,and 275 (59%,275/466) were boys.The age-specific incidence rates of acute diarrhea among children 13-24 and 1 - 12 months of age were 37.37%(37/99) and 26.26%(26/99),respectively,during the study period.A total of 99 strains of E.coli were detected.EPEC 59(59.59%) and EIEC 22(22.22%),were the most commonly found Escherichia coli strains detected in stools from children.Disk diffusion testing showed E.coli strains resistance to tetracycline(89.89%),chloramphenicol(88.88%),Ampicillin(79.79%),Amoxicillin (75.75%) and Ceficime(75.75%).Among risk factors like age,sex,haemoglubin,fathers and mothers education,food and weight of children only mother's education was significant(P =0.018).Conclusion: In most of the clinical laboratories in Iran,E.coli does not considered as an etiologic agent responsible for diarrhea. Results in this study revealed that E.coli should be considered as an etiologic agent causing acute diarrhea among children.We therefore,recommend the routine isolation and identification of E.coli strains in all the clinical laboratories in Sanandaj.Guidelines for appropriate use of antibiotics in Sanandaj need updating.

Predictors of Meningitis in Under-Fifteen Children Attending an Intensive Care Unit of an Urban Large Diarrheal Disease Hospital in Bangladesh

Background: Data are lack on predicting features of meningitis in diarrheal children although the great clinical importance. Objective: To evaluate clinical and laboratory features in predicting meningitis in under-fifteen children having diarrheal illnesses. Methods: Children aged 1 month to 15 years, admitted in the ICU of the Dhaka Hospital of icddr, b between March 2011 and February 2012 with fever and seizure or altered consciousness and having LP done were enrolled into this analysis. Those children who had abnormal CSF findings [pleocytosis (normal range of leukocyte, 0 - 10/mm3) and/or elevated protein (normal range, 0.10 - 0.45 mg/dl) and low glucose (normal value, 60% of corresponding blood glucose)] were defined as meningitis. Comparison was made between children with (cases = 17) and without meningitis (controls = 66) from our study children. Data were retrospectively collected from SHEBA, an online database system of the Dhaka Hospital of icddr, b. Results: Death was significantly higher among the cases compared to the controls (29% vs. 3%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, cases frequently had hypoxemia (95% CI 1.55 - 21.93), absent peripheral pulse (95% CI 1.95 - 27.13) and neutrophilia (95% CI 1.13 - 17.00). Conclusion: Our data suggest that children with meningitis had higher case fatality rate. Simple independent predictors of meningitis such as hypoxemia, absent peripheral pulse, and neutrophilia may help clinicians to initiate early and prompt management in order to curve lifelong sequel due to meningitis and death in such patient population especially those in resource poor settings.

Health and Nutritional Status of Young Foster Children Attending a Diarrhea Treatment Hospital in Bangladesh

There is scarcity of evidence-based information about socio-demographic as well as ailment factors associated with foster children in Bangladesh. Thus the aim of the present study was to determine the socio-economic, health and nutritional status of young foster children in urban Dhaka. A total of 208 (1%;n = 208/28,948) under-5 foster children were enrolled in the Diarrheal Disease Surveillance System of icddr,b between 1993-2012. Randomly selected under-5 children (n = 624) with a ratio of 1:3 were extracted and constituted as comparison group. Forty-three percent (n = 90) foster children were male. Lack of formal schooling of mother was higher among foster children compared to non-foster children (52% vs. 35%;p < 0.001). Higher proportion of foster children suffered from some or severe dehy-dration (60% vs. 47%;p = 0.001) and often received intravenous saline (12% vs. 5%;p = 0.002) in comparison to non-foster children. Significantly lower proportion of foster children had rotavirus diarrhea (26% vs. 43%;p < 0.001). In multivariate analysis, foster children were 2 times (95% CI: 1.31-4.32) more likely to be stunted and 194 times (95% CI: 82.25-457.76) more likely to be non-breastfed. Infants aged 6-11 months were 8 times (95% CI: 3.70-15.50) more likely to be foster compared to older children and probability of fostering was 7 times (95% CI: 3.96-13.33) higher among mothers with a median age of 25 years. The findings of our study clearly demonstrate the existing health and nutritional problems of foster children. Therefore, appropriate health and nutrition interventions are critical for foster children in Bangladesh.

Assessment of Diarrheal Disease Management Practice in Under-Five-Year Children According to WHO Guideline in Health Facilities of Hawassa City, SNNPR, Ethiopia

Objective: To explore the practice of management of diarrhea in under-5-year children at health facilities found in Hawassa town, and associated factors with malpractice in comparison. Methodology: Cross Sectional study was conducted in 2 hospitals, 2 health centers and 2 private clinics that are found in Hawassa city which is found in Southern Nations, Nationalities and peoples (SNNP), 275 KM to south from Addis Ababa, capital city of Ethiopia from august 2017-October 2017. Structured checklist was used to retrieve the required information from the patients on arrival and stay in pediatrics OPDs and wards. The data analysis carried out using SPSS version 20.0. Logistic regression was carried out to analyze the association between the independent and dependent variables. Statistically significant associations were declared at p-values of less than or equal to 0.05. Results: Out of 420, about 397 (94.5%) children with diarrheal disease between the ages of 3 - 59 months were studied. The study subjects were from governmental hospitals (35.5%), health centers (34.5%) and private clinics (30%) that are found in Hawassa City. Sign of dehydration was 66 (17%) of which majority 59 (83%) of them were rehydrated. As to Zink supplementation, only 180 (45%) received it;antibiotics were the commonly (59.1%) prescribed drugs. Only 43.3% of children were appropriately managed. Hospitals had higher odds of inappropriate management of diarrhea with AOR = 1.61 (95% CI: 1.04 - 2.5) and children one year or younger were more inappropriately managed for diarrhea at the health facilities with AOR of 2.3 (95% CI: 1.57 - 4.41). Conclusions: In the current study the management of diarrhea at the health facilities is unsatisfactory as only less than half of children with diarrhea were properly managed. Treatment of diarrhea at hospital level and the patient’s age being less than 1 year were found to significantly affect the level of mismanagement of the diarrheal disease. Therefore, orientation and trainings for health care providers especially GPs and Residents should be given to adhere to recommended zinc therapy, Oral Rehydration Salts (ORS) replacement therapy and rational antibiotics prescription.

Morbidity, Mortality and the Impact of Climate on the Evolution of Acute Rotavirus Diarrhea in Children under 5 Years Old in Bangui

Background: Rotavirus is the most common pathogen of severe acute diarrhea in children under five years of age worldwide. Objective: The objective of this study was to determine the morbidity and mortality of rotavirus diarrhea while describing the seasonal kinetics of the infection according to climatic parameters in Bangui. Methodology: This was a descriptive and analytical cross-sectional study conducted from January 1, 2011 to December 31, 2020 in the Central African Republic (CHUPB). The health data were recorded and processed with the Access 2019 software, then analyzed with the STATA version 14 software. The climatic trends in the study area and its seasonal variations were highlighted by the monthly rainfall coefficient of Alfred Angot: Cm = 12 Pm/P. Results: Morbidity was 45.99% of cases. The 1 to 12 months old represented 93.81% of cases. The mean age of the children was 6.8 months, the sex ratio was 1.20. The symptomatic triad was diarrhea (100%), vomiting (90.20%) and fever (87.5%). Moderate dehydration was reported in 81.05% of cases. The main genotype combinations found were P[8]G1 in 34.02% (n = 115/338), P[6]G1 in 21.59% (n = 73/338) and P[6]G2 in 16.86% (n = 57/338). Case fatality was 11.45%. The risk of death was influenced by rural origin, severe dehydration, hypovolemic cloc and duration of hospitalization > 5 days. Low rainfall correlated with the highest rates of rotavirus diarrhea. Likewise, high temperature correlated with the highest number of cases of rotavirus diarrhea. Conclusion: Acute rotavirus diarrhea is an important morbidity and mortality issue in children under 5 years old in Bangui.

Serum Zinc Levels and Immune Status of Children with Persistent Diarrhea Following Oral Zinc Supplementation

Background: Persistent diarrhea (PD) is a common disease in childhood worldwide. Clinical studies suggested that zinc supplementation is useful in most PD children. However, the relationship between the zinc and immune status of the PD children has not been reported. Objective: To examine serum zinc levels and immune status in 6 to 24 months old children with PD before and after 120 days of oral zinc supplementation and to evaluate the effects of zinc supplementation on serum zinc levels and immune status in PD children. Methods: A case control study was carried. Fifty-eight children aged 6 to 24 months with PD were enrolled. 58 patients were divided into two groups, zinc group (28 cases) and control group (30 cases). Laboratory investigation of serum zinc levels, Lymphocyte subsets (CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratio) and immunoglobulins (IgG, IgA and IgM) levels was carried out in all these patients once at enrollment and again after 120 days of treatment. Results: Before treatment, the serum zinc concentration was 4.37 ± 1.23 μmol/L in zinc group and 4.42 ± 1.45 μmol/L in control group (P > 0.05). However, after treatment, the serum zinc concentrations in the zinc group were significantly higher (8.81 ± 2.56 μmol/L), as compared to the control group (4.12 ± 1.02 μmol/L) (P < 0.05). Regarding immune status, Lymphocyte subsets CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratio and IgG, IgA and IgM levels of all the children with PD were measured once at enrollment and again after 120 days of treatment. There were no significant differences between the zinc and the control groups in CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratios (P > 0.05) before giving treatment. However, after 120 days of treatment, in the zinc group there was a significant rise in CD4+% (53.60 ± 5.78). The CD4 was significantly higher in the zinc group as compared to the control group (44.73 ± 4.39) (P < 0.05). Besides CD4+%, the CD4+/CD8+ ratio was also found to be higher among zinc group (1.49 ± 0.29) as compared to the control group (1.26 ± 0.18) after treatment (P < 0.05). But there were no statistically significant differences in CD3+% and CD8+% between zinc and control group after treatment (P > 0.05). Regarding immunoglobulins, there were no significant differences between zinc and control group in IgG, IgA and IgM levels (P > 0.05) at the time of enrollment (before treatment). However, after treatment, the mean IgG levels in zinc group and control group were 6.36 ± 0.95 g/l and 5.67 ± 0.74 g/l, respectively, P < 0.05. Similarly, after treatment, IgM levels in the zinc group were found significantly higher (1.58 ± 0.13 g/l), as compared to the control group (1.43 ± 0.20 g/l) (P < 0.05) but no significant differences in IgA levels were evident between the two groups after treatment. Conclusion: Administration of oral zinc supplement improved both serum zinc levels and immune status in children with PD. Zinc supplementation should be administered as adjunctive therapy for PD children.

Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: A systematic review with meta-analysis

BACKGROUND Diarrhea is a major infectious cause of childhood morbidity and mortality worldwide.In clinical trials,Lactobacillus rhamnosus GG ATCC 53013(LGG)has been used to treat diarrhea.However,recent randomized controlled trials(RCTs)found no evidence of a beneficial effect of LGG treatment.AIM To evaluate the efficacy of LGG in treating acute diarrhea in children.METHODS The EMBASE,MEDLINE,PubMed,Web of Science databases,and the Cochrane Central Register of Controlled Trials were searched up to April 2019 for metaanalyses and RCTs.The Cochrane Review Manager was used to analyze the relevant data.RESULTS Nineteen RCTs met the inclusion criteria and showed that compared with the control group,LGG administration notably reduced the diarrhea duration[mean difference(MD)-24.02 h,95%confidence interval(CI)(-36.58,-11.45)].More effective results were detected at a high dose≥1010 CFU per day[MD-22.56 h,95%CI(-36.41,-8.72)]vs a lower dose.A similar reduction was found in Asian and European patients[MD-24.42 h,95%CI(-47.01,-1.82);MD-32.02 h,95%CI(-49.26,-14.79),respectively].A reduced duration of diarrhea was confirmed in LGG participants with diarrhea for less than 3 d at enrollment[MD-15.83 h,95%CI(-20.68,-10.98)].High-dose LGG effectively reduced the duration of rotavirus-induced diarrhea[MD-31.05 h,95%CI(-50.31,-11.80)]and the stool number per day[MD-1.08,95%CI(-1.87,-0.28)].CONCLUSION High-dose LGG therapy reduces the duration of diarrhea and the stool number per day.Intervention at the early stage is recommended.Future trials are expected to verify the effectiveness of LGG treatment.

Acceptability and Compliance to a 10-Day Regimen of Zinc Treatment in Diarrhea in Rural Bangladesh

We hypothesised that the promotion of blister packs of zinc may be carried out by health personnel in health care facilities to the mothers of children suffering from diarrhea. We predicted that good acceptability and good compliance to zinc treatment in rural Bangladesh would be over 75% and at least 60%, respectively. Between January and December 2011, six hundred and thirty five children aged 6 - 59 months who presented with acute diarrhea received a 10-day zinc regimen. Determination of acceptability and compliance of a dispersible zinc tablet in children 6 - 59 months old was main point of the study. In-home follow-ups started within 2 - 3 weeks after the regimen began. Seventy seven percent of the mothers/caretakers perceived that the taste of the zinc tablets was the same or better than that of other medicines given to their children and expressed willingness to use zinc in the future (good acceptability). Sixty-two percent of the children completed full 10-day course of zinc treatment by taking one tablet a day that had been completely dissolved in a small amount of water (good compliance). There was 63% excess risk for poor compliance to zinc if father stays at home with the family [OR = 1.63 (95%CI;1.09, 2.46) p = 0.019]. Despite vomiting, 33% children continued to receive zinc tablet [OR = 0.67 (95%CI;(0.47, 0.97, 0.032)] after adjusting for co-variates. Both acceptability and compliance to dispersible zinc tablets in childhood diarrheal illnesses are still not at the expected level in rural Bangladesh.

Viral and Bacterial Etiology of Acute Diarrhea among Children under 5 Years of Age in Wuhan, China

Background： Acute diarrhea remains the serious problem in developing countries, especially among children under 5 years of age. Currently, only two or three common diarrhea pathogens were screened at most hospitals in China. The aim of this study was to provide a wide variety of diarrhea pathogens and their antimicrobial resistance patterns in children under 5 years of age. Methods： Totally 381 stool samples collected from Tongji Hospital between July 1, 2014 and June 30, 2015 were tested by culture and/or polymerase chain reaction for eight kinds of bacteria and five kinds of viruses. An antimicrobial sensitivity test was performed using dilution method recommended by the Clinical and Laboratory Standards Institute. Results： Viral infections were mainly identified in infants （0-11 months）, whereas bacterial infections were more prevalent in the age of 24-59 months. About 69.8% of samples were positive for at least one pathogen, 51.7% of samples were virus positive, followed by bacteria positive cases （19.4%）, and 12.6% of cases displayed co-infections with two viruses or a virus and a bacterium. Rotavirus was the most prevalent pathogen, followed closely by norovirus, while Salmonella was the most commonly isolated bacteria, followed by diarrheagenic Escherichia coli （DEC） and Campylobacter. More than 40% of Salmonella spp. and DEC isolates were resistant to first-line antibiotics （ampicillin, trimethoprim-sulfamethoxazole, and tetracycline）. Around 10% of Salmonella spp. isolates were resistant to ceftriaxone and ciprofloxacin simultaneously. Campylobacter spp. displayed high resistance to ciprofloxacin but kept low resistance to azithromycin and doxycycline. Conclusions： The etiology of acute diarrhea varies in children of different age groups. The high frequency of infection with viruses suggests the urgent demand for new viral vaccine development. Proper use of antibiotics in the treatment of acute diarrhea is crucial due to the high level of antibiotic resistance.

Chinese clinical practice guidelines for acute infectious diarrhea in children

Background The guidelines addressed the evidence-based indications for the management of children with acute infectious diarrhea in Chinese pediatric population. Data sources The experts group of evidence development put forward clinical problems, collects evidence, forms prelimi-nary recommendations, and then uses open-ended discussions to form recommendations. The literature review was done for developing this guideline in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to June 2013. Search the topic 'acute diarrhea' or 'enteritis' and 'adolescent' or 'child' or'Pediatric patient' or 'Baby' or 'Infant'. Results For the treatment of mild, moderate dehydration, hypotonic oral rehydration solutions (ORS) are strongly recom-mended. Intravenous (IV) rehydration is recommended for severe dehydration, with a mixture of alkali-containing dextrose sodium solution. Nasogastric feeding tube rehydration is used for children with severe dehydration without IV infusion conditions with ORS solution. Regular feeding should resume as soon as possible after oral rehydration or IV rehydration. The lactose-free diet can shorten the diarrhea duration. Zinc supplements are recommended in children with acute infectious diarrhea. Saccharomyces boulardii and Lactobacillus Rhamnus are recommended to be used in acute watery diarrhea. Sac-charomyces boulardii is recommended in children with antibiotic-associated diarrhea as well. Montmorillonite and Racec-adotril (acetorphan) can improve the symptoms of diarrhea or shorten the course of acute watery diarrhea. Antibiotics are recommended with dysenteric-like diarrhea, suspected cholera with severe dehydration, immunodeficiency, and premature delivery children with chronic underlying disease;otherwise, antibiotics are not recommended. Conclusion The principles of the most controversial treatments with of acute infectious disease are reaching to a consensus in China.

Astrovirus infection in young children with diarrhea hospitalized at Beijing Children’s Hospital

Background This study was to assess certain epidemiol ogical and clinical characteristics of astrovirus infection in children with diarrhea below 5 years old hospitalized at the Beijing Children’s Hospital.Methods From September 1999 to August 2001, a total of 288 children with diarrhea below 5 years old hospitalized at Beijing Children’s Hospital were studied. Fecal specimens collected from each patient were tested for astrovirus by using enzyme immunoassay (EIA) and further serotyped by reverse-transcription polymerase chain reaction (RT-PCR) using serotype-specific primers.Results Astrovirus antigen was positive in 9.0% of the patients, and the rate of coinfection with rotavirus was 19.2% among the a strovirus positive patients. The patients with astrovirus infection were at the age of 7 days to 17 months, most (92.3%) of them were less than 12 months. Astrovirus infection occurred mainly between October and March of the following year. Main symptoms included watery stool, vomiting, fever, and dehydration. Increased activity of myocardial enzyme was seen in 4 patients. Of the 22 astrovirus positive specimens, 14 were successfully serotyped by RT-PCR and they were all serotype 1.Conclusions The overall incidence of astrovirus infection in yo ung children with diarrhea hospitalized at the Beijing Children’s Hospital was 9.0%. The predominant serotype was type 1. Astrovirus may play an important role in viral diarrhea in young children in Beijing, China.