Associations between Household-Level Exposures and All-Cause Diarrhea and Pathogen-Specific Enteric Infections in Children Enrolled in Five Sentinel Surveillance Studies

Diarrheal disease remains a major cause of childhood mortality and morbidity causing poor health and economic outcomes. In low-resource settings, young children are exposed to numerous risk factors for enteric pathogen transmission within their dwellings, though the relative importance of different transmission pathways varies by pathogen species. The objective of this analysis was to model associations between five household-level risk factors—water, sanitation, flooring, caregiver education, and crowding—and infection status for endemic enteric pathogens in children in five surveillance studies. Data were combined from 22 sites in which a total of 58,000 stool samples were tested for 16 specific enteropathogens using qPCR. Risk ratios for pathogen- and taxon-specific infection status were modeled using generalized linear models along with hazard ratios for all-cause diarrhea in proportional hazard models, with the five household-level variables as primary exposures adjusting for covariates. Improved drinking water sources conferred a 17% reduction in diarrhea risk; however, the direction of its association with particular pathogens was inconsistent. Improved sanitation was associated with a 9% reduction in diarrhea risk with protective effects across pathogen species and taxa of around 10–20% risk reduction. A 9% reduction in diarrhea risk was observed in subjects with covered floors, which were also associated with decreases in risk for zoonotic enteropathogens. Caregiver education and household crowding showed more modest, inconclusive results. Combining data from diverse sites, this analysis quantified associations between five household-level exposures on risk of specific enteric infections, effects which differed by pathogen species but were broadly consistent with hypothesized transmission mechanisms. Such estimates may be used within expanded water, sanitation, and hygiene (WASH) programs to target interventions to the particular pathogen profiles of individual communities and prioritize resources.

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Study of acute diarrhoea among preschool children from below poverty line families of Lucknow district, North India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183588 ◽

2018 ◽

Vol 5 (9) ◽

pp. 4012

Author(s):

Khalid Mohammad ◽

Pratibha Gupta

Keyword(s):

Risk Factors ◽

Drinking Water ◽

Preschool Children ◽

Urban Areas ◽

Diarrheal Disease ◽

Acute Diarrhoea ◽

Poverty Line ◽

North India ◽

Household Level ◽

Diarrheal Illness

Background: Acute diarrheal illness remains one of the major causes of childhood morbidity and mortality especially among children under five in developing countries. Many of the risk factors for contracting diarrheal illnesses are associated with poverty, such as lacking access to safe water and sanitation, poor hygiene practices and unsafe human waste disposal. Objective of the study was to know the prevalence of acute diarrhoea and find out certain associated risk factors among preschool children from below poverty line family of Lucknow district.Methods: A community based cross sectional study was conducted using multistage sampling in rural and urban areas of Lucknow district from August, 2012 to July, 2013. Total 352 children aged 12-47 months from Below Poverty Line families were enrolled in this study. Mothers were interviewed after taking informed consent on pretested predesigned questionnaire.Results: A total of 352 children were participated in this study, of which 75 were suffering from acute diarrhea, thus giving a two-week prevalence of 21.3%. The main risk factors for acute diarrheal illness were found to be Unimproved/no toilet facility, unsafe disposal of children stool, having piped water supply, storage of drinking water at household level, not received complimentary feeding within specified period and no vitamin A supplementation.Conclusions: Approximately one-fifth of the children included in the study reported diarrheal disease. Building toilets and providing safe drinking water at the household level, interventions through effective health education of the community regarding appropriate complimentary feeding and immunization practices may reduce the burden of diarrhoea among these children.

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Exploring the utility of social-ecological and entomological risk factors for dengue infection as surveillance indicators in the dengue hyper-endemic city of Machala, Ecuador

10.1101/2020.08.31.20185355 ◽

2020 ◽

Author(s):

Catherine Lippi ◽

Anna M. Stewart-Ibarra ◽

Timothy P. Endy ◽

Mark Abbott ◽

Cinthya Cueva ◽

...

Keyword(s):

Risk Factors ◽

Aedes Aegypti ◽

Dengue Infection ◽

Good Condition ◽

Ecological Factors ◽

Dengue Case ◽

Infection Status ◽

Household Level ◽

Targeted Interventions ◽

Social Ecological

The management of mosquito-borne diseases is a challenge in southern coastal Ecuador, where dengue is hyper-endemic and co-circulates with other arboviral diseases. Prior work in the region has explored social-ecological factors, dengue case data, and entomological indices. In this study, we bring together entomological and epidemiological data to describe links between social-ecological factors associated with risk of dengue transmission at the household level in Machala, Ecuador. Households surveys were conducted from 2014-2016 to assess the presence of adult Aedes aegypti (collected via aspiration) and to enumerate housing conditions, demographics, and mosquito prevention behaviors. Household-level dengue infection status was determined by laboratory diagnostics in 2014-2015. Logistic models and multimodel selection were used to identify social-ecological variables associated with household presence of female Ae. aegypti and household dengue infection status, respectively. We identified significant risk factors for household-level dengue infection reflecting household condition, including bamboo cane construction material, shaded patios, and adjacency to abandoned properties, while housing structures in good condition were identified as protective against dengue infection. Aedes aegypti presence was associated with a greater than average number people per household and interrupted water supply, but was not associated with household level dengue infections. Models of Ae. aegypti presence were unstable, and not well resolved in ranking of competing models, suggesting that highly localized entomological surveillance indicators may not be indicative of risk in communities with hyperendemic dengue fever. These findings add to our understanding of the systems of mosquito-borne disease transmission in Machala, and in the larger region of southern Ecuador, aiding in the development of improved vector surveillance efforts, and targeted interventions.

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Exploring the utility of social-ecological and entomological risk factors for dengue infection as surveillance indicators in the dengue hyper-endemic city of Machala, Ecuador

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009257 ◽

2021 ◽

Vol 15 (3) ◽

pp. e0009257

Author(s):

Catherine A. Lippi ◽

Anna M. Stewart-Ibarra ◽

Timothy P. Endy ◽

Mark Abbott ◽

Cinthya Cueva ◽

...

Keyword(s):

Risk Factors ◽

Aedes Aegypti ◽

Dengue Infection ◽

Good Condition ◽

Ecological Factors ◽

Dengue Case ◽

Infection Status ◽

Household Level ◽

Targeted Interventions ◽

Social Ecological

The management of mosquito-borne diseases is a challenge in southern coastal Ecuador, where dengue is hyper-endemic and co-circulates with other arboviral diseases. Prior work in the region has explored social-ecological factors, dengue case data, and entomological indices. In this study, we bring together entomological and epidemiological data to describe links between social-ecological factors associated with risk of dengue transmission at the household level in Machala, Ecuador. Households surveys were conducted from 2014–2017 to assess the presence of adult Aedes aegypti (collected via aspiration) and to enumerate housing conditions, demographics, and mosquito prevention behaviors. Household-level dengue infection status was determined by laboratory diagnostics in 2014–2015. Bivariate analyses and multivariate logistic regression models were used to identify social-ecological variables associated with household presence of female Ae. aegypti and household dengue infection status, respectively. Aedes aegypti presence was associated with interruptions in water service and weekly trash collection, and household air conditioning was protective against mosquito presence. Presence of female Ae. aegypti was not associated with household dengue infections. We identified shaded patios and head of household employment status as risk factors for household-level dengue infection, while window screening in good condition was identified as protective against dengue infection. These findings add to our understanding of the systems of mosquito-borne disease transmission in Machala, and in the larger region of southern Ecuador, aiding in the development of improved vector surveillance efforts, and targeted interventions.

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Risk Factors for Acute Respiratory Infections (ARI) Among Under-five Children in Bangladesh

Journal of Scientific Research ◽

10.3329/jsr.v1i1.1055 ◽

2008 ◽

Vol 1 (1) ◽

pp. 72-81 ◽

Cited By ~ 10

Author(s):

Kazi Md. Abul Kalam Azad

Keyword(s):

Risk Factors ◽

Vitamin A ◽

Adolescent Mothers ◽

Home Visiting ◽

Respiratory Infections ◽

Vitamin A Deficiency ◽

Significant Risk ◽

Childhood Mortality ◽

Acute Respiratory Infections ◽

Mortality And Morbidity

Acute respiratory infection (ARI) is a major cause of childhood mortality and morbidity in Bangladesh. The aim of this study is to identify the significant risk factors for ARI in children less than five years of age. The data in this study comes from Bangladesh Demographic and Health Survey (BDHS) 2004. In this study, a child was considered as having experienced ARI if she or he had cough in the last two weeks preceding the survey with any one of the three symptoms of short but rapid breathing, difficulty of breathing or labored inspiration. Logistic regression was used on various independent variables to find the risk factors. Results showed that child's age, sex, body weight and Vitamin A deficiency were correlated with prevalence of ARI. Additionally mother's characteristics like age, malnutrition, education level, and family's socio-economic status were found to be associated. Recommendations include more specific knowledge of ARI to adolescent mothers from the lowest wealth quintile. A community service which could include home visiting for health education, supplementation of vitamin A, and advice would be an advantage if provided for poor or teenaged pregnant women. This in turn would reduce low birth weight incidence, and subsequently reduce incidence of ARI among these children.Keywords: Acute respiratory infections (ARI); Risk factors; Infant; Child under 5 years; Bangladesh.© 2009 JSR Publications. ISSN: 2070-0237(Print); 2037-0245 (Online). All rights reserved.DOI: 10.3329/jsr.v1i1.1055

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Household-Level Risk Factors for Aedes aegypti Pupal Density in Guayaquil, Ecuador

10.1101/2020.11.23.391938 ◽

2020 ◽

Author(s):

Thien-An Ha ◽

Tomás M. León ◽

Karina Lalangui ◽

Patricio Ponce ◽

John M. Marshall ◽

...

Keyword(s):

Risk Factors ◽

Aedes Aegypti ◽

Vector Control ◽

Negative Binomial Regression Model ◽

Control Methods ◽

Municipal Services ◽

Breeding Sites ◽

Household Level ◽

Level Model ◽

The Impact

AbstractBackgroundVector-borne diseases are a major cause of disease burden in Guayaquil, Ecuador, especially arboviruses spread by Aedes aegypti mosquitoes. Understanding which household characteristics and risk factors lead to higher Ae. aegypti densities and consequent disease risk can help inform and optimize vector control programs.MethodsCross-sectional entomological surveys were conducted in Guayaquil between 2013 and 2016, covering household demographics, municipal services, potential breeding containers, presence of Ae. aegypti larvae and pupae, and history of using mosquito control methods. A zero-truncated negative binomial regression model was fitted to data for estimating the household pupal index. An additional model assessed the factors of the most productive breeding sites across all of the households.ResultsOf surveyed households, 610 satisfied inclusion criteria. The final household-level model found that collection of large solid items (e.g., furniture and tires) and rainfall the week of and 2 weeks before collection were negatively correlated with average pupae per container, while bed canopy use, unemployment, container water volume, and the interaction between large solid collection and rainfall 2 weeks before the sampling event were positively correlated. Selection of these variables across other top candidate models with ΔAICc < 1 was robust, with the strongest effects from large solid collection and bed canopy use. The final container-level model explaining the characteristics of breeding sites found that contaminated water is positively correlated with Ae. aegypti pupae counts while breeding sites composed of car parts, furniture, sewerage parts, vases, ceramic material, glass material, metal material, and plastic material were all negatively correlated.ConclusionHaving access to municipal services like bulky item pickup was effective at reducing mosquito proliferation in households. Association of bed canopy use with higher mosquito densities is unexpected, and may be a consequence of large local mosquito populations or due to limited use or effectiveness of other vector control methods. The impact of rainfall on mosquito density is multifaceted, as it may both create new habitat and “wash out” existing habitat. Providing services and social/technical interventions focused on monitoring and eliminating productive breeding sites is important for reducing aquatic-stage mosquito densities in households at risk for Ae. aegypti-transmitted diseases.

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A computationally tractable birth-death model that combines phylogenetic and epidemiological data

10.1101/2020.10.21.349068 ◽

2020 ◽

Author(s):

Alexander E. Zarebski ◽

Louis du Plessis ◽

Kris V. Parag ◽

Oliver G. Pybus

Keyword(s):

Transmission Rate ◽

Epidemiological Data ◽

Heterogeneous Data ◽

Pathogen Transmission ◽

Data Sources ◽

Primary Data ◽

Analytic Approximation ◽

Data Set ◽

Combining Data ◽

Birth Death

Inferring the dynamics of pathogen transmission during an outbreak is an important problem in both infectious disease epidemiology and phylodynamics. In mathematical epidemiology, estimates are often informed by time-series of infected cases while in phylodynamics genetic sequences sampled through time are the primary data source. Each data type provides different, and potentially complementary, insights into transmission. However inference methods are typically highly specialised and field-specific. Recent studies have recognised the benefits of combining data sources, which include improved estimates of the transmission rate and number of infected individuals. However, the methods they employ are either computationally prohibitive or require intensive simulation, limiting their real-time utility. We present a novel birth-death phylogenetic model, called TimTam which can be informed by both phylogenetic and epidemiological data. Moreover, we derive a tractable analytic approximation of the TimTam likelihood, the computational complexity of which is linear in the size of the data set. Using the TimTam we show how key parameters of transmission dynamics and the number of unreported infections can be estimated accurately using these heterogeneous data sources. The approximate likelihood facilitates inference on large data sets, an important consideration as such data become increasingly common due to improving sequencing capability.

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Clinical outcome and risk factors of patients with suspected pneumonia in Southwest district of Ethiopia, 2020: A retrospective study

European Journal of Inflammation ◽

10.1177/20587392211048267 ◽

2021 ◽

Vol 19 ◽

pp. 205873922110482

Author(s):

Mengistu A Sebsibe ◽

Molla A Kebede ◽

Yosef H Kazintet ◽

Bizuayehu T Gosaye ◽

Addisalem M Teferi ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcome ◽

Clinical Features ◽

Respiratory Infections ◽

Management Strategies ◽

Childhood Mortality ◽

Poor Clinical Outcome ◽

Cross Sectional ◽

Early Management ◽

Suspected Pneumonia

Acute respiratory infections (ARIs), especially pneumonia, remain the leading cause of childhood mortality and the most common reason for adult hospitalization in low- and middle-income countries, despite advances in preventative and management strategies. This study was conducted to assess factors associated with poor clinical outcome of suspected pneumonia cases among hospitalized patients at the three public health hospitals in Southwest district of Ethiopia. A cross-sectional study was conducted from May to July, 2020. Those patients admitted with suspected pneumonia were followed up during their hospital stay, and data on outcomes were captured by study nurses. Socio-demographics, clinical features, and follow-up data were gathered, and analyzed using SPSS versions 20.0. The differences in patients’ outcome in relation to their clinical features and epidemiologically linked exposures were described and compared using chi-square tests at 95% confident intervals. In this study, 742 patients with suspected pneumonia were analyzed. Of these, 473 (62.8%) of them were male, and 264 (35.6%) were of age 1–4 years. About 533 (71.8%) patients with suspected pneumonia were presented with irregular respiratory signs/symptoms (more than one symptoms) and 132 (17.9%) had underline illnesses. About 633 (85.4%) of patients were improved after treatment, and 109 (14.7%) of them ended with poor clinical outcome after completion of their treatment. Age of the patients and presence of comorbid conditions such as HIV/AIDS infections and bronchial asthma were identified as the risk factors for poor outcome of patients with suspected pneumonia. The clinical outcome of patients with suspected pneumonia at the three hospitals in Southwest district of Ethiopia was not satisfactory. Our findings highlight that in order to reduce poor clinical outcome related to suspected pneumonia, the efforts should be focused on some factors like management and prevention of chronic comorbidities. Increasing clinicians’ awareness on early management of suspected pneumonia cases is also essential in reducing the burden of the disease .

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1342. TOSCANA: The Observational Seroepidemiologic Study of COVID-19 at the United States Naval Academy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1534 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S758-S759

Author(s):

Eugene Millar ◽

Eric Laing ◽

Adam Saperstein ◽

Jitu Modi ◽

Christopher Heaney ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Blood Sample ◽

Saliva Sample ◽

The United States ◽

Pathogen Transmission ◽

Naval Academy ◽

United States Naval Academy ◽

Increased Risk ◽

Seroepidemiologic Study

Abstract Background University students, including those at military service academies, are at increased risk of acute respiratory infection (ARI), including SAR-CoV-2, due to crowded living conditions, frequent social interaction and other factors that facilitate pathogen transmission. Unlike many universities, the United States Naval Academy (USNA) continued in-person instruction in Fall 2020 in the midst of the COVID-19 pandemic. The Observational Seroepidemiologic Study of COVID-19 at the United States Naval Academy (TOSCANA,) a longitudinal cohort characterizes the burden and risk factors of SARS-CoV-2 in USNA midshipmen. Methods Midshipmen were enrolled August- October 2020. Participants were queried about their ARI risk factors, COVID-19 history, and recent receipt of medical care for any ARI at enrollment, in December 2020 and again in May 2021. Subjects were also asked to provide blood and saliva samples to assess their SARS-CoV-2 serostatus at the same three timepoints. A saliva sample was collected by a subset of subjects in February 2021. Presence of anti-SARS-CoV-2 serum IgG in dried blood spots and saliva was measured by multiplex magnetic microparticle-based immunoassays. Results 181 midshipmen consented to the study and completed the baseline survey (Table 1). 17 (17.5%) of the 97 subjects who submitted baseline blood sample were SARS-CoV-2 seropositive. Only 4 (24%) positive individuals reported having been tested for or diagnosed with COVID-19 prior to arrival at USNA. 121 participants completed the midyear survey, of whom 61 (50%) submitted a blood sample. 16 (26%) of the midyear specimens were SARS-CoV-2 positive. Of these, 3 were new infections. 73 subjects completed the May survey, and 63 (100%) of the submitted blood samples were positive. 83 subjects provided baseline saliva samples, and ~55 submitted saliva at each successive time point. 1 (5%) was positive at enrollment, 9 (17%) were positive at midyear and 47 (96%) were positive in May. Table 1. Key characteristics of TOSCANA participants Conclusion SAR-CoV-2 prevalence in a sample of USNA midshipmen was < 20% at enrollment. A small proportion of subjects seroconverted between the September and December visits. SARS-CoV-2 positivity rose in May, following a COVID-19 outbreak in February and COVID-19 vaccination efforts in March at USNA. Disclosures Jitu Modi, MD, GSK (Speaker’s Bureau)

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Tularemia transmission to humans: a multifaceted surveillance approach

Epidemiology and Infection ◽

10.1017/s0950268818002492 ◽

2018 ◽

Vol 146 (16) ◽

pp. 2139-2145 ◽

Cited By ~ 4

Author(s):

N. Akhvlediani ◽

I. Burjanadze ◽

D. Baliashvili ◽

T. Tushishvili ◽

M. Broladze ◽

...

Keyword(s):

Risk Factors ◽

Disease Surveillance ◽

Incidence Rates ◽

Clinical Factors ◽

Notifiable Disease ◽

Surveillance Studies ◽

Disease Surveillance System ◽

Acute Infections ◽

System 2 ◽

Incident Cases

AbstractTularemia has sustained seroprevalence in Eurasia, with estimates as high as 15% in endemic regions. The purpose of this report is to characterise the current epidemiology of Francisella tularensis subspecies holarctica in Georgia. Three surveillance activities are summarised: (1) acute infections captured in Georgia's notifiable disease surveillance system, (2) infectious disease seroprevalence study of military volunteers, and (3) a study of seroprevalence and risk factors in endemic regions. Descriptive analyses of demographic, exposure and clinical factors were conducted for the surveillance studies; bivariate analyses were computed to identify risk factors of seropositivity using likelihood ratio χ2 tests or Fisher's exact tests. Of the 19 incident cases reported between 2014 and August 2017, 10 were confirmed and nine met the presumptive definition; the estimated annual incidence was 0.12/100 000. The first cases of tularemia in Western Georgia were reported. Seroprevalences of antibodies for F. tularensis were 2.0% for military volunteers and 5.0% for residents in endemic regions. Exposures correlated with seropositivity included work with hay and contact with multiple types of animals. Seroprevalence studies conducted periodically may enhance our understanding of tularemia in countries with dramatically underestimated incidence rates.

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THE MANAGEMENT OF THE CRITICALLY ILL CHILD WITH DEHYDRATION SECONDARY TO DIARRHEA

PEDIATRICS ◽

10.1542/peds.45.6.1029 ◽

1970 ◽

Vol 45 (6) ◽

pp. 1029-1036

Author(s):

Laurence Finberg

Keyword(s):

Diarrheal Disease ◽

Oral Intake ◽

The Body ◽

Critical Stage ◽

Water Losses ◽

Subcutaneous Infusion ◽

Routes Of Administration ◽

Parenteral Route ◽

Trained Personnel ◽

Enteric Infections

Diarrhea and vomiting, which so frequently complicate diarrheal diseases, occur in a variety of disorders affecting infants. Although enteric infections cause these symptoms more often than all other diseases combined, noninfectious causes may occasionally also occur. While each cause may have specific other effects, the discussion here will deliberately be limited to the management of the physiologic disturbances that accompany excessive loss of water and salts from tile gastrointestinal tract. Etiologic considerations, however important they may be, will not be further pursued. This emphasis is appropriate since survival following critical dehydration depends far more upon the correction of the physiologic disturbance than upon the removal of the cause. A critical stage in diarrheal disease may be defined as occurring when a volume of fluid equal in mass to about 10% of the body weight has been lost over a period of a day or two. Clinically, this usually occurs shortly after anorexia or vomiting has precluded oral intake. At this stage of illness, parenteral fluid therapy should be employed. Oral intake should be curtailed during the early hours of therapy. The use of milk or other foods high in calories and solute complicates management by markedly increasing stool water losses. Even if severe undernutrition coexists with tile diarrhea, the first 6 to 8 hours should be a period of brief starvation; the parenteral glucose will provide emergency calories. Although such routes of administration as intragastric drip and subcutaneous infusion have been employed successfully, their usage should be restricted to places where a deficiency of supplies or trained personnel interdicts the preferred parenteral route—continuous intravenous infusion.

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