Impact of azithromycin mass drug administration on the antibiotic-resistant gut microbiome in children: a randomized, controlled trial

Background Mass drug administration (MDA) with azithromycin is the primary strategy for global trachoma control efforts. Numerous studies have reported secondary effects of MDA with azithromycin, including reductions in childhood mortality, diarrhoeal disease and malaria. Most recently, the MORDOR clinical trial demonstrated that MDA led to an overall reduction in all-cause childhood mortality in targeted communities. There is however concern about the potential of increased antimicrobial resistance in treated communities. This study evaluated the impact of azithromycin MDA on the prevalence of gastrointestinal carriage of macrolide-resistant bacteria in communities within the MORDOR Malawi study, additionally profiling changes in the gut microbiome after treatment. For faecal metagenomics, 60 children were sampled prior to treatment and 122 children after four rounds of MDA, half receiving azithromycin and half placebo. Results The proportion of bacteria carrying macrolide resistance increased after azithromycin treatment. Diversity and global community structure of the gut was minimally impacted by treatment, however abundance of several species was altered by treatment. Notably, the putative human enteropathogen Escherichia albertii was more abundant after treatment. Conclusions MDA with azithromycin increased carriage of macrolide-resistant bacteria, but had limited impact on clinically relevant bacteria. However, increased abundance of enteropathogenic Escherichia species after treatment requires further, higher resolution investigation. Future studies should focus on the number of treatments and administration schedule to ensure clinical benefits continue to outweigh costs in antimicrobial resistance carriage. Trial registration ClinicalTrial.gov, NCT02047981. Registered January 29th 2014, https://clinicaltrials.gov/ct2/show/NCT02047981

The Role of Biosecurity in the Control of Campylobacter: A Qualitative Study of the Attitudes and Perceptions of UK Broiler Farm Workers

Campylobacter is the leading cause of human bacterial diarrhoeal disease worldwide, with poultry meat products contributing to a large proportion of cases. Due to the ubiquitous presence of Campylobacter in the poultry farm environment, biosecurity is the main area for intervention to prevent colonisation of commercial broiler chicken flocks. However, research has repeatedly demonstrated that farmers' uptake of biosecurity recommendations is often poor. This study explored farmers' attitudes towards biosecurity and identified barriers to effective implementation of biosecurity protocols. Semi-structured interviews were conducted with 1–3 members of staff on each of 16 broiler farms; 6 owned by, and 10 contracted to, 3 different UK poultry integrators. In total, 28 interviewees participated, including farm owners, managers, and workers, with a range of industry experience. Thematic analysis of the interviews revealed high levels of recognition amongst broiler farmers of the importance of Campylobacter and the responsibility of the whole farm-to-fork chain within the poultry industry to reduce Campylobacter contamination of chicken meat for the benefit of public health. Participants' self-reported awareness and implementation of biosecurity has improved significantly following the industry-wide focus on Campylobacter control. However, there are frustrations with the industry's approach to tackling Campylobacter and the heavy burden of responsibility that has been put on interventions at the farm-level. There was also scepticism amongst participants as to the effectiveness of current biosecurity measures in the reduction of Campylobacter. Nevertheless, the interviewees' recognition of the benefit of improved biosecurity on broiler health and welfare and other important targets, such as reducing antimicrobial usage, leaves a legacy of which the UK broiler industry can be proud. There is scope for further farmer education about the evidence supporting biosecurity interventions, particularly in the control of Campylobacter, and a need to establish more effective channels of communication. Furthermore, to give all players within the industry agency and investment in industry targets, contributions from all levels should be permitted in the design of future biosecurity interventions. Biosecurity compliance may be improved through collaborative efforts, such as participatory and co-design practises, to facilitate knowledge co-creation and exchange.

A Rapid Assessment of Knowledge, Attitudes and Practices of Mothers Admitted with Diarrhoea Suffering Children in West Urban Region of Unguja-Zanzibar

BackgroundThe knowledge, attitude and health practices of the mothers directly reflect on the health and vitality of the child in most of diarrhoea affected communities. The aim of the study was to determine the knowledge, attitude and practice of mothers and caregivers (house girls) towards diarrhoeal disease among children under-five in Unguja, Zanzibar Tanzania. MethodsA quantitative cross-sectional study using a rapid appraisal technique to assess the knowledge, attitudes and practice of mothers and caregivers admitted with children with diarrhoeal diseases was conducted in 23 hospitals of west urban region of Unguja, Zanzibar. ResultsA total of 102 mothers and caregivers were studied. From the respondents 97 (95%) had satisfactory level of knowledge on diarrhoea while 5 (5%) had unsatisfactory knowledge. A total of 52 (51%) rejected the use of Oral Rehydration Solution (ORS) at home due to taste and smell and 50 (49%) agreed its use. A total of 55 (54%) children were served by caregivers. Collectively mothers and caregivers were asked for their practice of drinking treated or boiling water where 47 (46%) reported not to practice. A total of 48 (47%) respondents reported hand washing after helping children with defecation while only 19 (19%) respondents reported washing hands before preparing food. ConclusionLimited use of water sanitation and hygiene (WASH) practices was observed among mothers and caregivers in the prevention and management of under-five children with diarrhoeal disease.

Patterns of diarrhoeal disease among under-five children in Plateau State, Nigeria, 2013–2017

Background Diarrhoea is the second commonest cause of under-five mortality accounting for over half a million deaths annually. Although the prevalence of diarrhoea in Plateau State is lower than the national figure, the level remains high despite remarkable progress in the reduction of under-five mortality. This study seeks to determine the pattern of diarrhoea disease among under-fives in Plateau State. Methods We extracted data from the Integrated Disease Surveillance and Response platform between January 2013 and December 2017 and analysed the trends of diarrhoea, age-specific case fatality rate (ASCFR), and seasonal patterns. We modelled the quarterly pattern of diarrhoea cases using additive time series and predicted the expected cases for 2018–2020. Results We documented 60,935 cases of diarrhoea with age group 12–59 months having the highest number of cases (49.3%). The age group < 1 month had the highest ASCFR of 0.53%. Seasonal variation showed cases peaked in the first and third quarters of each year, except for the year 2016. The time series projection estimated 16,256, 17,645 and 19,034 cases in the year 2018, 2019 and 2020 respectively. Conclusion Seasonal variation exists, and trends show an increased pattern of diarrhoeal disease among under-fives. There is a need to strengthen the implementation of diarrhoeal preventive and control strategy in the state and to improve the quality of data reporting.

Type VI secretion system mutations reduced competitive fitness of classical Vibrio cholerae biotype

The gram-negative bacterium Vibrio cholerae is the causative agent of the diarrhoeal disease cholera and is responsible for seven recorded pandemics. Several factors are postulated to have led to the decline of 6th pandemic classical strains and the rise of El Tor biotype V. cholerae, establishing the current 7th pandemic. We investigated the ability of classical V. cholerae of the 2nd and 6th pandemics to engage their type six secretion system (T6SS) in microbial competition against non-pandemic and 7th pandemic strains. We report that classical V. cholerae underwent sequential mutations in T6SS genetic determinants that initially exposed 2nd pandemic strains to microbial attack by non-pandemic strains and subsequently caused 6th pandemic strains to become vulnerable to El Tor biotype V. cholerae intraspecific competition. The chronology of these T6SS-debilitating mutations agrees with the decline of 6th pandemic classical strains and the emergence of 7th pandemic El Tor V. cholerae.

The socio-economic difference in the prevalence and treatment of diarrheal disease in children under five years across the geo-political zones in Nigeria

Background Diarrhoeal disease is one of the leading causes of mortality among under-5 children globally and affects the low socio-economic population. Objectives This study aimed at evaluating the socioeconomic differences in the prevalence and its effect on the treatment of diarrheal disease in children in the different geopolitical zone in Nigeria. Methods Data of children under-5 from the 2018 Nigeria Demographic and Health Survey (NDHS) was used. A total of 30,068 women, that had at least a child under-5 year of age and answered diarrhoea specific questions were analysed for the prevalence, while data on 3885 children that reported symptoms of diarrhoea during the 2 weeks preceding the NDHS survey interview were analysed for treatment intervention offered during diarrhoea episodes. Logistic regression models adjusted for socio-demographic factors were used to study the association. Results The overall prevalence of diarrhoea was 12.9% with the highest prevalence in the North East (24.7%), among the poor (17.1%) and the children of uneducated mothers (16.4%). Compared to South-West region, children in North-East (AOR 4.64, 95% CI 3.90, 5.51), North-West (AOR 2.34, 95% CI 1.97, 2.78) and North Central (AOR 2.02, 95% CI 1.69, 2.42) had a high likelihood of having diarrhoea. Children from a poor household (AOR 1.49, 95% CI 1.31, 1.70) had more chance of having diarrhoea. Children in North-East (AOR 2.11, 95% CI 1.49, 3.01) and North-West (AOR 2.52, 95% CI 1.77, 3.60) were more likely to receive treatment in a health care facility and also had less likely to receive more amount of drink and food during diarrhoea compared to South-West region. Conclusions Diarrhoea prevalence is high in Nigeria with significant regional difference both in the prevalence and treatment of diarrheal disease which is also associated with household socio-economic status.

Prevalence of Diarrhoeal Diseases among Under-Five Paediatric Patients in a Tertiary Health Care Facility, South Eastern Nigeria: A 5-Year Review

Background: Diarrhoeal disease remains a major cause of morbidity and mortality in children, especially in developing countries. Although Nigeria has already achieved remarkable progress in reducing under-five mortality in the last decades, studies done in different parts of Nigeria had shown that diarrhoea is still a major public health problem. Objectives: This study aimed at determining the prevalence of diarrhoea in under-five children who presented to Nnamdi Azikiwe University Teaching Hospital Neni through the period of January 2016 - December 2020, a 5-year review. It is also aimed at noting the influence of other socio demographic factors such as age, sex and seasonal variation on the occurrence of diarrhoeal diseases. Methods: A retrospective study design was used as patients’ records were obtained from the medical records for the said duration of study and a pro forma was used in extracting needed information. Results: A total of 128 cases of diarrhoeal disease were recorded out of the 897 under-five aged children that visited the hospital at the said period of study. Thus with a prevalence of 14.27%. Higher number of cases were recorded in the dry season 96 (75.0%) than the wet season; 32 (25.0%) cases. More males were affected; 78(60.1%) than females;50 (39.1%). Children aged 0-11 months were affected more; 62 (48.4%) followed by those within the age bracket of 12-23 months 32(25.0%) with those within the ages 48-59months having the least number of cases; 8 (6.3%). Conclusions: From the study it was concluded that diarrhoea occurs more in the dry season in this region than in the wet season. It was also concluded that the general risk of diarrhoeal disease decreases with increasing age in children and toddlers are the most at risk group of suffering the disease.

Epidemiology of Cryptosporidium sp. infection among free-range and intensive farm birds in Akure South LGA, Ondo State, Nigeria

Background Cryptosporidium spp. is an intracellular zoonotic protozoan parasite that causes cryptosporidiosis, a diarrhoeal disease of humans and domestic animals. Transmission of Cryptosporidiosis to humans and other animals is by ingestion of oocysts of the parasite and as low as ten oocysts can cause clinical infections in otherwise healthy persons. The aim of this study is to investigate the prevalence of Cryptosporidiosis and compare the rate of infection between free range bird and poultry bird reared in Akure South LGA, Ondo State, Nigeria. Result The overall prevalence of Cryptosporidium reported in this study was 11.9%. Free-range birds show a higher prevalence rate 13.2% of Cryptosporidium oocysts than 10.9% in poultry birds. Aule recorded the highest prevalence of Cryptosporidium oocysts infection (16.1%) followed by Ipinsa (12.2%), Onigari (10%), and FUTA (8.1%). The highest prevalence 15.9% was recorded in broilers, while turkey showed no infection (0%) by Cryptosporidium. Semi-intensive system of farming was showed to be more susceptible to Cryptosporidium oocysts infection at 13.3% followed by the 12.6%, 10.3% in deep litter and battery cage. The female birds recorded higher Cryptosporidium oocysts infection (12.2%) than the male (11.6%). Conclusion The study established the presence of Cryptosporidium oocysts infection among studied birds in Akure South LG of Ondo State, Nigeria.

Cryptosporidium and Rotavirus Diarrhoea in Children under the Age of Five Years in FCT Abuja, Nigeria

Introduction: Diarrhoea is the second leading cause of death among children, and Nigeria has the continent's highest mortality with little information on the specific cause, proportion affected by Cryptosporidium and Rotavirus, and the prevalent genotypes for Rotavirus. Aim: To identify children with diarrhoea, in Abuja in the Federal Capital Territory; to estimate the proportion of children with Cryptosporidium and rotavirus diarrhoea. Study Design: One-year cross-sectional study of children under five years with acute diarrhea. Duration: The study was conducted in Abuja from June 2018 to May 2019. Methodology: Cryptosporidium and Rotavirus ELISA were done with commercially available kits. Results: Stool samples were collected from 1450 participants, of whom 1185 (81.7%) were ambulatory, 109 (7.5%) were hospitalized, and 156 (10.7%) were controls without diarrhoea. Cryptosporidium-ELISA was positive among 274 (21.1%) children with diarrhoea and 23 (1.7%) of children without diarrhoea, with August and September as peak months for infection. Rotavirus-ELISA was positive among 231 (17.8%) children with diarrhoea and 29 (2.2%) controls, with November, December, and January as peak months. Children of 12 to 17 months were most affected for both and Rotavirus (39.8%) and Cryptosporidium (37.2%). Conclusion: Cryptosporidium and Rotavirus are essential pathogens in children, especially among Rotavirus unvaccinated children in Abuja. Local and national infrastructure is inadequate for essential surveillance of diarrhoeal disease, and this will have to be improved, together with access to virological and parasitic stool testing, to monitor the planned vaccine program, especially for Rotavirus.