RESUMO
OBJECTIVE: To determine the relationship between geophagy (mouthing of dirt, sand, clay, or mud) and growth faltering in young children. STUDY DESIGN: We examined linear growth as height and weight standardized by age and sex, and weight standardized by height, in a cohort of children aged 6-36 months in rural Mirzapur, Bangladesh. We determined geophagy behavior at baseline through caregiver report. Anthropometric measurements were assessed at baseline and at a 1-year follow-up. RESULTS: We found that among children not stunted at baseline, those with caregiver-reported geophagy at baseline grew less over 1 year compared with their peers, with a difference in the change of standardized height for age and sex of -0.31 (95% CI, -0.61 to -0.01). CONCLUSION: These findings show that caregiver-reported geophagy was associated with growth faltering in a pediatric population in rural Bangladesh. Future studies are needed to learn more about this exposure pathway and its relevance to child growth.
Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Pica , Antropometria , Bangladesh/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estado Nutricional , População RuralRESUMO
OBJECTIVE: To investigate the relationship between unsafe child feces disposal, environmental enteropathy, and impaired growth, we conducted a prospective cohort study of 216 young children in rural Bangladesh. STUDY DESIGN: Using a prospective cohort study design in rural Bangladesh, unsafe child feces disposal, using the Joint Monitoring Program definition, was assessed using 5-hour structured observation by trained study personnel as well as caregiver reports. Anthropometric measurements were collected at baseline and at a 9-month follow-up. Stool was analyzed for fecal markers of environmental enteropathy: alpha-1-antitrypsin, myeloperoxidase, neopterin (combined to form an environmental enteropathy disease activity score), and calprotectin. FINDINGS: Among 216 households with young children, 84% had an unsafe child feces disposal event during structured observation and 75% had caregiver reported events. There was no significant difference in observed unsafe child feces disposal events for households with or without an improved sanitation option (82% vs 85%, P = .72) or by child's age (P = .96). Children in households where caregivers reported unsafe child feces disposal had significantly higher environmental enteropathy scores (0.82-point difference, 95% CI 0.11-1.53), and significantly greater odds of being wasted (weight-for-height z score <-2 SDs) (9% vs 0%, P = .024). In addition, children in households with observed unsafe feces disposal had significantly reduced change in weight-for-age z-score (-0.34 [95% CI -0.68, -0.01] and weight-for-height z score (-0.52 [95% CI -0.98, -0.06]). CONCLUSION: Unsafe child feces disposal was significantly associated with environmental enteropathy and impaired growth in a pediatric population in rural Bangladesh. Interventions are needed to reduce this high-risk behavior to protect the health of susceptible pediatric populations.
Assuntos
Exposição Ambiental/efeitos adversos , Fezes , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Enteropatias/epidemiologia , Enteropatias/etiologia , Saneamento/normas , Bangladesh/epidemiologia , Peso Corporal , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Saúde da População RuralRESUMO
The seventh cholera pandemic caused by Vibrio cholerae O1 El Tor (ET) has been superseded in Asia and Africa by altered ET possessing the cholera toxin (CTX) gene of classical (CL) biotype. The CL biotype of V. cholerae was isolated, along with prototypic and altered ET, during the 1991 cholera epidemic in Mexico and subsequently remained endemic until 1997. Microbiological, molecular, and phylogenetic analyses of clinical and environmental V. cholerae isolated in Mexico between 1998 and 2008 revealed important genetic events favoring predominance of ET over CL and altered ET. V. cholerae altered ET was predominant after 1991 but not after 2000. V. cholerae strains isolated between 2001 and 2003 and a majority isolated in 2004 lacked CTX prophage (Φ) genes encoding CTX subunits A and B and repeat sequence transcriptional regulators of ET and CL biotypes: i.e., CTXΦ(-). Most CTXΦ(-) V. cholerae isolated in Mexico between 2001 and 2003 also lacked toxin coregulated pili tcpA whereas some carried either tcpA(ET) or a variant tcpA with noticeable sequence dissimilarity from tcpA(CL). The tcpA variants were not detected in 2005 after CTXΦ(+) ET became dominant. All clinical and environmental V. cholerae O1 strains isolated during 2005-2008 in Mexico were CTXΦ(+) ET, carrying an additional truncated CTXΦ instead of RS1 satellite phage. Despite V. cholerae CTXΦ(-) ET exhibiting heterogeneity in pulsed-field gel electrophoresis patterns, CTXΦ(+) ET isolated during 2004-2008 displayed homogeneity and clonal relationship with V. cholerae ET N16961 and V. cholerae ET isolated in Peru.
Assuntos
Prófagos/genética , Vibrio cholerae/isolamento & purificação , Análise por Conglomerados , Eletroforese em Gel de Campo Pulsado , Genoma Bacteriano , Humanos , México/epidemiologia , Dados de Sequência Molecular , Filogenia , Vibrio cholerae/genética , Vibrio cholerae/patogenicidadeRESUMO
Cholera outbreak following the earthquake of 2010 in Haiti has reaffirmed that the disease is a major public health threat. Vibrio cholerae is autochthonous to aquatic environment, hence, it cannot be eradicated but hydroclimatology-based prediction and prevention is an achievable goal. Using data from the 1800s, we describe uniqueness in seasonality and mechanism of occurrence of cholera in the epidemic regions of Asia and Latin America. Epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. This causal mechanism is markedly different from endemic cholera where tidal intrusion of seawater carrying bacteria from estuary to inland regions, results in outbreaks.
Assuntos
Cólera/epidemiologia , Meio Ambiente , Epidemias , Vibrio cholerae/isolamento & purificação , Ásia/epidemiologia , Haiti/epidemiologia , Humanos , América Latina/epidemiologia , Chuva , Rios/microbiologia , Estações do Ano , Água do Mar/microbiologia , Temperatura , Microbiologia da ÁguaRESUMO
This study investigated a small subset of the two community water-disinfection systems--hypochlorinators and tablet feeders-in rural Honduras. Levels of residual chlorine were assessed at three locations within the distribution system: the tank, the proximal house, and the distal house. The levels of residual chlorine were compared with the standard guidelines set by the Pan American Health Organization and the International Rural Water Association for potable water that require a minimum of 1.0 (tank), 0.5 (proximal house), and 0.2 (distal house) ppm for each location. The levels of residual chlorine were also compared across systems, e.g. hypochlorinators to tablet feeders. At the tank and proximal house, tablet feeders had significantly higher mean values for levels of residual chlorine (measured in ppm) than hypochlorinators (tank: 1.20 vs 0.67; proximal house: 0.44 vs 0.32, p < 0.001 for both) with no significant difference at the distal house (0.16 vs 0.16). At the tank and proximal house, tablet feeders were more likely to meet recommended standards than hypochlorinators (90.3% vs 13.3%, p < 0.0001 and 41.3% vs 23.7%, p < 0.0001) with a smaller difference seen at the distal house (30.6% vs 27.1%, p = 0.24). The apparent dichotomy in chlorine levels of tablet feeders (e.g. between tank/proximal house and distal house) is discussed. The results suggest that tablet feeders may be more effective than hypochlorinators in supplying clean water in rural, resource-poor settings and possibly serve as an alternative technology for water disinfection. Further research on techniques for empowering and building capacity within community water boards will help organize and introduce sustainable water systems in developing countries.
Assuntos
Cloro/isolamento & purificação , Resíduos de Drogas/análise , Água Doce/química , Abastecimento de Água/normas , Ingestão de Líquidos , Honduras , Humanos , Saneamento , Microbiologia da Água , Purificação da ÁguaRESUMO
BACKGROUND: Adjuvant therapy to ORT with probiotic bacteria for infants with acute watery diarrhea has been under active investigation. Most studies have been done in the developed world showing benefit only for viral mild gastroenteritis. We evaluated the effect of a milk formula containing one billion (109) cfu/ml of Lactobacillus casei strain GG (LGG) upon duration and severity of diarrhea in infants in an environment with more severe acute diarrhea, where etiologic agents other than rotavirus are involved more frequently, and where mixed infections are more prevalent. METHODS: Male infants aged 3-36 months brought for treatment of acute watery diarrhea of less than 48 hours were eligible. After rehydration was completed with the WHO's oral rehydration solution, patients were randomly assigned to receive a milk formula either containing LGG or not. Stool volume was periodically measured using a devise suited to collect stools separate from urine. Duration of diarrhea was estimated based on stools physical characteristics. RESULTS: Eighty nine patients received the placebo milk formula and ninety received the LGG containing formula. Both groups were comparable in their baseline characteristics. Total stool output was significantly larger (p = 0.047) in the LGG group (247.8 ml/kg) than in the placebo group (195.0 ml/kg). No significant differences were found in duration of diarrhea (58.5 hours with LGG vs. 50.4 hours with placebo), rate of treatment failure (21.1% with LGG vs. 18.0% with placebo), and proportion of patients with unresolved diarrhea after 120 hours (12.2% with LGG vs. 12.5% with placebo). The rate of stools with reducing substances after 24 hours of treatment increased significantly in both groups (from 41.4% to 72.2% with LGG and from 45.9% to 68.0% with placebo). CONCLUSION: This study did not show a positive effect of LGG on the clinical course of acute watery diarrhea. Positive beneficial effects of LGG, as had been reported elsewhere, could have been masked in our study by worsening diarrhea due to transient lactose malabsorption. Further studies with low-lactose or non-lactose conveyors of LGG are desirable.
Assuntos
Diarreia Infantil/terapia , Lacticaseibacillus casei , Probióticos/uso terapêutico , Doença Aguda , Pré-Escolar , Terapia Combinada , Diurese , Método Duplo-Cego , Fezes , Hidratação , Humanos , Lactente , Alimentos Infantis , Fórmulas Infantis , Masculino , Falha de Tratamento , VômitoRESUMO
The occurrence and distribution of Vibrio cholerae in sea water and plankton along the coast of Peru were studied from October 1997 to June 2000, and included the 1997-98 El Niño event. Samples were collected at four sites in coastal waters off Peru at monthly intervals. Of 178 samples collected and tested, V. cholerae O1 was cultured from 10 (5.6%) samples, and V. cholerae O1 was detected by direct fluorescent antibody assay in 26 out of 159 samples tested (16.4%). Based on the number of cholera cases reported in Peru from 1997 to 2000, a significant correlation was observed between cholera incidence and elevated sea surface temperature (SST) along the coast of Peru (P < 0.001). From the results of this study, coastal sea water and zooplankton are concluded to be a reservoir for V. cholerae in Peru. The climate-cholera relationship observed for the 1997-98 El Niño year suggests that an early warning system for cholera risk can be established for Peru and neighbouring Latin American countries.
Assuntos
Reservatórios de Doenças , Água do Mar/microbiologia , Vibrio cholerae O1/isolamento & purificação , Zooplâncton/microbiologia , Animais , Antígenos de Bactérias/análise , Cólera/epidemiologia , Clima , Técnica Direta de Fluorescência para Anticorpo , Peru/epidemiologia , Temperatura , Vibrio cholerae O1/crescimento & desenvolvimento , Microbiologia da ÁguaRESUMO
Intestinal infection with Vibrio cholerae results in the loss of large volumes of watery stool, leading to severe and rapidly progressing dehydration and shock. Without adequate and appropriate rehydration therapy, severe cholera kills about half of affected individuals. Cholera toxin, a potent stimulator of adenylate cyclase, causes the intestine to secrete watery fluid rich in sodium, bicarbonate, and potassium, in volumes far exceeding the intestinal absorptive capacity. Cholera has spread from the Indian subcontinent where it is endemic to involve nearly the whole world seven times during the past 185 years. V cholerae serogroup O1, biotype El Tor, has moved from Asia to cause pandemic disease in Africa and South America during the past 35 years. A new serogroup, O139, appeared in south Asia in 1992, has become endemic there, and threatens to start the next pandemic. Research on case management of cholera led to the development of rehydration therapy for dehydrating diarrhoea in general, including the proper use of intravenous and oral rehydration solutions. Appropriate case management has reduced deaths from diarrhoeal disease by an estimated 3 million per year compared with 20 years ago. Vaccination was thought to have no role for cholera, but new oral vaccines are showing great promise.
Assuntos
Cólera , África/epidemiologia , Ásia/epidemiologia , Cólera/epidemiologia , Cólera/microbiologia , Cólera/prevenção & controle , Vacinas contra Cólera/uso terapêutico , Farmacorresistência Bacteriana/genética , Regulação Bacteriana da Expressão Gênica , Saúde Global , Humanos , Epidemiologia Molecular , América do Sul/epidemiologia , Vibrio cholerae/classificação , Vibrio cholerae/genética , Vibrio cholerae/metabolismoRESUMO
The effects of environmental temperature, presence and severity of El Niño, presence of cholera in the community, and interactions among these variables on the number of adult diarrhoeal patients attending the Hospital Nacional Cayetano Heredia in Lima, Peru, during 1991-1998, were evaluated. During 1991-1996, an increased number of visits to the hospital due to acute diarrhoea in the warmer months was observed. This periodic pattern was altered in 1997, when rising of the environmental temperature was observed in Lima secondarily associated with a strong El Niño event. A multivariate model was built in which environmental temperature and interaction between environmental temperature and presence of cholera predicted the number of adult patients with acute diarrhoea attending the Hospital Nacional Cayetano Heredia. Monitoring of environmental temperature and presence of cholera may be used as a warning system to predict epidemics of diarrhoea in adults, which may have a tremendous impact on healthcare strategies and management of health services in general.
Assuntos
Cólera/epidemiologia , Diarreia/epidemiologia , Temperatura , Doença Aguda , Adulto , Diarreia/microbiologia , Feminino , Humanos , Masculino , Peru/epidemiologia , Estudos RetrospectivosRESUMO
Los paquetes conteniendo la mezcla de glucosa-electrolitos recomendada por la Organización Mundial de la Salud (OMS) para la rehidratación oral pueden hacerse inservibles cuando se almacenan bajo condiciones de humedad debido a que la glucosa sufre un proceso de polimerización, en una reacción favorecida por el bicarbonato de sodio, que causa un oscurecimiento de la mezcla y disminución de su solubilidad. La sustitución del bicarbonato por el citrato de sodio, sin embargo, mejora marcadamente la estabilidad de la mezcla. En un ensayo clínico randomizado, doble ciego, hemos comparado la eficacia de una solución de Rehidratación Oral (SRO)- conteniendo citrato con la SRO - conteniendo bicarbonato en el tratamiento de niños con deshidratación diarreica admitidos al Departamento de Pediatría del Hospital de la Universidad Cayetano Heredia. Noventaisiete niños, de tres a 24 meses de edad fueron estudiados; 49 fueron tratados con la SRO - conteniendo bicarbonato y 48, con la SRO - conteniendo citrato . Los dos grupos fueron similares en todos los parámetros medidos al empezar el tratamiento. El tratamiento fue igualmente eficaz en ambos grupos determinado por la respuesta clínica y el flujo fecal. La rehidratación oral fue exitosa (esto es, no se requirió fluidos endovenosos durante el tratamiento) en 85 por ciento de los pacientes estudiados; la tasa de éxito fue similar en ambos grupos. La concentración sérica de CO2 total incrementó de un modo similar en ambos grupos alzando valores casi normales a las 48 horas después de la admisión. Concluímos que el citrato de sodio puede sustituir al bicarbonato en la formulación de la SRO recomendado por la OMS para el tratamiento de rehidratación oral de niños con deshidratación diarréica.