Nguyen Kim Tien.*, Nguyen Van Tam*, Huynh Thu Thuy*
Nguyen Thi Thu*, Le Hoang San**, Nguyen Van Trai**
* Pasteur Institute of HoChiMinh city
**
Diarrhoeal diseases are one of major causes of high
morbidity and mortality in children, specially in
A community prospective cohort study method was applied for 2,100 children under 5 years of age selected randomly 24 communes of CaiBe district by 30 clusters method of WHO. The study children were visited and investigated at home every week by trained health workers of health commune and hamlet centers and supervised every two-week by epidemiologists from district, province health centers and Pasteur Institute. The diarrhoeal child was interviewed, recorded in a preceded form, distributed oral rehydration solution and collected stool sample. Diarrhea was defined as three or more liquid or semiliquid stools passed in 24-hour period.
The diarrhoeal density incidence was calculated as the number of episodes per child-year at risk. Child-years at risk of diarrhea included all days in the study period surveyed without diarrhea for a child. The child was only included in the study sample if he was observed for more than 3 months. Throughout study, children becoming 5 years old, absent for long time or die were eliminated then replaced by selected neighbor children.
Univariable analysis by software EPINIFO and multivariable logistic regressive analysis by EGRET were applied to evaluate the association between the exposed factors and the prolongation of diarrhoeal episode duration with the value of relative risk (RR) and 95% confidence interval (95% CI).
Stool specimens were collected at home at the beginning of episode. Stools were preserved in Cary - Blair transport media and transported with cold packs to the laboratory. Rotavirus were detected by ELISA kit. Salmonella, Shigella, Vibrios and Campylobacter were identified using standard techniques. Identification of E.Coli (ETEC and EAEC) will be done by molecular biology method.
At the beginning of the study, the survey was conducted in order to select 2,100 children and to understand the background of the study population.
-
Diarrhoeal
prevalence of last two weeks: 5.6%
-
Number
of diarrhoeal episodes/ child/ year: 1.5
-
Hygiene
condition:
· Latrine on river accounted for 58.8% of total of household, fish pond latrines: 37.4%, good hygiene latrines: 2.9%.
· Source of water: 91% of households used river water, 4.6%: pond water, 4.6%: well water, 1.2%: pipe water.
· Drinking water: 24.8% of households drank river water without boiling, 29.9%: boiling water.
Table 1: Incidence of diarrhea
distributed by age and duration
|
|
|
|
|
|
|
Episode duration (days) |
|||||
|
|
|
|
|
|
|
< 3 days |
3-14 days |
>14 days |
|||
|
Age group (month) |
No children observed |
No. following days |
No Child-year |
No. diarrheal episodes |
Inc.D |
No. diarrheal episodes |
Inc.D |
No. diarrheal episodes |
Inc.D |
No. diarrheal episodes |
Inc.D |
|
0-6 |
403 |
135,708 |
371.8 |
63 |
16.9 |
21 |
5.7 |
41 |
11.0 |
1 |
0.3 |
|
6-12 |
325 |
135,279 |
370.6 |
145 |
39.1 |
56 |
15.1 |
89 |
24.0 |
0 |
0.0 |
|
12-18 |
258 |
116,557 |
319.3 |
157 |
49.2 |
56 |
17.5 |
99 |
31.0 |
2 |
0.6 |
|
18-24 |
252 |
118,865 |
325.7 |
140 |
43.0 |
64 |
19.7 |
74 |
22.7 |
2 |
0.6 |
|
24-30 |
231 |
109,155 |
299.1 |
94 |
31.4 |
34 |
11.4 |
60 |
20.1 |
0 |
0.0 |
|
30-36 |
252 |
117,382 |
321.6 |
71 |
22.1 |
34 |
10.6 |
36 |
11.2 |
1 |
0.3 |
|
36-42 |
218 |
101,104 |
277.0 |
45 |
16.3 |
19 |
6.9 |
26 |
9.4 |
0 |
0.0 |
|
42-48 |
201 |
94,100 |
257.8 |
44 |
17.1 |
12 |
4.7 |
32 |
12.4 |
0 |
0.0 |
|
48-54 |
223 |
71,312 |
195.4 |
30 |
15.4 |
16 |
8.2 |
14 |
7.2 |
0 |
0.0 |
|
54-60 |
179 |
25,652 |
70.3 |
52 |
74.0 |
18 |
25.6 |
34 |
48.4 |
0 |
0.0 |
|
|
2,542 |
1,025,114 |
2,808.5 |
841 |
29.9 |
330 |
11.8 |
505 |
18.0 |
6 |
0.2 |
Inc.D: Diarrhea incidence / 100x child-year
at risk
Table 2: Exposed factors
associated to the duration of diarrhea (evaluated by test c2)
|
|
Episode duration
(days) |
||||
|
Exposed factors |
< 3 days |
3-14 days |
>14days |
Total |
p |
|
|
n = 330 |
n = 494 |
n = 17 |
841 |
|
|
Stool
frequency > 5 episodes in 24 h* |
30 |
74 |
9 |
113 |
4.10-7 |
|
Mucus
in stool * |
50 |
129 |
6 |
185 |
4.10-4 |
|
Blood
in stool * |
12 |
29 |
6 |
47 |
2.10-8 |
|
Eating
meat, fish, shrimp..** |
302 |
244 |
9 |
555 |
7.10-4 |
|
Oil,
fat diet *** |
60 |
150 |
7 |
217 |
1.10-4 |
* Clinical symptoms detected on the
first day of episode
** Food consumed one day prior to
episode
*** Nutrition regime during the
episode
All these factors were
associated significantly to duration of diarrhea
Table 3: Risk
factors associated to prolongation of diarrhea according to univariable
analysis
|
|
Episode duration |
Episode duration |
|
|
|
|
|
|
n = 511 |
n = 330 |
841 |
|
|
|
|
Stool
frequency > 5 episodes in 24 h * |
83 |
30 |
113 |
1.3 |
1.1-1.4 |
0.003 |
|
Blood
in stool * |
35 |
12 |
47 |
1.2 |
1.04-1.5 |
0.05 |
|
Mucus
in stool * |
135 |
50 |
185 |
1.3 |
1.2-1.4 |
0.0001 |
|
Using
antibiotic* |
116 |
87 |
203 |
1.04 |
0.9-1.2 |
0.6 |
|
Acute respiratory infection* * |
79 |
18 |
97 |
1.4 |
1.3-1.7 |
0.00001 |
|
Oil, fat diet |
157 |
60 |
217 |
1.3 |
1.1-1.4 |
0.00006 |
|
Free domestic animals in house |
106 |
40 |
146 |
1.2 |
1.1-1.4 |
0.001 |
|
Poor and very poor |
149 |
50 |
199 |
1.3 |
1.2-1.4 |
0.00008 |
|
Bottle feeding*** |
26 |
9 |
35 |
1.2 |
1.0-1.5 |
0.1 |
|
Stopping breast - feeding < 12 months of age**** |
50 |
26 |
76 |
1.2 |
1-1.6 |
0.08 |
* Characters detected on the first day of
episode
** Diseases
getting, one month prior to the episode
*** Nutrition
regime one day prior to the episode (only for cases below 2 years of age)
**** Only for cases below 2 years of
age
Comments:
Three risk factors: bottle feeding, stopping breast-feeding and using
antibiotic were not associated statistical significantly to the duration of
diarrhea. The rest were associated significantly to the prolongation of episode
Table 4:
Protective factors associated to the duration of episode
|
|
Episode duration |
Episode duration |
|
|
|
|
|
|
n = 511 |
n = 330 |
841 |
|
|
|
|
Eating
meat, fish, shrimp |
311 |
244 |
555 |
0.8 |
0.7-0.9 |
0.0002 |
|
Eggs |
67 |
70 |
137 |
0.8 |
0.7-0.9 |
0.0002 |
|
Rice |
379 |
268 |
647 |
0.9 |
0.8-0.9 |
0.03 |
|
Vegetables,
fruits |
103 |
123 |
226 |
0.7 |
0.6-0.8 |
1.10-7 |
Foods consumed one
day prior to episode were associated significantly to duration of episode as
the protective factors
Table 5: Enteropathogen
isolated in stool of diarrheal cases and health children in Caibe district,
Tiengiang province (15, April 1996 - 30, June 1997)
|
|
Diarrhoeal
cases in community inincommunity |
Diarrhoeal
hospitalised cases |
Healthy
children in community |
||||||||
|
Entropathogen |
Total |
Total |
|
Total |
Total |
|
Total |
Total |
|
||
|
|
Sample |
positive |
% |
Sample |
positive |
% |
Sample |
positive |
% |
||
|
1.
Salmonella: |
167 |
5 |
3% |
39 |
4 |
10.30% |
568 |
23 |
4% |
||
|
OMA |
|
4 |
2.40% |
|
4 |
10.30% |
|
23 |
4% |
||
|
Sal.para
B |
|
3 |
1.80% |
|
1 |
2.60% |
|
6 |
1% |
||
|
Sal.para
C |
|
|
|
|
1 |
2.60% |
|
17 |
3% |
||
|
Sal.group
E |
|
1 |
0.60% |
|
1 |
2.60% |
|
|
|
||
|
Indetermined |
|
|
|
|
1 |
2.60% |
|
|
|
||
|
OMB |
|
1 |
0.60% |
|
|
|
|
|
|
||
|
2.
Shigella |
167 |
2 |
1.20% |
39 |
1 |
2.60% |
568 |
0 |
0% |
||
|
Shi.sonnei |
|
2 |
1.20% |
|
1 |
2.60% |
|
|
|
||
|
Shi.flexneri |
|
|
|
|
|
|
|
|
|
||
|
3.
E coli: EPEC |
167 |
5 |
3% |
39 |
3 |
7.70% |
568 |
20 |
3.50% |
||
|
4.
Rotavirus |
167 |
17 |
10.20% |
39 |
12 |
30.80% |
568 |
4 |
0.70% |
||
|
5.
Candida albicans |
167 |
11 |
6.60% |
39 |
1 |
2.60% |
568 |
7 |
1.20% |
||
|
6.
Cryptosporidium |
167 |
1 |
0.60% |
39 |
0 |
0% |
568 |
0 |
0% |
||
|
7.
Ascaris |
167 |
1 |
0.60% |
39 |
0 |
0% |
568 |
2 |
0.30% |
||