Trend of morbidity and mortality indicators due to acute diarrheal disease in children under five years old in the State of Piauí (2000-2019) / Tendência de indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos no estado do Piauí (2000-2019)

Abstract Objectives: to analyze the trend of morbidity and mortality indicators due to acute diarrheal diseases in children under five years old in Piauí. Methods: ecological study with data from the Information Technology Department at the Public Health System. The indicators of hospitalization rate and coefficient of mortality from the disease between 2000 and 2019 were calculated. A descriptive analysis of the indicators was carried out in the studied period and by the macro-regions in the State. For trend analysis, the simple linear regression model with log-transformation was used. Trends were classified as increasing, decreasing and stable, with a significance level of 5%. Results: the average on hospitalization rate was higher in the semi-arid macro-region (36.6/1000 children under five years old) and lower in Teresina (14.9/1000 children under five years old). The mean mortality coefficients were higher in the coastal macro-region (0.98/1000 live births) and lower in Teresina (0.47/1000 live births). The indicators showed a downward trend in all analyzed locations (p<0.05). A turning point was noted from 2009, with a significant reduction in hospitalization rates in the savanna and semi-arid macro-regions. Conclusion: indicators of morbidity and mortality due to acute diarrheal diseases in children under five years old showed a downward trend in Piauí between 2000 and 2019, with differences in trends between the evaluated macro-regions.

Resumo Objetivos: analisar a tendência de indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos no Piauí. Métodos: estudo ecológico com dados do Departamento de Informática do Sistema Único de Saúde. Calculou-se os indicadores taxa de internação e coeficiente de mortalidade pela doença entre 2000 e 2019. Realizou-se análise descritiva dos indicadores no período estudado e pelas macrorregiões do estado. Para análise da tendência, foi utilizado o modelo de regressão linear simples com log-transformação. As tendências foram classificadas como crescentes, decrescentes e estáveis, com nível de significância de 5%. Resultados: a média das taxas de internação foi maior na macrorregião semiárido (36,6/1000 menores de cinco anos) e menor em Teresina (14,9/1000 menores de cinco anos). A média dos coeficientes de mortalidade foi maior na macrorregião litoral (0,98/1000 nascidos vivos) e menor em Teresina (0,47/1000 nascidos vivos). Os indicadores mostraram tendência de redução em todos os locais analisados (p<0,05). Notou-se um ponto de inflexão a partir de 2009, com redução significativa das taxas de internação nas macrorregiões cerrados e semiárido. Conclusão: os indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos mostraram tendência de redução no Piauí entre 2000 e 2019, com diferenças das tendências entre as macrorregiões avaliadas.

Global estimated Disability-Adjusted Life-Years (DALYs) of diarrheal diseases: A systematic analysis of data from 28 years of the global burden of disease study.

BACKGROUND: Diarrheal disease (DD)-associated mortality has declined since 1990; however, the incidence of DD has experienced a less-pronounced decrease. Thus, it is important to track progress in managing DD by following loss of healthy years. A disability-adjusted life-year (DALY), which combines data on years-of-life lost (YLL) and years-lived with-disability (YLD), is a metric that can track such a burden. METHODS AND FINDINGS: Using all 28 years of data in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we compared DD DALYs among different demographic subsets including sex, age, country, and World Bank (WB) income level. We also evaluated DD DALYs as a function of the socio-demographic index (SDI), a measure of a region's socio-demographic development. On a global level, DD DALYs have decreased by approximately 85.43% from 1990 to 2017. Incidence and prevalence have decreased by 1.53% and 4.45%, respectively. A dramatic decrease in DD DALYs were observed for WB low-income countries, but not for WB high-income constituents. The temporal decrease in DD DALY rates in WB low-income countries was likely driven by a decrease in YLL. Alternatively, temporal increases in both YLL and YLD may have contributed to the apparent lack of progress in WB high-income countries. Regardless of WB income classification, children under the age of five and the elderly were the most vulnerable to DD. In nearly every year from 1990 to 2017, DD DALYs for females were higher than those for males in WB high-income regions, but lower than those for males in WB low-income constituents. The reason for these differences is not known. We also observed that the rate of DD DALYs was highly correlated to SDI regardless of WB income classification. CONCLUSIONS: To the best of our knowledge, this is the only temporal study of DD DALYs that encompasses all 28 years of data available from the GBD. Overall, our analyses show that temporal reductions in DD DALYs are not equivalent across regions, sexes and age groups. Therefore, careful attention to local and demography-specific risk factors will be necessary to tailor solutions in region- and demography-specific manners.

Identifying Infectious Diarrhea Hot spots and Associated Socioeconomic Factors in Anhui Province, China.

Infectious diarrhea cases have increased during the past years in the Anhui Province of China, but little is known about its spatial cluster pattern and associated socioeconomic factors. We obtained county-level total cases of infectious diarrhea in 105 counties of Anhui in 2016 and computed age-adjusted rates. Socioeconomic factors were collected from the Statistical Yearbook. Hot spot analysis was used to identify hot and cold spot counties for infectious diarrhea incidence. We then applied binary logistic regression models to determine the association between socioeconomic factors and hot spot or cold spot clustering risk. Hot spot analysis indicated there were both significant hot spot (29 counties) and cold spot (18 counties) clustering areas for infectious diarrhea in Anhui (P < 0.10). Multivariate binary logistic regression results showed that infectious diarrhea hot spots were positively associated with per capita gross domestic product (GDP), with an adjusted odds ratio (AOR): 3.51, 95% CI: 2.09-5.91, whereas cold spots clustering were positively associated with the number of medical staffs (AOR: 1.18, 95% CI: 1.08-1.29) and negatively associated with the number of public health physicians (AOR: 0.27, 95% CI: 0.09-0.86). We identified locations for hot and cold spot clusters of infectious diarrhea incidence in Anhui, and the clustering risks were significantly associated with health workforce resources and the regional economic development. Targeted interventions should be carried out with considerations of regional socioeconomic conditions.

Upstream watershed condition predicts rural children's health across 35 developing countries.

Diarrheal disease (DD) due to contaminated water is a major cause of child mortality globally. Forests and wetlands can provide ecosystem services that help maintain water quality. To understand the connections between land cover and childhood DD, we compiled a database of 293,362 children in 35 countries with information on health, socioeconomic factors, climate, and watershed condition. Using hierarchical models, here we find that higher upstream tree cover is associated with lower probability of DD downstream. This effect is significant for rural households but not for urban households, suggesting differing dependence on watershed conditions. In rural areas, the effect of a 30% increase in upstream tree cover is similar to the effect of improved sanitation, but smaller than the effect of improved water source, wealth or education. We conclude that maintaining natural capital within watersheds can be an important public health investment, especially for populations with low levels of built capital.Globally diarrheal disease through contaminated water sources is a major cause of child mortality. Here, the authors compile a database of 293,362 children in 35 countries and find that upstream tree cover is linked to a lower probability of diarrheal disease and that increasing tree cover may lower mortality.

Burden of Rotavirus and Enteric Bacterial Pathogens among Children under 5 Years of Age Hospitalized with Diarrhea in Suburban and Rural Areas in Kenya.

This cross-sectional descriptive study aimed to investigate the incidence of rotavirus and enteric bacterial infections among children up to 5 years old with diarrhea living in suburban and rural areas of Kenya. Between August 2011 and December 2013, a total of 1,060 diarrheal fecal specimens were obtained from 722 children at Kiambu County Hospital (KCH), located in a suburban area, and from 338 children from Mbita District Hospital (MDH), located in a rural part of western Kenya. Of the 1,060 isolates, group A rotavirus was detected in 29.6% (214/722) and 11.2% (38/338) fecal specimens from KCH and MDH, respectively. Diarrheagenic Escherichia coli (DEC) was found to be the most frequently isolated bacterial pathogens in both study areas (32.8% at KCH and 44.1% at MDH). Two different mixed infection patterns (virus/bacteria and bacteria/bacteria) were observed among patients. A significantly higher infection rate of rotavirus (17.6%, p = 0.001) and DEC (10.5%, p = 0.007) were observed during the dry season. Our study found that in both suburban and rural settings in Kenya, rotavirus and DEC are the principal cause of pediatric diarrhea and exhibit higher incidence during the dry season.

[INCIDENCE, PREDISPOSING RISK FACTORS FOR THE DEVELOPMENT AND SPREADING OF ACUTE INTESTINAL INFECTIONS IN THE NORTH-EASTERN REGION OF UKRAINE].

Using data of the branch statistical reporting of the State Sanitary and Epidemiological Service in Sumy region and Sumy Regional State Laboratory of Veterinary Medicine, the incidence rate, modern risk factors for the development and spreading of acute infectious diarrheas were determined in the North-Eastern region of Ukraine. Under the current conditions incidence rate indices of acute intestinal infections and food toxicoinfections are within the range of 159.8-193.6 per 100 thousands. pop. Seasonal and epidemical rises are associated with a species of the agent. In the etiological structure of acute diarrheal infections there are dominated viruses, of food toxicoinfections--Klebsiellae pneumoniae, Staphylococcus aureus and Enterobacter cloacae (p < 0.05). Predictors of the complication of epidemiological situation of Shigella infections are the gain in the detection of bacterially contaminated samples of milk and dairy products (r = 0.75), for food toxicoinfections caused by Klebsiellae pneumoniae and Enterobacter cloacae--pastry with cream and cooking meat products (r = 0.64; r = 0.75). Epizootic situation in the region affects on the salmonellosis incidence rate of the population (r = 0.89). There were revealed correlations between the selection of E. coli bacteria from swabs taken from the enterprises of catering, in child care centers and the levels of incidence rates of salmonellosis, acute intestinal infections of unknown etiology (r = 0.59; r = 0.60). Timely detection and sanitation of Shigella carriers are a powerful instrument to reduce the incidence rate of shigellosis (r = 0.83).

Doenças diarreicas agudas relacionadas ao saneamento básico no Estado de Pernambuco no período de 2008 a 2014 / Acute diarrheal diseases related to basic sanitation in the state of Pernambuco from 2008 to 2014

A doença diarreica aguda (DDA) é a doença que mais aflige a humanidade, ocorrendo anualmente mais de quatro bilhões de casos em todo o mundo: cerca de 1,8 milhões de crianças morrem em decorrência desta doença ou outras provocadas por água inadequada para o consumo humano e por más condições de saneamento. Este estudo analisa a correlação entre número de casos, internações e óbitos por doenças diarreicas agudas com as condições de saneamento básico, além de outras variáveis socioeconômicas, para o Estado de Pernambuco. Foi aplicado o teste de correlação de Spearman ao nível de 5% e 1%. Os dados são provenientes de: i) saneamento - Sistema de Informação de Atenção Básica (SIAB), ii) número e o custo das internações hospitalares - Sistema de Informação Hospitalar (SIH), iii) DDA por município - Sistema de Vigilância Epidemiológica das Doenças Diarreicas Agudas (SIVEP/DDA), e iv) dados populacionais e renda per capita - Instituto de Bibliografia e Estatística (IBGE). Observa-se que houve declínio no número de internações, gastos e óbitos por DDA, e que há correlação significativa e negativa entre o número de internações e de óbitos por DDA e fatores como renda, taxa de analfabetismo, serviço de coleta e lixo, esgotamento sanitário e energia elétrica. Em relação ao percentual de cobertura de atenção básica e de abastecimento de água, notouse uma correlação pouco significativa e positiva. Conclui-se que algumas características socioeconômicas dos municípios, em especial, o saneamento básico tem grande relevância com a DDA e suas consequências.(AU)

Acute diarrheal disease (ADD) is a disease that afflicts more humanity, occurring annually over four billion cases worldwide: about 1.8 million children die from this disease or other caused by inadequate water for human consumption and poor sanitation. This study examines the correlation between number of cases, hospitalizations and deaths from acute diarrheal diseases with basic sanitation, and other socioeconomic variables, for the state of Pernambuco. Spearman correlation test was used at 5% and 1%. The data are derived from: i) sanitation - Primary Care Information System (SIAB), ii) number and cost of hospital admissions - Hospital Information System (SIH), iii) DDA by municipality - Epidemiological Surveillance System Disease diarrheal Agudas (SIVEP / DDA), and iv) population data and per capita income - Institute of Bibliography and Statistics (IBGE). It is observed that there was a decline in the number of admissions, expenses and deaths by DDA, and that there is a significant negative correlation between the number of hospitalizations and deaths by DDA and factors such as income, literacy rate, collection service and waste, sewage health and electricity. Regarding the primary care coverage percentage and water supply, it was noted only a slight positive correlation. We conclude that some socioeconomic characteristics of municipalities, in particular sanitation has great relevance to the DDA and its consequences.(AU)

[Problems of epidemiology of acute infectious diseases in the areas affected by flooding in July 1997 in Poland]. / Problemy epidemiologiczne ostrych chorób zakaznych na terenach objetych powodzia w lipcu 1997 r. w polsce.

In 1997, Poland experienced a flood of high-intensity. Some predicted major threats from communicable diseases caused by deterioration of the sanitary-epidemiological conditions. On the basis of data from 1997, in this article is presented range of counter epidemic measures recommended in the conditions of public health treats caused by natural disasters like floods. Fears regarding health effects of flood were confronted with surveillance data on infectious diseases reported in 1997.

Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates.

BACKGROUND: Calculation of disease rates in developing countries using facility-based surveillance is affected by patterns of health utilization. We describe temporal patterns in health care seeking by syndrome as part of population-based morbidity surveillance in rural western Kenya. METHODS: From July 2006 to June 2008, health utilization data were collected from 27 171 participants at biweekly home visits and at Lwak Hospital, the designated referral clinic where free care provided by dedicated study clinical staff was available. Ill persons were asked if and where they sought care. Proportions seeking care for children and adults with fever, acute respiratory infection (ARI), acute lower respiratory infection (ALRI), and diarrhea were compared by Chi-square test. Care-seeking by distance was evaluated by logistic regression. RESULTS: While care-seeking outside the home was common for all syndromes (>50%), only 18-38% of care-seeking was to health facilities. Children were more likely than adults to visit health facilities for all syndromes. Of ill persons visiting Lwak Hospital, 45-54% had previously sought care elsewhere, mostly from informal drug sellers, and 11-24% with fever, ARI, or ALRI had already taken an antimalarial or antibiotic. The distance from the participant's home to Lwak Hospital was the most common reason (71%) for ill participants not seeking care there. The likelihood of visiting Lwak decreased with increasing distance of residence (p<0.001) and fluctuated significantly over the study period. CONCLUSIONS: Even in a study setting where free and reliable care is offered, health utilization is affected by other factors, such as distance. Health utilization data in population-based surveillance are important in adjusting disease rates.

Assessment of E. coli and Salmonella spp. infection risks associated with different fecal sludge disposal practices in Thailand.

The proper management of fecal sludge (FS), to block the transmission pathways of pathogens, is rarely enforced in many parts of the world. Health risks associated with different disposal practices of FS in peri-urban settings of a large metropolis in Thailand were assessed; Tha Klong sub-district with indiscriminate FS dumping, and Klong Luang sub-district which has an FS treatment system. The study showed that indiscriminate FS dumping from along the canal banks and discharge of market waste were likely the major sources of E. coli and Salmonella spp. in contamination of the canal water. The increased microbial pathogen concentrations near the FS treatment facility also indicated contamination risks from poorly designed treatment facilities. Quantitative microbial risk assessment (QMRA) indicated very high water-related infection risk levels compared to the actual locally recorded disease occurrences. These results indicated that the QMRA model needs to be modified to take account of immunological differences between populations in developed countries, where the model was developed, and developing countries. In addition, further sensitivity factors are needed to reflect different societal behavior patterns, and therefore contact with potentially contaminated water, in different sub-populations of many less developed communities.

Surveillance of antibiotic susceptibility pattern among shigella flexneri strain isolated in Nagpur district during three years period, January 2009-January 2012.

OBJECTIVE: In the few cases of childhood dirrhea that require the antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains and pattern of antimicrobial resistance. Shigellosis is one of the most improtant examples of this group of intestinal infections. In order to establish such parameters in Nagpur city, this study was carried out to determine the antimcrobial resistance profile of Shigella flexneri isolated from patients suffering from diahhrea admitted to Various hoapitals in Nagpur district, India. MATERIALS AND METHODS: The study included 110 stool samples collected from patients during the 3 year period. All the isolates were characterized and confirmed by VITEK® 2 GN ID cards and antimicrobial susceptibility was tested by VITEK® 2 AST test cards. RESULTS: We received 73 positive cultures of S. flexneri out of 110 stool samples during three year periods of January 2009 to January 2012. S. flexneri strains presented a high resistance rate to Ampicillin (100%), Chloramphenicol (76.71%), Trimethoprime-sulfamethaxazole (TMP-SMZ) (68.49%) and low resistance to third- and fourth-generation Cephalosporin. None of the isolates was found to be resistant to Ciprofloxacin (MIC ≥ 4), Norfloxacin (MIC ≥12), and Nalidixic acid (MIC ≥30). CONCLUSION: Our results provide data on antimicrobial resistance to choose a proper antibiotic for the treatment of Shigellosis in our country. According to current findings, Quinolones and Cephalosporins are the drug of choice for the diarrheic patients. In conclusion, systematic monitoring is needed to identify changes in the antimicrobial resistance.

Estimating the burden of disease attributable to unsafe water and lack of sanitation and hygiene in South Africa in 2000.

OBJECTIVES: to estimate the burden of disease attributable to unsafe water, sanitation and hygiene (wsh) by age group for South Africa in 2000. DESIGN: World Health Organization comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. A scenario-based approach was applied for estimating diarrhoeal disease burden from unsafe WSH. Six exposure scenarios were defined based on the type of water and sanitation infrastructure and environmental faecal-oral pathogen load. For 'intestinal parasites' and schistosomiasis, the burden was assumed to be 100% attributable to exposure to unsafe WSH. SETTING: South Africa. OUTCOME MEASURES: Disease burden from diarrhoeal diseases, intestinal parasites and schistosomiasis, measured by deaths and disability-adjusted life years (DALYs). RESULTS: 13,434 deaths were attributable to unsafe WSH accounting for 2.6% (95% uncertainty interval 2.4 - 2.7%) of all deaths in South Africa in 2000. The burden was especially high in children under 5 years, accounting for 9.3% of total deaths in this age group and 7.4% of burden of disease. Overall, the burden due to unsafe WSH was equivalent to 2.6% (95% uncertainty interval 2.5 - 2.7%) of the total disease burden for South Africa, ranking this risk factor seventh for the country. CONCLUSIONS: Unsafe WSH remains an important risk factor for disease in South Africa, especially in children under 5. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and to promoting safe hygiene behaviours, particularly among children.

Epidemiologic herd-level assessment of causative agents and risk factors for winter dysentery in dairy cattle.

OBJECTIVE: To test the association between exposure to bovine coronavirus (BCV) and outbreaks of winter dysentery (WD) in dairy herds and to examine other risk factors for outbreaks of WD in dairy herds. ANIMALS: 12 dairy herds in Ohio affected with WD (case herds). For each case herd, 2 unaffected herds from the same area were concurrently used as control herds. PROCEDURE: A case-control study was conducted, using herds as the unit of investigation. Multivariate logistic regression modeling was used to identify risk factors for contracting disease. RESULTS: 4 factors appeared to increase a herd's risk for WD: increase in herd prevalence of adult cows that had a fourfold or more increase in BCV serum IgG antibody titer; increase in herd prevalence of adult cows that had a fourfold or more increase in bovine viral diarrhea virus (BVDV) titer; housing cattle in tiestall or stanchion barns rather than free-stall facilities; and use of equipment to handle manure and subsequently handle feed. The adjusted population-attributable risk for these variables was 71, 43, 53, and 31%, respectively, and 99% overall, indicating that these variables had considerable impact on WD outbreaks for the study population. CONCLUSIONS AND CLINICAL RELEVANCE: In dairies in Ohio, recent herd exposure to BCV appeared to increase the risk for WD outbreaks. Some WD outbreaks might have been associated with acute BVDV infection. Certain housing and management practices may have increased the risk of an outbreak of WD.

An epidemiological study of winter dysentery in fifteen herds in France.

Winter dysentery is a highly contagious disease of cattle seen most often during the winter months. In the course of an epidemiological study, the management, production, hygiene and previous diseases in 15 herds were characterized by 32 variables. Each herd was then visited twice a week for 8 weeks and 8 to 10 cows were clinically examined during each visit. Winter dysentery occurred in half of the herds during the survey. All data were analysed by classical statistical methods and by multivariate analysis. Mild or severe disease provoked nasal discharge and was associated with significant economic loss. Winter dysentery outbreaks appeared to be associated with small farms in which the area available per cow is either too small or too large, the presence of coronavirus in the faeces and variations in the temperature of the stable and of the drinking water.

Financial benefit from the eradication of swine dysentery.

Swine dysentery was eradicated from a 270 sow herd by using medication in conjunction with cleaning and disinfection, without reducing the herd size. The feed conversion efficiency, cost per kg liveweight gain and veterinary costs in the herd were compared with similar Meat and Livestock Commission recorded herds before swine dysentery entered the farm, while it was present and after its eradication. During the four years when the disease was endemic in the herd the feed conversion efficiency deteriorated by 0.58, equivalent to 7.31 pounds per pig, the cost per kg liveweight gain was 15 per cent higher and the costs of veterinary care and medicines were 1.38 pounds per pig greater. Although there were pigs with clinical swine dysentery in the herd during the four year period, the poor production figures were attributed mainly to subclinical disease. The cost of eradicating the disease was more than 20,000 pounds but this sum was recouped within 12 months by the improved production and reduced drug usage. The chances of success of such a programme have been estimated to be between 54 and 90 per cent.