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1.
J Agric Food Chem ; 68(2): 441-450, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31736308

RESUMO

Absorption of glucose, via intestinal Na+/glucose cotransporter 1 (SGLT1), activates salt and water absorption and is an effective route for treating Escherichia coli (E. coli)-induced diarrhea. Activity and expression of SGLT1 is regulated by sensing of sugars and artificial/natural sweeteners by the intestinal sweet receptor T1R2-T1R3 expressed in enteroendocrine cells. Diarrhea, caused by the bacterial pathogen E. coli, is the most common post-weaning clinical feature in rabbits, leading to mortality. We demonstrate here that, in rabbits with experimentally E. coli-induced diarrhea, inclusion of a supplement containing stevia leaf extract (SL) in the feed decreases cumulative morbidity, improving clinical signs of disease (p < 0.01). We show that the rabbit intestine expresses T1R2-T1R3. Furthermore, intake of SL enhances activity and expression of SGLT1 and the intestinal capacity to absorb glucose (1.8-fold increase, p < 0.05). Thus, a natural plant extract sweetener can act as an effective feed additive for lessening the negative impact of enteric diseases in animals.


Assuntos
Diarreia/veterinária , Células Enteroendócrinas/metabolismo , Infecções por Escherichia coli/veterinária , Escherichia coli/fisiologia , Mucosa Intestinal/efeitos dos fármacos , Adoçantes não Calóricos/administração & dosagem , Extratos Vegetais/administração & dosagem , Coelhos/microbiologia , Transportador 1 de Glucose-Sódio/metabolismo , Stevia/química , Animais , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Diarreia/mortalidade , Células Enteroendócrinas/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/mortalidade , Feminino , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiologia , Masculino , Folhas de Planta/química , Coelhos/metabolismo , Transportador 1 de Glucose-Sódio/genética
2.
Artigo em Inglês | MEDLINE | ID: mdl-31522662

RESUMO

A cluster of gastrointestinal illness was detected following receipt of a complaint of becoming ill after a multi-course dinner at a restaurant in Canberra, Australian Capital Territory (ACT), Australia. The complaint led to an investigation by ACT Health. Food samples retained by the restaurant for microbiological analysis returned an unsatisfactory level of Bacillus cereus in beef (19,000 colony forming units/gram [cfu/g]) and a satisfactory level in arancini (50 cfu/g). These positive samples underwent whole genome sequencing and genes encoding diarrhoeal toxins were detected with no laboratory evidence of the emetic toxin. No stool specimens were collected. A cohort study was undertaken and 80% (33/41) of patrons took part in a structured interview. There was no significant difference in age or sex between those ill and not ill. Due to universal exposure most foods were unable to be statistically analysed and no significant results were found from the food history. The ill cohort diverged into two distinct groups based on incubation period and symptoms suggesting this outbreak involved B. cereus intoxication with both diarrhoeal and potentially emetic toxins. Some hygiene practices during food preparation were noted to be inadequate and heating and cooling procedures were unverified when questioned. A combination of the incubation periods and symptom profile, food laboratory evidence, and genomic sequencing of the B. cereus diarrhoeal gene suggest a probable aetiology of B. cereus intoxication. Public health action included the restaurant rectifying hygiene practices and documenting heating/cooling procedures.


Assuntos
Bacillus cereus/isolamento & purificação , Toxinas Bacterianas/toxicidade , Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Gastroenterite/epidemiologia , Carne Vermelha/microbiologia , Animais , Território da Capital Australiana/epidemiologia , Bacillus cereus/genética , Bovinos , Estudos de Coortes , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/mortalidade , Eméticos , Feminino , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/mortalidade , Gastroenterite/microbiologia , Gastroenterite/mortalidade , Humanos , Masculino , Restaurantes , Estudos Retrospectivos , Inquéritos e Questionários
3.
BMC Infect Dis ; 19(1): 804, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519160

RESUMO

BACKGROUND: Globally, diarrhea is the leading cause of morbidity and mortality among less than 5 years old children and it contributes to the deaths of approximately one million children every year. In Ethiopia, diarrhea is the second cause of under-five mortality and morbidity. However, in the study area, studies were limited. Therefore, this study has assessed the prevalence of diarrhea and associated factors among < 5 years of age in Jamma district, Northeast Ethiopia. METHODS: A community-based cross-sectional study was conducted from August 15 to September 15, 2017, in Jamma district, South Wello zone, northeast Ethiopia. A Systematic random sampling technique was used to select 614 households and a pretested structured questionnaire was used to collect the data. A multivariable logistic regression analysis was used to investigate factors associated with diarrheal disease. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) for variables with P-value < 0.05 was used to show statistically significant association. RESULTS: In this study, the prevalence of diarrhea among under-five children was 23.1% (95% CI: (19.4, 26.5). Child's age 6 to 23 months [AOR: 2.46, 95% CI: (1.49, 4.05)], Living in rural area [AOR: 2.75, 95% CI: (1.33,5.66)], absence of latrine [AOR: 4.80, 95% CI: (2.39,9.60)], absence of handwashing facility [AOR: 2.45, 95% CI: (1.53,3.93], unprotected drinking water source [AOR:2.68, 95% CI: (1.54,4.68)], and Improper waste disposal practices [AOR:3.86, 95% CI: (2.38,6.26)] were associated with diarrhea disease. CONCLUSION: There was a high prevalence of diarrheal disease among children in the study area. Child age, rural residence, availability of latrine and handwashing facility, source of drinking water, and improper waste disposal were notably associated with childhood diarrheal disease. Therefore, improving handwashing practices and pure water supply, proper waste disposal including the availability of latrines would minimize the burden of diarrheal disease.


Assuntos
Diarreia/epidemiologia , Meio Ambiente , Pré-Escolar , Estudos Transversais , Diarreia/mortalidade , Água Potável/normas , Etiópia/epidemiologia , Características da Família , Feminino , Desinfecção das Mãos , Habitação , Humanos , Lactente , Masculino , Razão de Chances , Prevalência , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Toaletes/estatística & dados numéricos
4.
J Dairy Sci ; 102(10): 9259-9267, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31400894

RESUMO

Diarrhea is one of the most common causes of antimicrobial use and mortality in young calves. To reduce antimicrobial use and resistance on dairy farms, research on alternative therapies for calf diarrhea is necessary. Our laboratory previously conducted a randomized clinical trial investigating the effectiveness of lactoferrin, an iron-binding protein found in colostrum, as a treatment for calf diarrhea. The trial showed significantly reduced calf mortality in diarrheic calves that were administered lactoferrin. Thus, the objective of this study was to corroborate the results of our prior clinical trial across multiple farms and to investigate the effect of lactoferrin on the morbidity and mortality of preweaned calves with naturally occurring cases of diarrhea. This randomized field trial was conducted on 5 commercial dairy farms in Ohio. In total, 485 calves (≤21 d of age) were enrolled at first diarrhea diagnosis (fecal score ≥2 defined as loose to watery) and randomly assigned to receive an oral dose of lactoferrin (3 g of lactoferrin powder dissolved in 30 mL of water) or 30 mL of water (control) once daily for 3 consecutive days. Health assessments were conducted on the day of diarrhea diagnosis (d 0) and 1, 2, 3, 7, 14, 21, 28, and 35 d following diagnosis. Producer records of disease treatment and mortality were collected 120 d following diagnosis. A Poisson regression model was used to test differences between treatments in disease frequency through 35 d post-diarrhea diagnosis and the incidence risk of treatment and mortality risk 120 d post-diarrhea diagnosis; the model controlled for calf age at enrollment, farm, and treatment. Median calf age at enrollment was 11 d and ranged from 1 to 26 d of age. At study enrollment, 51.3% (123/240) and 52.2% (128/245) of calves in the control and lactoferrin treatment groups, respectively, were diagnosed with severe diarrhea (fecal score = 3). The frequency of disease (diarrhea, dehydration, depression, signs of respiratory disease) through 35 d following diarrhea diagnosis was not significantly different for calves in the lactoferrin and control groups. Overall mortality risk for enrolled calves was 9.9%, and 10.7% (22/243) and 9.1% (26/242) of calves in the lactoferrin and control groups, respectively, died or were culled in the 120 d following diarrhea diagnosis. The relative risk of death or culling did not differ between treatment groups, however. Therefore, as performed in this study, lactoferrin as a treatment for calf diarrhea was not beneficial.


Assuntos
Antibacterianos/uso terapêutico , Doenças dos Bovinos/tratamento farmacológico , Diarreia/veterinária , Lactoferrina/uso terapêutico , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/mortalidade , Diarreia/tratamento farmacológico , Diarreia/mortalidade , Feminino , Incidência , Ohio , Gravidez
5.
BMC Public Health ; 19(1): 1132, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420035

RESUMO

BACKGROUND: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. METHODS: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. RESULTS: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. CONCLUSIONS: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.


Assuntos
Saúde da Criança/economia , Mortalidade da Criança/tendências , Pobreza/economia , Assistência Pública/economia , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Diarreia/economia , Diarreia/mortalidade , Equador/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Análise de Regressão , Infecções Respiratórias/economia , Infecções Respiratórias/mortalidade
6.
J Glob Health ; 9(1): 010505, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31293782

RESUMO

Background: In Kenya, diarrheal disease is the second leading cause of death among children under five. The Government of Kenya launched a national plan to increase coverage of oral rehydration solution (ORS) and zinc by addressing demand and supply-side barriers. This study evaluates progress of ORS and zinc uptake in Kenya according to the national plan from 2011 to 2016. Methods: In 2016, we conducted a nationally representative population-based household survey to estimate coverage of ORS and zinc for treatment of diarrhea cases among children under five. We also used ORS and zinc coverage data from the two most recent Kenya Demographic and Health Surveys in 2008/09 and 2014 to estimate annual changes in coverage rates during the program period. Based on these inputs, we used the Lives Saved Tool to estimate the number of diarrhea deaths averted between 2011 and 2016 due to increased use of ORS and zinc. Results: The 2016 survey results showed that ORS coverage was 42% (95% confidence interval (CI) = 38%, 47%) and zinc coverage was 18% (95% CI = 15%, 23%). The estimated coverage for the combined use of ORS and zinc was 15% in 2016 (95% CI = 12%, 19%). Compared to 2011, an additional 3340 (sensitivity bounds = 2 670, 3 920) diarrhea deaths among children under five were averted due to increases in ORS and zinc coverage. Conclusions: Kenya was successful in catalyzing uptake of combined treatment with ORS and zinc, which rose from 0.8% in 2011 to 15% in 2016. Ongoing efforts are necessary to further build on these gains.


Assuntos
Diarreia/terapia , Hidratação/estatística & dados numéricos , Programas Governamentais , Soluções para Reidratação/uso terapêutico , Zinco/uso terapêutico , Pré-Escolar , Diarreia/mortalidade , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento
7.
S Afr Med J ; 109(7): 480-485, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266573

RESUMO

BACKGROUND: The Rapid Mortality Surveillance System has reported reductions in child mortality rates in recent years in South Africa (SA). In this article, we present information about levels of mortality and causes of death from the second SA National Burden of Disease Study (SA NBD) to inform the response required to reduce child mortality further. OBJECTIVES: To estimate trends in and causes of childhood mortality at national and provincial levels for the period 1997 - 2012, to highlight the importance of the SA NBD. METHODS: Numbers of registered child deaths were adjusted for under-reporting. Adjustments were made for the misclassification of AIDS deaths and the proportion of ill-defined natural causes. Non-natural causes were estimated using results from the National Injury Mortality Surveillance System for 2000 and the National Injury Mortality Survey for 2009. Six neonatal conditions and 11 other causes were consolidated from the SA NBD and the Child Health Epidemiological Reference Group lists of causes of death for the analysis. The NBD cause-fractions were compared with those from Statistics South Africa, the United Nations Children's Fund (UNICEF) and the Institute for Health Metrics and Evaluation (IHME). RESULTS: Under-5 mortality per 1 000 live births increased from 65 in 1997 to 79 in 2004 as a result of HIV/AIDS, before dropping to 40 by 2012. The neonatal mortality rate declined from 1997 to 2001, followed by small variations. The death rate from diarrhoeal diseases began to decrease in 2008 and the death rate from pneumonia from 2010. By 2012, neonatal deaths accounted for 27% of child deaths, with conditions associated with prematurity, birth asphyxia and severe infections being the main contributors. In 1997, KwaZulu-Natal, Free State, Mpumalanga and Eastern Cape provinces had the highest under-5 mortality, close to 80 per 1 000 live births. Mortality rates in North West were in the mid-range and then increased, placing this province in the highest group in the later years. The Western Cape had the lowest mortality rate, declining throughout the period apart from a slight increase in the early 2000s. CONCLUSIONS: The SA NBD identified the causes driving the trends, making it clear that prevention of mother-to-child transmission of HIV, the Expanded Programme on Immunisation and programmes aimed at preventing neonatal deaths need to be equitably implemented throughout the country to address persistent provincial inequalities in child deaths. The rapid reduction of childhood mortality since 2005 suggests that the 2030 Sustainable Development Goal target of 25 per 1 000 for under-5 mortality is achievable for SA. Comparison with alternative estimates highlights the need for cause-of-death data from civil registration to be adjusted using a burden-of-disease approach.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Asfixia Neonatal/mortalidade , Criança , Pré-Escolar , Diarreia/mortalidade , Infecções por HIV/mortalidade , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Pneumonia/mortalidade , Vigilância da População , África do Sul/epidemiologia , Tuberculose/mortalidade , Ferimentos e Lesões/mortalidade
8.
J Glob Health ; 9(1): 010801, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263547

RESUMO

Background: In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas. Methods: The Lives Saved Tool (LiST) was used to estimate reductions in all-cause child mortality due to changes in coverage of treatment for the integrated community case management (iCCM) illnesses - malaria, pneumonia, and diarrhea - while accounting for other changes in maternal and child health interventions in each RAcE project area. Data from RAcE baseline and endline household surveys, Demographic and Health Surveys, and routine health service data were used in each LiST model. The models yielded estimated change in under-five mortality rates, and estimated number of lives saved per year by malaria, pneumonia and diarrhea treatment. We adjusted the results to estimate the number of lives saved by community health worker (CHW)-provided treatment. Results: The LiST model accounts for coverage changes in iCCM intervention coverage and other health trends in each project area to estimate mortality reduction and child lives saved. Under five mortality declined in all six RAcE sites, with an average decline of 10 percent. An estimated 6200 under-five lives were saved by malaria, pneumonia, and diarrhea treatment in the DRC, Malawi, Niger, and Nigeria, of which approximately 4940 (75 percent) were saved by treatment provided by CHWs. This total excludes Mozambique, where there were no estimated under-five lives saved likely due to widespread stockouts of key medications. In all other project areas, lives saved by CHW-provided treatment contributed substantially to the estimated decline in under-five mortality. Conclusions: Our results suggest that iCCM is a strategy that can save lives and measurably decrease child mortality in settings where access to health facility services is low and adequate resources for iCCM implementation are provided for CHW services.


Assuntos
Administração de Caso/organização & administração , Mortalidade da Criança/tendências , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde , Acesso aos Serviços de Saúde/organização & administração , Mortalidade Infantil/tendências , Pré-Escolar , República Democrática do Congo/epidemiologia , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Moçambique/epidemiologia , Níger/epidemiologia , Nigéria/epidemiologia , Pneumonia/mortalidade , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde , Organização Mundial da Saúde
9.
J Glob Health ; 9(1): 010803, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263548

RESUMO

Background: Access to prompt and appropriate treatment is key to survival for children with malaria, pneumonia and diarrhoea. Community-based services are vital to extending care to remote populations. Malaria Consortium supported Niger state Ministry of Health, Nigeria, to introduce and implement an integrated community case management (iCCM) programme for four years in six local government areas (LGAs). The objective was to increase coverage of effective treatment for malaria, pneumonia and diarrhoea among children aged 2-59 months. Methods: The programme involved training, equipping, ongoing support and supervision of 1320 community volunteers (CORPs) to provide iCCM services to their communities in all six LGAs. Demand creation activities were also conducted; these included community dialogues, household mobilization, sensitization and mass media campaigns targeted at programme communities. To assess the level of changes in care seeking and treatment, baseline and endline household surveys were conducted in 2014 and 2017 respectively. For both surveys, a 30×30 multi-stage cluster sampling method was used, the sampling frame being RAcE programme communities. Results: Care-seeking from an appropriate provider increased overall and for each iCCM illness from 78% to 94% for children presenting with fever (P < 0.01), from 72% to 91% for diarrhoea cases (P < 0.01), and from 76% to 89% for cases of cough with difficult or fast breathing (P < 0.05). For diagnosis and treatment, the coverage of fevers tested for malaria increased from 34% to 77% (P < 0.001) and ACT treatments from 57% to 73% (<0.005); 56% of cases of cough or fast breathing who sought care from a CORP, had their respiratory rate counted and 61% with cough or fast breathing received amoxicillin. At endline caregivers sought care from CORPs in their communities for most cases of childhood illnesses (84%) compared to other providers at hospitals (1%) or health centres (9%).This aligns with caregivers' belief that CORPs are trusted providers (94%) who provide quality services (96%). Conclusion: Implementation of iCCM with focused demand creation activities can improve access to quality lifesaving interventions from frontline community providers in Nigeria. This can contribute towards achieving SDGs if iCCM is scaled up to hard-to-reach areas of all states in the country.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde , Diarreia/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Malária/terapia , Pneumonia/terapia , Pré-Escolar , Diarreia/mortalidade , Humanos , Lactente , Malária/mortalidade , Nigéria/epidemiologia , Pneumonia/mortalidade , Avaliação de Programas e Projetos de Saúde
10.
J Glob Health ; 9(1): 010804, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263549

RESUMO

Background: Despite strong evidence of integrated community case management (iCCM) of childhood illnesses being a proven intervention for reducing childhood morbidity and mortality, sustainability remains a challenge in most settings. Community ownership and contribution are important factors in sustainability. The purpose of this study was to document the process and scale achieved for community engagement and mobilisation to foster ownership, service uptake and sustainability of iCCM activities. Methods: A review of data collected by the RAcE project was conducted to describe the scale and achievement of leveraging community resources to support the community-oriented resource persons (CORPs). The Rapid Access Expansion (RAcE)-supported iCCM programme in Niger state (2014-2017), aimed at improving coverage of case management services for malaria, pneumonia, and diarrhoea, among children aged 2-59 months. Resources donated were documented and costed based on the market value of goods and services at the time of donation. These monetary valuations were validated at community dialogue meetings. Descriptive statistics were used to summarise quantitative variables. The mean of the number of CORPs in active service and the percentages of the mobilised resources received by CORPs were calculated. Results: The community engagement activities included 143 engagement and advocacy visits, and meetings, 300 community dialogues, reactivation of 60 ward development committees, and 3000 radio messages in support of iCCM. 79.5% of 1659 trained CORPs were still in active iCCM service at the end of the project. We estimated the costs of all support provided by the community to CORPs in cash and kind as US$ 123 062. Types of support included cash; building materials; farming support; fuel for motorcycles, and transport fares. Conclusions: The achievements of community engagement, mobilisation, and the resources leveraged, demonstrated acceptability of the project to the beneficiaries and their willingness to contribute to uninterrupted service provision by CORPs.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde , Acesso aos Serviços de Saúde/organização & administração , Pré-Escolar , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Nigéria/epidemiologia , Pneumonia/mortalidade , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde
11.
J Glob Health ; 9(1): 010805, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263550

RESUMO

Background: Ensuring the quality of health service data is critical for data-driven decision-making. Data quality assessments (DQAs) are used to determine if data are of sufficient quality to support their intended use. However, guidance on how to conduct DQAs specifically for community-based interventions, such as integrated community case management (iCCM) programs, is limited. As part of the World Health Organization's (WHO) Rapid Access Expansion (RAcE) Programme, ICF conducted DQAs in a unique effort to characterize the quality of community health worker-generated data and to use DQA findings to strengthen reporting systems and decision-making. Methods: We present our experience implementing assessments using standardized DQA tools in the six RAcE project sites in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria. We describe the process used to create the RAcE DQA tools, adapt the tools to country contexts, and develop the iCCM DQA Toolkit, which enables countries to carry out regular and rapid DQAs. We provide examples of how we used results to generate recommendations. Results: The DQA tools were customized for each RAcE project to assess the iCCM data reporting system, trace iCCM indicators through this system, and to ensure that DQAs were efficient and generated useful recommendations. This experience led to creation of an iCCM DQA Toolkit comprised of simplified versions of RAcE DQA tools and a guidance document. It includes system assessment questions that elicit actionable responses and a simplified data tracing tool focused on one treatment indicator for each iCCM focus illness: diarrhea, malaria, and pneumonia. The toolkit is intended for use at the national or sub-national level for periodic data quality checks. Conclusions: The iCCM DQA Toolkit was designed to be easily tailored to different data reporting system structures because iCCM data reporting tools and data flow vary substantially. The toolkit enables countries to identify points in the reporting system where data quality is compromised and areas of the reporting system that require strengthening, so that countries can make informed adjustments that improve data quality, strengthen reporting systems, and inform decision-making.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Confiabilidade dos Dados , Prestação Integrada de Cuidados de Saúde , Acesso aos Serviços de Saúde/organização & administração , Pré-Escolar , República Democrática do Congo/epidemiologia , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Moçambique/epidemiologia , Níger/epidemiologia , Nigéria/epidemiologia , Pneumonia/mortalidade , Pneumonia/terapia
12.
J Glob Health ; 9(1): 010811, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263554

RESUMO

Background: The use of mobile health (mHealth) technology to improve quality of care (QoC) has increased over the last decade; limited evidence exists to espouse mHealth as a decision support tool, especially at the community level. This study presents evaluation findings of using a mobile application for integrated community case management (iCCM) by Malawi's health surveillance assistants (HSAs) in four pilot districts to deliver lifesaving services for children. Methods: A quasi-experimental study design compared adherence to iCCM guidelines between HSAs using mobile application (n = 137) and paper-based tools (n = 113), supplemented with 47 key informant interviews on perceptions about QoC and sustainability of iCCM mobile application. The first four sick children presenting to each HSA for an initial consultation of an illness episode were observed by a Ministry of Health iCCM trainer for assessment, classification, and treatment. Results were compared using logistic regression, controlling for child-, HSA-, and district-level characteristics, with Holm-Bonferroni-adjusted significance levels for multiple comparison. Results: HSAs using the application tended to assess sick children according to iCCM guidelines more often than HSAs using paper-based tools for cough (adjusted proportion, 98% vs 91%; P < 0.01) and five physical danger signs - chest in-drawing; alertness; palmar pallor; malnourishment; oedema (80% vs 62%; P < 0.01), but not for fever (97% vs 93%; P = 0.06), diarrhoea (94% vs 87%; P = 0.03), and three danger signs - not able to eat or drink; vomits everything; has convulsions (88% vs 79%; P = 0.01). Across illnesses and danger signs, 81% of HSAs using the application correctly classified sick children, compared to 58% of HSAs using paper-based tools (P < 0.01). No differences existed for their treatment (P = 0.27). Interview respondents corroborated these findings that using iCCM mobile application ensures protocol adherence. Respondents noted barriers to its consistent and wide use including hardware problems and limited resources. Conclusion: Generally, the mobile application is a promising tool for improving adherence to the iCCM protocol for assessing sick children and classifying illness by HSAs. Limited effects on treatments and inconsistent use suggest the need for more studies on mHealth to improve QoC at community level.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/psicologia , Prestação Integrada de Cuidados de Saúde , Fidelidade a Diretrizes/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Pré-Escolar , Agentes Comunitários de Saúde/estatística & dados numéricos , Diarreia/mortalidade , Diarreia/terapia , Feminino , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Masculino , Pneumonia/mortalidade , Pneumonia/terapia , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
13.
J Glob Health ; 9(2): 020101, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360441

RESUMO

In 2012, the Government of Canada awarded a grant to the World Health Organization's Global Malaria Programme (GMP) to support the scale-up of integrated community case management (iCCM) of pneumonia, diarrhoea and malaria among children under 5 in sub-Saharan Africa under the Rapid Access Expansion Programme (RAcE). The two main objectives of the programme were to: (1) Contribute to the reduction of child mortality due to malaria, pneumonia and diarrhoea by increasing access to diagnostics, treatment and referral services, and (1) Stimulate policy updates in participating countries and catalyze scale-up of integrated community case management (iCCM) through documentation and dissemination of best practices. Based on the results of the implementation research and programmatic lessons, this collection provides evidence on impact and improving coverage of iCCM in routine health systems, and opportunities and challenges of implementing and sustaining delivery of iCCM at scale.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , África ao Sul do Saara/epidemiologia , Canadá , Mortalidade da Criança/tendências , Pré-Escolar , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Recém-Nascido , Cooperação Internacional , Malária/mortalidade , Malária/terapia , Pneumonia/mortalidade , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde
14.
J Glob Health ; 9(1): 010504, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31217963

RESUMO

Background: In Uganda, diarrhoea was the third leading cause of mortality among children under the age of five in 2010. To address this issue, the Ministry of Health (MOH) formed a national Diarrhoea and Pneumonia Coordination Committee (DPCC) in 2011. One of the objectives of the DPCC for reducing diarrhoea mortality was to increase the use of oral rehydration salts (ORS) and zinc. This study aimed to describe and evaluate efforts by the DPCC to increase ORS and zinc coverage. Methods: We conducted a retrospective mixed-methods evaluation to describe the activities conducted under the DPCC and evaluate the extent to which the committee's goal of increasing ORS and zinc use was achieved. We conducted secondary analysis using Uganda's Demographic and Health Survey from 2011 and 2016, analyzed cross-sectional private medicine outlet surveys from 2014 and 2016, analyzed ORS and zinc distribution data from the Uganda National Medical Stores, and reviewed program documents from DPCC partners. Results: Nationally, the proportion of children under five with diarrhoea treated with ORS and zinc increased from 1% (95% confidence interval (CI) = 1%, 2%) in 2011 to 30% (95% CI = 27%, 32%) in 2016. Among private medicine outlets, the adjusted odds of having any zinc in-stock was 1.5 (95% CI = 1.14, 1.97) times higher in 2016 than in 2014, and the retail price for a complete treatment (2 ORS sachets and 10 zinc tablets) declined by $0.19 (95% CI = -0.31, -0.06), or 14%. Conclusions: Use of combined ORS and zinc for treatment of diarrhoea in children under five significantly increased in Uganda during the program period. The range of activities conducted by the various members of the DPCC likely contributed to the increase in the use of combined ORS and zinc.


Assuntos
Diarreia/terapia , Hidratação/estatística & dados numéricos , Zinco/uso terapêutico , Pré-Escolar , Estudos Transversais , Diarreia/mortalidade , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estudos Retrospectivos , Uganda/epidemiologia
15.
BMJ Health Care Inform ; 26(1): 0, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31039122

RESUMO

The World Health Organization identifies the leading cause of morbidity and mortality in developing countries as infectious and communicable diseases. Health records coded uniformly using ICD-10 can form an accurate database and conclusions drawn from this are extremely important for understanding the public health situation.The aim of this study is to analyse the trend of intestinal infectious diseases recorded at a tertiary care hospital in India.A retrospective disease index study was conducted on data comprising 5317 cases from 2012 to 2016 for intestinal infectious diseases, analysed with ICD-10.Of these, 5.5% were from the age group 0-5 years; 57.66% were male; and 85% deaths in this cohort (62/73) were due to diarrhoea and gastroenteritis of presumed infectious origin.The findings of this study highlight an urgent need for health education among the population regarding infectious intestinal diseases and to redesign health promotion and preventive strategies for addressing these problems.


Assuntos
Classificação Internacional de Doenças/tendências , Enteropatias/mortalidade , Centros de Atenção Terciária , Adulto , Causas de Morte/tendências , Diarreia/mortalidade , Feminino , Humanos , Masculino , Morbidade/tendências , Estudos Retrospectivos
16.
J Vet Intern Med ; 33(4): 1807-1813, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31124588

RESUMO

BACKGROUND: Nonantibiotic alternatives providing local gut immunity have been recommended for managing calf diarrhea. ANIMALS: One hundred and two calves with diarrhea. HYPOTHESIS: Oral supplementation with immunoglobulins in calves with diarrhea will reduce time to resolution of diarrhea, number of treatment events, and mortality rate. METHODS: Randomized controlled trial. Calves were assigned into 1 of 3 groups. The treatment group was supplemented with 20 g of immunoglobulins in milk twice daily for 14 days. The placebo group was supplemented with 20 g of a product with similar nutritional value as the treatment group, but without immunoglobulins, in milk, twice daily for 14 days. The control group received no supplements. Medical treatments, time to resolution of diarrhea, and case fatality rates were compared. RESULTS: There was no difference in the proportion of treatment events (treatment, 79% versus placebo, 77% versus control, 71%) among groups (P = .69). The median time to resolution of diarrhea was not different between the treatment (10.5 days; 95% confidence interval [CI], 7, 13) and control (8 days; 95% CI, 5, 10) groups (P = .08) or between the placebo (6.5 days; 95% CI, 3, 9) and control groups (P = .89). Median time to resolution was shorter (P = .008) in the placebo compared to the treatment group (6.5 versus 10.5 days). Case fatality rates among groups (treatment, 12% versus placebo, 3% versus control, 3%) were not different (P = .36). CONCLUSIONS AND CLINICAL IMPORTANCE: Expected benefits of conferring local gut immunity by immunoglobulin supplementation in calves with diarrhea were not evident.


Assuntos
Doenças dos Bovinos/dietoterapia , Diarreia/veterinária , Suplementos Nutricionais , Imunoglobulinas/administração & dosagem , Animais , Animais Recém-Nascidos/imunologia , Bovinos , Doenças dos Bovinos/mortalidade , Colostro , Diarreia/dietoterapia , Diarreia/mortalidade , Leite , Distribuição Aleatória
17.
BMC Infect Dis ; 19(1): 322, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987589

RESUMO

BACKGROUND: Despite major improvements in child survival rates, the number of deaths due to diarrhea remains unacceptably high. We aimed to describe diarrhea-associated mortality and evaluate risk factors for death among Mozambican children with moderate-to-severe diarrhea (MSD). METHODS: Between December 2007 and November 2012, children under-five with MSD were enrolled in Manhiça district, as part of the Global Enteric Multicenter study (GEMS). Clinical, epidemiological, and socio-demographic characteristics were collected. Anthropometric measurements were performed and stool samples collected upon recruitment. A follow-up visit ~ 60 days post-enrolment was conducted and verbal autopsies performed in all death cases. RESULTS: Of the 916 MSD-cases analyzed; 90% (821/916) completed 60 days follow-up and 69 patients died. The case fatality rate at follow-up was 8% (69/821), and the mortality rate 10.2 (95%CI: 7.75-13.59) deaths per 1000 persons-week at risk. Nearly half of the deaths 48% (33/69) among study participants clustered within 2 weeks of the onset of diarrhea. Typical enteropathogenic Escherichia coli (typical EPEC) and Cryptosporidium were the two pathogens associated to an increased risk of death in the univariate analysis with (HR = 4.16, p = 0.0461) and (H = 2.84, p = 0.0001) respectively. Conversely, Rotavirus infection was associated to a decreased risk of death (HR = 0.52, p = 0.0198). According to the multivariate analysis, risk factors for death included co-morbidities such as malnutrition (HR = 4.13, p <  0.0001), pneumonia/lower respiratory infection (HR = 3.51, p <  0.0001) or invasive bacterial disease (IBD) (HR = 6.80, p = 0.0009), presenting on arrival with lethargy or overt unconsciousness (HR = 1.73, p = 0.0302) or wrinkled skin (HR = 1.71, p = 0.0393), and cryptosporidium infection (HR = 2.14, p = 0.0038). When restricting the analysis to those with available HIV results (n = 191, 22% of the total study sample), HIV was shown to be a significant risk factor for death (HR = 5.05, p = 0.0009). Verbal autopsies were conducted in 100% of study deaths, and highlighted diarrhea as the main underlying cause of death 39%, (27/69); followed by HIV/AIDS related deaths 29.0% (20/69) and sepsis 11.6% (8/69). CONCLUSION: Preventive strategies targeting Cryptosporidium, malnutrition and early identification and treatment of associated co-morbidities could contribute to the prevention of the majority of diarrhea associated deaths in Mozambican children.


Assuntos
Diarreia/mortalidade , Estudos de Casos e Controles , Pré-Escolar , Comorbidade , Criptosporidiose/epidemiologia , Criptosporidiose/mortalidade , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/virologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique/epidemiologia , Fatores de Risco , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/mortalidade , Taxa de Sobrevida
19.
Anaerobe ; 58: 13-21, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30851427

RESUMO

Clostridioides difficile is considered one of the main etiological agents of bacterial diarrhea associated with the use of antibiotics. It is an important nosocomial pathogen and the main cause of morbidity and mortality. In recent years, infections associated with C. difficile have led to numerous investigations. It is well known that C. difficile associated diarrhea (CDAD) is favored by the suppression or imbalance of the intestinal microbiome during or after antibiotic therapy. Other risk factors are, for instance, advanced age, long periods of hospitalization, chemotherapy, and other gastrointestinal infections. In the 2000's, the number of CDAD cases largely increased due to the emergence of the epidemic clone named BI/NAP1 ribotype 027, responsible for causing several outbreaks in developed countries, such as Canada, the United States, and the United Kingdom. The presence of the epidemic clone has been reported in Asia, Latin America and Australia, however, infections associated with C. difficile (CDI) in these geographic regions are usually caused by other ribotypes. In Brazil, for instance, epidemiological data on the incidence of CDI are still limited, especially regarding the spread of C. difficile within hospital units, the spectrum of toxigenic genes and the antimicrobial resistance profile. Some studies have demonstrated the importance of notifying cases related to CDI and taking special care measures in order to minimize the spread of epidemic strains in Brazil. Finally, epidemiological analysis of the prevalent and/or exclusive ribotypes circulating in Brazil can contribute to understand and to correlate characteristics associated with the biology of this pathogen with other globally circulating ribotypes. This review aimed to summarize all published work related to the isolation of C. difficile from human patients in Brazil, being the main focus, the methodologies used for identification of prevalent ribotypes, the antimicrobial susceptibility profile, and the diseases associated with the acquisition of CDI.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Diarreia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Brasil/epidemiologia , Criança , Pré-Escolar , Infecções por Clostridium/microbiologia , Infecções por Clostridium/mortalidade , Clostridium difficile/classificação , Clostridium difficile/genética , Diarreia/microbiologia , Diarreia/mortalidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Ribotipagem , Fatores de Risco , Adulto Jovem
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