The Enterics for Global Health (EFGH) Shigella Surveillance Study in Kenya.

Background: Although Shigella is an important cause of diarrhea in Kenyan children, robust research platforms capable of conducting incidence-based Shigella estimates and eventual Shigella-targeted clinical trials are needed to improve Shigella-related outcomes in children. Here, we describe characteristics of a disease surveillance platform whose goal is to support incidence and consequences of Shigella diarrhea as part of multicounty surveillance aimed at preparing sites and assembling expertise for future Shigella vaccine trials. Methods: We mobilized our preexisting expertise in shigellosis, vaccinology, and diarrheal disease epidemiology, which we combined with our experience conducting population-based sampling, clinical trials with high (97%-98%) retention rates, and healthcare utilization surveys. We leveraged our established demographic surveillance system (DSS), our network of healthcare centers serving the DSS, and our laboratory facilities with staff experienced in performing microbiologic and molecular diagnostics to identify enteric infections. We joined these resources with an international network of sites with similar capabilities and infrastructure to form a cohesive scientific network, designated Enterics for Global Health (EFGH), with the aim of expanding and updating our knowledge of the epidemiology and adverse consequences of shigellosis and enriching local research and career development priorities. Conclusions: Shigella surveillance data from this platform could help inform Shigella vaccine trials.

Population Enumeration and Household Utilization Survey Methods in the Enterics for Global Health (EFGH): Shigella Surveillance Study.

Background: Accurate estimation of diarrhea incidence from facility-based surveillance requires estimating the population at risk and accounting for case patients who do not seek care. The Enterics for Global Health (EFGH) Shigella surveillance study will characterize population denominators and healthcare-seeking behavior proportions to calculate incidence rates of Shigella diarrhea in children aged 6-35 months across 7 sites in Africa, Asia, and Latin America. Methods: The Enterics for Global Health (EFGH) Shigella surveillance study will use a hybrid surveillance design, supplementing facility-based surveillance with population-based surveys to estimate population size and the proportion of children with diarrhea brought for care at EFGH health facilities. Continuous data collection over a 24 month period captures seasonality and ensures representative sampling of the population at risk during the period of facility-based enrollments. Study catchment areas are broken into randomized clusters, each sized to be feasibly enumerated by individual field teams. Conclusions: The methods presented herein aim to minimize the challenges associated with hybrid surveillance, such as poor parity between survey area coverage and facility coverage, population fluctuations, seasonal variability, and adjustments to care-seeking behavior.

The role of HIV infection in the etiology and epidemiology of diarrheal disease among children aged 0-59 months in Manhiça District, Rural Mozambique.

BACKGROUND: Diarrhea is an important health problem among HIV-infected patients. This study evaluated the role of HIV in the epidemiology, etiology, and severity of diarrheal disease among children. METHODS: The Global Enteric Multicenter Study enrolled children with moderate-to-severe diarrhea (MSD) and less-severe diarrhea (LSD) between December 2007 and November 2012. One to three controls for MSD cases and one per LSD case were enrolled and matched by age, sex, and neighborhood. All children were tested for HIV. Clinical data, anthropometric data, and stool samples were collected. Follow-up was performed at 60 days. RESULTS: Two hundred and fourteen MSD cases and 418 controls, together with 349 LSD cases and 214 controls were tested. HIV prevalence was 25% among MSD cases (4% for matched controls) and 6% among LSD cases (6% among matched controls). HIV-infected children were more likely to have MSD (odds ratio 5.6, p<0.0001). Mortality rates were higher among HIV-infected children than among the uninfected (34 vs. 5 per 1000 child-weeks at risk; p=0.0039). Cryptosporidium, Giardia, and enteroaggregative Escherichia coli (aatA only) were more prevalent among HIV-infected MSD cases than among uninfected ones. CONCLUSION: HIV is an important risk factor for MSD. The high mortality rate implies that children with MSD should be screened for HIV and managed accordingly.

The role of HIV infection in the etiology and epidemiology of diarrheal disease among children aged 0­59 months in Manhiça District, Rural Mozambique

The Global Enteric Multicenter Study enrolled children with moderate-to-severe diarrhea (MSD) and less-severe diarrhea (LSD) between December 2007 and November 2012. One to three controls for MSD cases and one per LSD case were enrolled and matched by age, sex, and neighborhood. All children were tested for HIV. Clinical data, anthropometric data, and stool samples were collected. Follow-up was performed at 60 days. Results Two hundred and fourteen MSD cases and 418 controls, together with 349 LSD cases and 214 controls were tested. HIV prevalence was 25% among MSD cases (4% for matched controls) and 6% among LSD cases (6% among matched controls). HIV-infected children were more likely to have MSD (odds ratio 5.6, p < 0.0001). Mortality rates were higher among HIV-infected children than among the uninfected (34 vs. 5 per 1000 child-weeks at risk; p = 0.0039). Cryptosporidium, Giardia, and enteroaggregative Escherichia coli (aatA only) were more prevalent among HIV-infected MSD cases than among uninfected ones.

Evaluation of antinociceptive and antihyperglycemic activities in methanol extracts of whole plants of Alternanthera philoxeroides [Mart.] Griseb. [Amaranthaceae] in mice

The present study evaluated the antinociceptive and antihyperglycemic effects of crude methanol extract of whole plants of Alternanthera philoxeroides [Mart.] Griseb. [Amaranthaceae] in Swiss albino mice. Antinociceptive activity was evaluated by attenuation of the number of constrictions in acetic acid-induced gastric pain, while antihyperglycemic activity was evaluated through oral glucose tolerance tests in glucose-loaded mice. Dose-dependent and significant inhibitions in the number of constrictions were seen in mice administered with extract at doses of 50, 100, 200 and 400 mg per kg body weight. At these concentrations, the numbers of constrictions were reduced, respectively, by 31.0, 32.7, 37.9 and 44.8%. In comparison, a standard antinociceptive drug, aspirin reduced the number of constrictions by 37.9 and 67.2%, when administered at doses, respectively, of 200 and 400 mg per kg body weight. The extract also exhibited dose-dependent and significant antihyperglycemic activity when administered to mice at the aforementioned four doses. Serum glucose concentrations were reduced, respectively, by 36.3, 58.6, 65.0 and 65.6% at the four doses administered. The results compare favorably with a standard antihyperglycemic drug, glibenclamide, which when administered at a dose of 10 mg per kg body weight reduced serum glucose level by 42.7%. Taken together, the results obtained indicate that the extract merit further scientific studies towards discovery of components, which may prove beneficial in ameliorating pain, as well as high sugar levels of diabetic patients

Antibacterial Activity of Manilkara zapota [L.] Royen and Cynometra ramiflora [L.]

Methanolic extract of the seed of Manilkara zapota [L.] Royen [Family: Sapotaceae] and the bark of Cynometra ramiflora Linn. [Family: Leguminosae] were tested for their antibacterial activity. The methanolic extract of Manilkara zapota showed a moderate antibacterial activity against E. coli, S. flexneri and Staphylococcus aureus, whereas the methanolic extract of Cynometraramiflora was found to have a moderate antibacterial activity against all the tested species