BMJ Paediatrics Open (Apr 2024)
Clinical and nutritional correlates of bacterial diarrhoea aetiology in young children: a secondary cross-sectional analysis of the ABCD trial
- ,
- Jie Liu,
- Christopher R Sudfeld,
- Per Ashorn,
- Queen Dube,
- Tahmeed Ahmed,
- Pratibha Dhingra,
- Usha Dhingra,
- Arup Dutta,
- Sunil Sazawal,
- Karim Manji,
- Rodrick Kisenge,
- Mohamed Bakari,
- Christopher P Duggan,
- Rajiv Bahl,
- Naor Bar-Zeev,
- Ayesha De Costa,
- Nigel Cunliffe,
- Sadia Shakoor,
- Desiree Witte,
- Doreen Rwigi,
- Judd L Walson,
- Shahida Qureshi,
- Eric Houpt,
- James Platts-mills,
- Jonathon Simon,
- Chifundo Ndamala,
- Sarah Somji,
- Abraham Samma,
- Fadima Cheick Haidara,
- Karen Kotloff,
- Emily L Deichsel,
- Md Chisti,
- Benson Singa,
- Patricia Pavlinac,
- Samba Sow,
- Mohammad Tahir Yousafzai,
- Farah Qamar,
- Muhammad Waliur Rahman,
- Irin Parvin,
- Md. Farhad Kabir,
- Anil Kumar Sharma,
- Vijay Kumar Jaiswal,
- Churchil Nyabinda,
- Christine McGrath,
- Maurine Anyango,
- Kevin Mwangi Kariuki,
- Stephanie N Tornberg-Belanger,
- Flanon Coulibaly,
- Jasnehta Permala-Booth,
- Dramane Malle,
- Latif Ndeketa,
- Rozina Thobani,
- Jan Mohammed,
- Cecylia Msemwa
Affiliations
- Division of Surgery & Interventional Science, University College London, London, UK
- Jie Liu
- Department of Pediatric Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Christopher R Sudfeld
- Department of Global Health and Population and Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Per Ashorn
- 6 Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
- Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Pratibha Dhingra
- Usha Dhingra
- Centre for Public Health Kinetics (CPHK), Delhi, India
- Arup Dutta
- Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania
- Sunil Sazawal
- Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania
- Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Mohamed Bakari
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Christopher P Duggan
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Boston, USA
- Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent and Health and Ageing, World Health Organization, Geneva, Switzerland
- Naor Bar-Zeev
- Global Disease Epidemiology and Control, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
- Ayesha De Costa
- Department of Maternal, Newborn, Child and Adolescent Health, and Ageing, World Health Organization, Geneve, Switzerland
- Nigel Cunliffe
- Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
- Sadia Shakoor
- Pathology and Laboratory Medicine, Aga Khan University, Karachi, Sindh, Pakistan
- Desiree Witte
- Faculty of Life and Health Sciences, University of Liverpool, Liverpool, UK
- Doreen Rwigi
- 2 Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Judd L Walson
- Department of Pediatrics and Medicine (Infectious Diseases), University of Washington, Seattle, Washington, USA
- Shahida Qureshi
- Eric Houpt
- Department of Medicine, Infectious Diseases, University of Virginia, Charlottesville, Virginia, USA
- James Platts-mills
- Jonathon Simon
- director
- Chifundo Ndamala
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Sarah Somji
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Abraham Samma
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Fadima Cheick Haidara
- Center for Vaccine Development–Mali, Bamako, Mali
- Karen Kotloff
- 27 Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Emily L Deichsel
- 1 Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Md Chisti
- Division of Nutrition and Clinical Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Benson Singa
- Centre for Public Health Kinetics (CPHK), Delhi, India
- Patricia Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Samba Sow
- Centre pour le Developpement des Vaccins Mali, Bamako, Mali
- Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Heath, The Aga Khan University, Karachi, Sindh, Pakistan
- Farah Qamar
- Department of Pediatrics and Child Heath, The Aga Khan University, Karachi, Sindh, Pakistan
- Muhammad Waliur Rahman
- Irin Parvin
- Md. Farhad Kabir
- Anil Kumar Sharma
- Vijay Kumar Jaiswal
- Churchil Nyabinda
- Christine McGrath
- Maurine Anyango
- Kevin Mwangi Kariuki
- Stephanie N Tornberg-Belanger
- Flanon Coulibaly
- Jasnehta Permala-Booth
- Dramane Malle
- Latif Ndeketa
- Rozina Thobani
- Jan Mohammed
- Cecylia Msemwa
- DOI
- https://doi.org/10.1136/bmjpo-2023-002448
- Journal volume & issue
-
Vol. 8,
no. 1
Abstract
Objective The objective was to assess the association between nutritional and clinical characteristics and quantitative PCR (qPCR)-diagnosis of bacterial diarrhoea in a multicentre cohort of children under 2 years of age with moderate to severe diarrhoea (MSD).Design A secondary cross-sectional analysis of baseline data collected from the AntiBiotics for Children with Diarrhoea trial (NCT03130114).Patients Children with MSD (defined as >3 loose stools within 24 hours and presenting with at least one of the following: some/severe dehydration, moderate acute malnutrition (MAM) or severe stunting) enrolled in the ABCD trial and collected stool sample.Study period June 2017–July 2019.Interventions None.Main outcome measures Likely bacterial aetiology of diarrhoea. Secondary outcomes included specific diarrhoea aetiology.Results A total of 6692 children with MSD had qPCR results available and 28% had likely bacterial diarrhoea aetiology. Compared with children with severe stunting, children with MAM (adjusted OR (aOR) (95% CI) 1.56 (1.18 to 2.08)), some/severe dehydration (aOR (95% CI) 1.66 (1.25 to 2.22)) or both (aOR (95% CI) 2.21 (1.61 to 3.06)), had higher odds of having likely bacterial diarrhoea aetiology. Similar trends were noted for stable toxin-enterotoxigenic Escherichia coli aetiology. Clinical correlates including fever and prolonged duration of diarrhoea were not associated with likely bacterial aetiology; children with more than six stools in the previous 24 hours had higher odds of likely bacterial diarrhoea (aOR (95% CI) 1.20 (1.05 to 1.36)) compared with those with fewer stools.Conclusion The presence of MAM, dehydration or high stool frequency may be helpful in identifying children with MSD who might benefit from antibiotics.
