1. Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network
- Author
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Cohen, AL, Platts-Mills, JA, Nakamura, T, Operario, DJ, Antoni, S, Mwenda, JM, Weldegebriel, G, Rey-Benito, G, de Oliveira, LH, Ortiz, C, Daniels, DS, Videbaek, D, Singh, S, Njambe, E, Sharifuzzaman, M, Grabovac, V, Nyambat, B, Logronio, J, Armah, G, Dennis, FE, Seheri, ML, Magagula, N, Mphahlele, J, Fumian, TM, Maciel, ITA, Leite, JPG, Esona, MD, Bowen, MD, Samoilovich, E, Semeiko, G, Abraham, D, Giri, S, Praharaj, I, Kang, G, Thomas, S, Bines, J, Liu, N, Kyu, HH, Doxey, M, McQuade, ETR, McMurry, TL, Liu, J, Houpt, ER, Tate, JE, Parashar, UD, Serhan, F, Cohen, AL, Platts-Mills, JA, Nakamura, T, Operario, DJ, Antoni, S, Mwenda, JM, Weldegebriel, G, Rey-Benito, G, de Oliveira, LH, Ortiz, C, Daniels, DS, Videbaek, D, Singh, S, Njambe, E, Sharifuzzaman, M, Grabovac, V, Nyambat, B, Logronio, J, Armah, G, Dennis, FE, Seheri, ML, Magagula, N, Mphahlele, J, Fumian, TM, Maciel, ITA, Leite, JPG, Esona, MD, Bowen, MD, Samoilovich, E, Semeiko, G, Abraham, D, Giri, S, Praharaj, I, Kang, G, Thomas, S, Bines, J, Liu, N, Kyu, HH, Doxey, M, McQuade, ETR, McMurry, TL, Liu, J, Houpt, ER, Tate, JE, Parashar, UD, and Serhan, F
- Abstract
INTRODUCTION: Diarrhoea remains a leading cause of child morbidity and mortality. Systematically collected and analysed data on the aetiology of hospitalised diarrhoea in low-income and middle-income countries are needed to prioritise interventions. METHODS: We established the Global Pediatric Diarrhea Surveillance network, in which children under 5 years hospitalised with diarrhoea were enrolled at 33 sentinel surveillance hospitals in 28 low-income and middle-income countries. Randomly selected stool specimens were tested by quantitative PCR for 16 causes of diarrhoea. We estimated pathogen-specific attributable burdens of diarrhoeal hospitalisations and deaths. We incorporated country-level incidence to estimate the number of pathogen-specific deaths on a global scale. RESULTS: During 2017-2018, 29 502 diarrhoea hospitalisations were enrolled, of which 5465 were randomly selected and tested. Rotavirus was the leading cause of diarrhoea requiring hospitalisation (attributable fraction (AF) 33.3%; 95% CI 27.7 to 40.3), followed by Shigella (9.7%; 95% CI 7.7 to 11.6), norovirus (6.5%; 95% CI 5.4 to 7.6) and adenovirus 40/41 (5.5%; 95% CI 4.4 to 6.7). Rotavirus was the leading cause of hospitalised diarrhoea in all regions except the Americas, where the leading aetiologies were Shigella (19.2%; 95% CI 11.4 to 28.1) and norovirus (22.2%; 95% CI 17.5 to 27.9) in Central and South America, respectively. The proportion of hospitalisations attributable to rotavirus was approximately 50% lower in sites that had introduced rotavirus vaccine (AF 20.8%; 95% CI 18.0 to 24.1) compared with sites that had not (42.1%; 95% CI 33.2 to 53.4). Globally, we estimated 208 009 annual rotavirus-attributable deaths (95% CI 169 561 to 259 216), 62 853 Shigella-attributable deaths (95% CI 48 656 to 78 805), 36 922 adenovirus 40/41-attributable deaths (95% CI 28 469 to 46 672) and 35 914 norovirus-attributable deaths (95% CI 27 258 to 46 516). CONCLUSIONS: Despite the substantial impact of r
- Published
- 2022