Diarrheal morbidity and mortality in children in the Central African Republic

Abstract

Diarrheal morbidity and mortality in children less than 5 years old were studied in Bangui, Central African Republic, by a cluster survey. We found a high prevalence of diarrheal disease with an estimated annual incidence of 7 episodes of diarrhea per child per year. The estimated annual mortality rate for children less than 5 years old was 28.6 per 1,000 and 85.8 per 1,000 for infants; 51.6% of deaths were reported to be associated with diarrhea. During the survey, stool specimens were collected from 133 children with current diarrhea and 117 control children to study the etiologic agents of diarrheal disease in the community. An enteric pathogen was identified in 58% of diarrheal children's stools and 48% of stools of well children. A statistically significant association between diarrhea and rotavirus was found, with it being isolated from 8 of 33 (24%) of stools of infants with diarrhea compared to 0 of 25 (0%) of control infants. Isolation rates for Campylobacter jejuni, Entamoeba histolytica, pathogenic Escherichia coli, and other bacterial enteropathogens did not differ significantly between children with diarrhea and control children.

PIP: Using a cluster sample survey, researchers studied diarrheal morbidity and mortality in children 5 years old in Bangui, Central African Republic in November 1983. They collected fecal samples from all children who had diarrhea the day of the investigation. They also took stools from children not ill with diarrhea at the time and who had 3 stools/day for the past week. Researchers looked for an age matched control in the same cluster, but not in the same home, for each child with diarrhea. They were unable to explain at least 42% of the diarrhea cases and much more when they considered the high isolation rates among the nondiarrheic children. This highlights the need for further research to better understand the carrier state. 57.8% of the diarrheic children's stools had 1 or more enteric pathogens, while 47.8% of the nondiarrheic children's tools did. In children 1 year old, rotavirus was the most frequent enteropathogen associated with diarrhea (p.05). Parasitic organisms were found more frequently as the age of the child increased. A high carrier state of different enteric pathogens existed, including Campylobacter jejuni, Entamoeba histolytica, Giardia intestinalis, and enteropathogenic Escherichia coli. The annual child and infant mortality rates were very high (28.6/1000 and 85.8/1000 respectively). Death was related to diarrhea in 19.1% of the cases and associated with diarrhea in 50% of the cases. The annual attack rate stood at 7 episodes/child which is greater than is usually reported.