Diarrheal diseases - WHO documents and publications
Diarrheal diseases - Uganda
PubMed/Medline
Abstracts of selected papers
Accorsi S, Fabiani M, Nattabi B, Ferrarese N, Corrado B, Iriso R, Ayella
EO, Pido B, Yoti Z, Corti D, Ogwang M, Declich S. Differences in
hospital admissions for males and females in northern Uganda in the
period 1992-2004: a consideration of gender and sex differences in
health care use. Trans R Soc Trop Med Hyg. 2007 Sep;101(9):929-38.
To inform our understanding of male and female health care use, we
assessed sex differences in hospital admissions by diagnosis and for
in-patient mortality using discharge records for 210319 patients
admitted to the Lacor Hospital in northern Uganda in the period
1992-2004. These differences were interpreted using a gender framework.
The overall number of admissions was similar by sex, yet differences
emerged among age groups. In children (0-14 years), malaria was the
leading cause of admission, and the distribution of diseases was similar
between sexes. Among 15-44 year olds, females had more admissions,
overall, and for malaria, cancer and anaemia, in addition to delivery
and gynaeco-obstetrical conditions (25.7% of female admissions). Males
had more admissions for injuries, liver disease and tuberculosis in the
same age group. In older persons (>or=45 years), women had more
admissions for cancer, hypertension, malaria and diarrhoea, while, as
for the previous age group, males had more admissions for injuries,
liver disease and tuberculosis. This study provides insight into sex-
and gender-related differences in health. The analysis and documentation
of these differences are crucial for improving service delivery and for
assessing the achievement of the dual goals of improving health status
and reducing health inequalities.
Shrestha RK, Marseille E, Kahn JG, Lule JR, Pitter C, Blandford JM,
Bunnell R, Coutinho A, Kizito F, Quick R, Mermin J. Cost-effectiveness
of home-based chlorination and safe water storage in reducing diarrhea
among HIV-affected households in rural Uganda. Am J Trop Med Hyg. 2006
May;74(5):884-90.
Safe water systems (SWSs) have been shown to
reduce diarrhea and death. We examined the cost-effectiveness of SWS for
HIV-affected households using health outcomes and costs from a
randomized controlled trial in Tororo, Uganda. SWS was part of a
home-based health care package that included rapid diarrhea diagnosis
and treatment of 196 households with relatively good water and
sanitation coverage. SWS use averted 37 diarrhea episodes and 310
diarrhea-days, representing 0.155 disability-adjusted life year (DALY)
gained per 100 person-years, but did not alter mortality. Net program
costs were 5.21 dollars/episode averted, 0.62 dollars/diarrhea-day
averted, and 1,252 dollars/DALY gained. If mortality reduction had
equaled another SWS trial in Kenya, the cost would have been 11
dollars/DALY gained. The high SWS cost per DALY gained was probably
caused by a lack of mortality benefit in a trial designed to rapidly
treat diarrhea. SWS is an effective intervention whose
cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea
incidence, and effective clinical management.
Lule JR, Mermin J, Ekwaru JP, Malamba S, Downing R, Ransom R, Nakanjako
D, Wafula W, Hughes P, Bunnell R, Kaharuza F, Coutinho A, Kigozi A,
Quick R. Effect of home-based water chlorination and safe storage on
diarrhea among persons with human immunodeficiency virus in Uganda. Am J
Trop Med Hyg. 2005 Nov;73(5):926-33.
Diarrhea is frequent among
persons infected with human immunodeficiency virus (HIV) but few
interventions are available for people in Africa. We conducted a
randomized controlled trial of a home-based, safe water intervention on
the incidence and severity of diarrhea among persons with HIV living in
rural Uganda. Between April 2001 and November 2002, households of 509
persons with HIV and 1,521 HIV-negative household members received a
closed-mouth plastic container, a dilute chlorine solution, and hygiene
education (safe water system [SWS]) or simply hygiene education alone.
After five months, HIV-positive participants received daily
cotrimoxazole prophylaxis (160 mg of trimethoprim and 800 mg of
sulfamethoxazole) and were followed for an additional 1.5 years. Persons
with HIV using SWS had 25% fewer diarrhea episodes (adjusted incidence
rate ratio [IRR] = 0.75, 95% confidence interval [CI] = 0.59-0.94, P =
0.015), 33% fewer days with diarrhea (IRR = 0.67, 95% CI = 0.48-0.94, P
= 0.021), and less visible blood or mucus in stools (28% versus 39%; P <
0.0001). The SWS was equally effective with or without cotrimoxazole
prophylaxis (P = 0.73 for interaction), and together they reduced
diarrhea episodes by 67% (IRR = 0.33, 95% CI = 0.24-0.46, P < 0.0001),
days with diarrhea by 54% (IRR = 0.46, 95% CI = 0.32-0.66, P < 0.0001),
and days of work or school lost due to diarrhea by 47% (IRR = 0.53, 95%
CI = 0.34-0.83, P < 0.0056). A home-based safe water system reduced
diarrhea frequency and severity among persons with HIV living in Africa
and large scale implementation should be considered.
Tumwine JK, Kekitiinwa A, Bakeera-Kitaka S, Ndeezi G, Downing R, Feng X,
Akiyoshi DE, Tzipori S. Cryptosporidiosis and microsporidiosis in
ugandan children with persistent diarrhea with and without concurrent
infection with the human immunodeficiency virus. Am J Trop Med Hyg. 2005
Nov;73(5):921-5.
Cryptosporidium spp. and Enterocytozoon bieneusi
are enteric pathogens that have emerged as significant causes of
persistent diarrhea (PD) in immunologically compromised individuals
particularly in association with HIV/AIDS. We conducted a
cross-sectional study on the clinical epidemiology of E. bieneusi and
Cryptosporidium in children with PD, with and without HIV/AIDS,
attending Uganda's Mulago National Referral Hospital. Two hundred
forty-three children aged < 60 months, admitted between November 2002
and May 2003 with PD (> 14 days), were analyzed for HIV status and CD4
lymphocyte counts, and stools were screened for the presence of E.
bieneusi and Cryptosporidium by microscopy and positive samples
genotyped by polymerase chain reaction-restriction fragment length
polymorphism (PCR-RFLP) analysis. Eighty (32.9%) of the children were
excreting E. bieneusi, and 76 (31.3%) were excreting Cryptosporidium.
Ninety-one of the 243 children had HIV, of who 70 (76.9%) had E.
bieneusi, versus 10 (6.6%) of the 152 without (odds ratio = 47.33; 95%
CI = 19.88 to 115.97), while 67 (73.6%) had Cryptosporidium, versus 9
(5.9%) without (odds ratio = 44.36; 95% CI = 18.39 to 110.40). Children
with counts < 25% CD4 cells were more likely to have either E. bieneusi
(odds ratio = 7.42; 95% CI = 3.77 to 14.69) or Cryptosporidium (odds
ratio = 6.45; 95% CI = 3.28 to 12.76) than those with higher CD4
percentages. However, only HIV status was independently associated with
either Cryptosporidium or E. bieneusi. Among the 243 children with PD,
67 (27.8%) were infected with both enteric pathogens, with HIV being the
only independent predictor of coinfection. Finally, some 81% of
HIV-infected children with PD excreted one or both organisms, compared
with only 10% of children with PD testing negative for HIV. Seventy-four
percent of isolates were C. hominis, the anthroponotic species, 17% were
C. parvum, the zoonotic species, and 8% were a mixture of the two or
others.
Waku M, Napolitano L, Clementini E, Staniscia T, Spagnolli C, Andama A,
Kasiriye P, Innocenti P. Risk of cancer onset in sub-Saharan Africans
affected with chronic gastrointestinal parasitic diseases. Int J
Immunopathol Pharmacol. 2005 Jul-Sep;18(3):503-11.
Gastrointestinal Schistosomiasis and Amebiasis are uncommon in the
western world, while such infections are frequent in the African
community. In addition to the problems associated with the clinical
symptoms of these parasitic infections, it is important to stress the
increase in cancer of the Gastro-Intestinal (GI) tract. In this study we
evaluate the prevalence of cancer in patients affected by chronic
inflammatory diseases caused by the above named parasites. In three
years, from January 2000 to December 2003, we observed a total of 1199
subject. Of these, 950 presented with complaints of diarrhoea, vomiting,
abdominal pain, melena, hematemesis, rectal discharges and alteration of
bowel habits. A total of 818 patients were evaluated in Uganda (Mulago
and Arua hospitals) and 381 at Luisa Guidotti Hospital in Zimbabwe. An
exhaustive clinical history was collected for each patient and then
physical and laboratory examinations were performed. The clinical files
of all patients previously admitted to the respective hospitals were
obtained and the information taken from these files was then integrated
with our clinical findings. Subjects who were found free of
gastro-intestinal disease after examinations and did not have a clinical
history of infective GI disease but presented with other pathologies,
were regarded as control group. The control group was composed of 249
subjects. The subjects who were positive on examination underwent
further investigations. The number of patients affected by
schistosomiasis and amebiasis were 221 and 224 respectively. The number
of patients who suffered from aspecific enterocolitis was 454,
intestinal tuberculosis was present in 21 patients and we found 30
patients with esophageal candidiasis. Patients who had the above
mentioned GI diseases were then divided into 3 groups. First group was
composed of patients who had a clinical history of infective GI diseases
and were re-admitted for similar symptoms, and on examination were
positive for the presence of the same infective GI diseases. Such
patients were placed in the Chronic group. The second group was formed
of patients who had previously undergone treatment for infective GI
diseases but on readmission were found free of infective GI disease, and
this group was described as the Cured group. They had symptoms
associated with other pathologies. A third group, which we described as
the Acute group was composed of patients who did not have any previous
case of GI infection and were admitted for the first time. Such patients
were found positive on examination for infective GI diseases. In the 950
patients, we found a total of 45 tumors. The tumors were prevalent (42
tumors) in the chronic group. In 34 patients the tumor was in the
colo-rectal region, in 3 patients in the stomach, in 4 patients in the
esophagus and 1 patient had cancer in the small bowel. Our results show
a strong association between the chronic infection of the GI tract and
the likelihood to develop tumors. However, it is not clear which
biological mechanisms are implicated in such transformations. They may
depend on the chronic inflammation of the GI mucous which permits the
entrance of carcinogenic materials or on the effects of mutagenic
products produced by the parasites or both.
Mbonye AK. Risk factors for diarrhoea and upper respiratory tract
infections among children in a rural area of Uganda. J Health Popul
Nutr. 2004 Mar;22(1):52-8.
This study explored risk factors
associated with diarrhoea and upper respiratory tract infections (URTIs)
among children in Sembabule district, Uganda. Data were collected from
300 women with children aged less than two years using the WHO
30-cluster sampling technique. The prevalence of diarrhoea among
children was 40.3%. A child not immunized (odds ratio [OR] 2.8, p <
0.001), absence of latrine in a house (OR 1.4, p < 0.03), low knowledge
of mixing oral rehydration salts (OR 1.7, p < 0.01), garbage thrown
anywhere around the house (OR 2.6, p < 0.001), not washing hands after
using latrine (OR 1.8, p < 0.03), and not washing hands before preparing
food (OR 1.4, p < 0.04) were risk factors for diarrhoea. The prevalence
of URTIs among children was 37.4%. A child not immunized (OR 2.4, p <
0.001), children aged 6-11 months (OR 2.1, p < 0.03), and previous
episode of diarrhoea (OR 2.5, p < 0.001) were risk factors for URTIs.
The results showed that low immunization status was an important risk
factor for diarrhoea and URTIs among children in the study district of
Uganda. For 75% of the children, care for fever was obtained from drug
shops, while 9.2% were taken to health units. This is in contrast to
diarrhoea cases where 49.5% of children were taken to health units for
care. To reduce the burden of disease among children in this district,
an integrated package of immunization services and other childcare
programmes need to be implemented in addition to improved personal and
environmental hygiene. There is also a need to design well-focused
health-education messages to improve treatment-seeking behaviour for
childhood diseases.
Bitarakwate E, Mworozi E, Kekitiinwa A. Serum zinc status of children
with persistent diarrhoea admitted to the diarrhoea management unit of
Mulago Hospital, Uganda. Afr Health Sci. 2003 Aug;3(2):54-60.
INTRODUCTION: Despite great advances in the management of diarrhoeal
diseases, persistent diarrhoea remains a major problem in developing
countries due to its syndromic nature. Zinc depletion ranks high among
the factors contributing to the detrimental effects of persistent
diarrhoea on the human body. This however, has not been investigated in
the Ugandan population. OBJECTIVE: To determine the serum zinc status of
children with persistent diarrhoea. DESIGN: Cross-sectional descriptive
study. METHODS: Children aged 6-36 months with persistent diarrhoea were
enrolled from the diarrhoea management unit of Mulago hospital.
Socio-demographic and morbidity data were collected, and laboratory
investigations were carried out after recruitment. Healthy children of
similar age and sex were recruited to determine reference levels of
serum zinc for comparison. RESULTS: The mean serum zinc level in the
children with persistent diarrhoea was 5.83mol/l while that of children
without diarrhoea was 8.99mol/l with no age or sex difference. The serum
zinc concentration of children with persistent diarrhoea was
significantly lower than that of children without diarrhoea (p<0.001).
The prevalence of zinc deficiency in children with persistent diarrhoea
was 47.9%. Of the children with persistent diarrhoea, 64 (66.7%) were
stunted, wasted or both. However no significant association was observed
between nutritional status and serum zinc levels. Only hypoproteinaemia
was significantly associated with serum zinc levels in these children
(p=0.03). CONCLUSION: There is a high prevalence of zinc deficiency and
malnutrition among Ugandan children with persistent diarrhoea.
Tumwine JK, Kekitiinwa A, Nabukeera N, Akiyoshi DE, Rich SM, Widmer G,
Feng X, Tzipori S. Cryptosporidium parvum in children with diarrhea in
Mulago Hospital, Kampala, Uganda. Am J Trop Med Hyg. 2003
Jun;68(6):710-5.
A cross-sectional case-control study (ratio =
3:1) was conducted over a 15-month period to determine the prevalence
and consequences of cryptosporidiosis in hospitalized diarrheic children
(0-5 years old) at Mulago Hospital in Kampala, Uganda. Cryptosporidium
parvum was detected and genotyped among 2,446 children of whom 1,779
(72.7%) had diarrhea, and 667 (27.3%) were age- and sex-matched
controls. Of the 1,779 children with diarrhea, 532 (29.9%) had
persistent (> 14 days) diarrhea and 1,247 (70.1%) had acute diarrhea.
Overall, 444 (25.0%) of the 1,779 children with diarrhea had C. parvum,
compared with only 57 (8.5%) of the 667 children without diarrhea (chi2
= 80.2, P < or = 0.0001). Within this group of infected children, 72.8%
were infected with genotype 1, 18.4% with genotype 2, and 4.1% with a
mixture of both genotypes, and 4.1% isolates were either unclassified or
C. meleagridis. The prevalence was highest during the rainy months of
April to June. Of the 532 children with persistent diarrhea, 166 (31.2%)
had C. parvum compared with 278 (22.3%) of the 1,247 children with acute
diarrhea (chi2 = 15.8, P < or = 0.0001). There was a significant
association between C. parvum and malnutrition including stunting, being
underweight, and wasting. Unfavorable outcome (death or failure to
resolve within 14 days) occurred in 139 (72.8%) of the 191 children with
C. parvum, and in only 65.1% of the 545 without (odds ratio = 1.117, 95%
confidence interval = 1.005-1.243, P = 0.05), Of the 191 children with
C. parvum, 24 (12.6%) died, compared with 34 (6.2%) of the 545 without
C. parvum (P = 0.005). Mortality rates were higher among children with
severe dehydration and persistent diarrhea, and in stunted or
underweight children infected with C. parvum. Among Ugandan children,
cryptosporidiosis, which remains untreatable, is frequently associated
with diarrhea and other serious and unfavorable consequences.
Tumwine JK, Kekitiinwa A, Nabukeera N, Akiyoshi DE, Buckholt MA, Tzipori
S. Enterocytozoon bieneusi among children with diarrhea attending Mulago
Hospital in Uganda. Am J Trop Med Hyg. 2002 Sep;67(3):299-303.
The prevalence of Enterocytozoon bieneusi in the general population is
unknown. Using genetic tools, we investigated its prevalence and
contribution to diarrhea and malnutrition in hospitalized children in
Uganda. A cross-sectional, case-control study involving diarrheic
children who were matched for age and sex (3:1) with control children.
Measurements included anthropometry and clinical assessment. A total of
17.4% of 1,779 children with diarrhea were infected with E. bieneusi
compared with 16.8% of 667 control children (CHI2 = 0.137, P = 0.712).
Prevalence was highest during the rainy seasons. There was no
significant relationship between infection with E. bieneusi and
stunting, being underweight, wasting, or acute diarrhea. However,
children who were E. bieneusi-positive by a polymerase chain reaction
(PCR) had diarrhea for a longer period (15.15 versus 9.67 days; F =
12.02; P = 0.001) compared with children who were either uninfected or
were E. bieneusi-positive by a nested PCR. We conclude that E. bieneusi
is widespread among children 3-36 months of age in Uganda, and that in a
cross-sectional study, there was no clear association of E. bieneusi
with poor nutrition or diarrhea. Since E. bieneusi is closely linked
with persistent diarrhea and wasting in adults who are positive for
human immunodeficiency virus/acquired immunodeficiency syndrome
(HIV/AIDS), the outcome of follow-up studies involving children who are
HIV/AIDS-positive and severely malnourished children may be entirely
different and warrants further study.
Kelly P. Diarrhoea and AIDS: recent developments in the African setting.
Afr Health. 1998 Sep;20(6):16-8.
PIP: Acute diarrhea refers to
diarrhea which persists for less than 2 weeks duration, while persistent
diarrhea lasts for longer than 2 weeks. Recurrent and frequent attacks,
such as may be experienced among people with AIDS, often seem to be one
long episode of persistent diarrhea. Since acute and persistent diarrhea
have different causes and treatments, it is important to ask patients
with diarrhea when the diarrhea first began. Studies from Zaire, the
Central African Republic, Uganda, and Tanzania suggest that 40-80% of
people with AIDS will suffer from persistent diarrhea at some stage. The
etiology of diarrhea in AIDS, treatment, and prevention are discussed
based upon the author's experience working in Lusaka. Progress has been
slow in addressing problems relevant to people with AIDS in sub-Saharan
Africa and much remains to be learned in preventing and treating such
diseases.
Tumwine JK, Thompson J, Katua-Katua M, Mujwajuzi M, Johnstone N, Porras
I. Diarrhoea and effects of different water sources, sanitation and
hygiene behaviour in East Africa. Trop Med Int Health. 2002
Sep;7(9):750-6.
Apart from "Drawers of Water (DOW I)" published
in 1972, there have been only a handful of published studies on domestic
water use and environmental health in East Africa, based on direct
observations or other reliable research methods. The objective of this
study was to carry out a repeat analysis of domestic water use and
environmental health in East Africa based on DOW I. The study was
conducted in the same sites as DOW I. Field assistants spent at least 1
day in each household observing and conducting semi-structured
interviews. They measured the amount of water collected, recorded the
amount of water used in the home, and noted household socio-demographic
characteristics, prevalence of diarrhoea, state and use of latrines,
sources of water and conditions of use. We surveyed 1015 households in
33 sites in Uganda, Tanzania and Kenya in 1997. From 1967 to 1997, the
prevalence of diarrhoea, in the week preceding the survey, increased
from 6% to 18% in Kenya and from 16% to 21% in Uganda; it declined
slightly in Tanzania (11-8%). Determinants of diarrhoea morbidity
included poor hygiene (unsafe disposal of faeces and wastewater),
education level of household head, obtaining water from surface sources
or wells and per capita water used for cleaning. Hygiene practices are
an important complement to improved water and sanitation in reducing
diarrhoea morbidity.
Brink AK, Mahé C, Watera C, Lugada E, Gilks C, Whitworth J, French N.
Diarrhea, CD4 counts and enteric infections in a community-based cohort
of HIV-infected adults in Uganda. J Infect. 2002 Aug;45(2):99-106.
OBJECTIVES: To examine relationships between diarrhoea, CD4 cell counts
and stool pathogens in a community-based cohort of HIV-infected adults
in Uganda. PATIENTS AND METHODS: Stool specimens, obtained between
October 1995 and December 1997, were linked to patients' symptoms and
laboratory results. The relationship between CD4 counts and symptoms was
tested using the Wilcoxon rank-sum test and those between organisms and
diarrhoea using first a univariate Mantel-Haenszel analysis and then a
logistic regression model adjusted for CD4 count and multiple organisms.
RESULTS: 1,213 HIV-infected individuals (70% women, median CD4 cell
count at enrollment 215 cells/microl) were followed for 1,224 person
years of observation (pyo). 484 stool samples were examined, 357 from
patients with diarrhoea. The rate of diarrhoea was 661 episodes per
1,000 pyo. CD4 counts were significantly lower in individuals with
diarrhoea than those without (P < 0.001, Wilcoxon rank-sum test).
Forty-nine percent of diarrhoeal stools and 39% of stools from
asymptomatic patients contained enteric pathogens. The most frequent
isolates were helminths (29.5% of all stools), followed by bacteria
(19.2%) and then protozoa (8.9%). Rates of isolation of
diarrhoea-associated pathogens were 29% from diarrhoeal stools and 17%
from asymptomatic stools (P = 0.01, chi(2) test). The association
between diarrhoea and infection with bacteria or protozoa was weak and
there was no association with helminths.Cryptosporidium parvum infection
alone was associated with low CD4 counts. CONCLUSIONS: Diarrhoea was
common and most strongly associated with low CD4 counts. Bacteria were
frequently found, even in stools from asymptomatic individuals. Over
two-thirds of diarrhoeal episodes were undiagnosed, suggesting that
unidentified agents or primary HIV enteropathy are important causes of
diarrhoea in this population.
Kaddu-Mulindw DH, Aisu T, Gleier K, Zimmermann S, Beutin L. Occurrence
of Shiga toxin-producing Escherichia coli in fecal samples from children
with diarrhea and from healthy zebu cattle in Uganda. Int J Food
Microbiol. 2001 May 21;66(1-2):95-101.
Fecal samples collected
from 237 diarrheic infants in Kampala, Uganda and from 159 healthy
cattle from a ranch in the Central Region of Uganda were investigated
for the presence of Escherichia coli O157 and other types of Shiga
toxin-producing E. coli (STEC). E. coli O157 were not detected in 150
stool samples from children which were cultivated on sorbitol MacConkey
agar. A search for all types of STEC performed on 87 additional human
stool samples with an enzyme-immunoassay for Shiga toxins (Premier EHEC)
was also negative. Forty-two stool samples from infants were
additionally investigated for enteropathogenic E. coli (EPEC) by
DNA-hybridization with an eae-specific gene probe. Compared to STEC,
EPEC were frequent and found in six (14.3%) of these 42 randomly
selected stool specimens. We were further interested in the role of
cattle as a reservoir for STEC in Uganda. STEC were isolated from 45 of
159 cattle from a herd in the Central Region of Uganda. STEC strains
from cattle belonged to 16 different O- and nine different H-types and
nine O:H types were identical to those found in bovine STEC from other
continents. Only one bovine STEC strain was positive for the eae-gene,
and O-groups associated with enterohemorrhagic E. coli (EHEC) types
(O26, O103, O111, O145 and O157) were not found. Our report demonstrates
that STEC are not frequent in urban children in Uganda, but domestic
cattle were identified as an important natural reservoir for these
organisms in this country.
Nasinyama GW, McEwen SA, Wilson JB, Waltner-Toews D, Gyles CL,
Opuda-Asibo J. Risk factors for acute diarrhoea among inhabitants of
Kampala District, Uganda. S Afr Med J. 2000 Sep;90(9):891-8.
OBJECTIVE: To identify modifiable individual and household risk factors
for diarrhoea among people of all ages in Kampala district, Uganda.
DESIGN: A cross-sectional, analytical study. SETTING: Multi-stage
sampling. Four purposively selected parishes, two each from low and high
socio-economic residential areas in Kampala district. Two randomly
selected zones per parish with 60 households randomly selected from each
zone. STUDY GROUP: All members present in each household at time of
study. Individual and household information collected by means of
personal interview using a questionnaire. MAIN OUTCOME MEASURES: Odds of
diarrhoea among individuals or households exposed to a study factor
compared with the odds of diarrhoea among those not exposed to the
factor. RESULTS: Drinking raw chicken eggs was significantly (P < 0.01)
and strongly (odds ratio (OR) = 99) associated with diarrhoea among
residents of Kampala district. The odds of diarrhoea in households that
'cooked just enough food per meal' was significantly less (OR = 0.42)
than in those that did not. People who used municipal water supplies and
those who boiled their drinking water were significantly less likely (OR
= 0.27, OR = 0.33, respectively) than those who used other water sources
and/or who did not boil drinking water to report an episode of diarrhoea
in the 2 weeks preceding the survey. The odds of diarrhoea were 2.6
times greater for individuals who reported a pest problem than for those
who did not, while keeping pets was found to be protective (OR = 0.43).
The number of income earners was also significantly (P < 0.5) and
negatively (OR = 0.59) associated with the occurrence of diarrhoea in a
member of the household. CONCLUSIONS: The findings of this study
underscore the importance of proper food handling, preparation and
eating habits as well as safe water, sanitation practices and
socio-economic factors in the epidemiology of diarrhoea in developing
countries.
Katabira ET. Epidemiology and management of diarrheal disease in
HIV-infected patients. Int J Infect Dis. 1999 Spring;3(3):164-7.
Diarrhea is the most common gastrointestinal symptom in human
immunodeficiency virus (HIV) infection. It affects up to 90% of
patients, becoming more frequent and severe as the immune system
deteriorates. It often is associated with significant morbidity and
mortality particularly in the developing countries. Gastrointestinal
infections, some of which are attributable to inadequate sanitation and
poor hygiene are the predominant cause of diarrhea, although multiple
medications, including traditional herbs, also may be causes. The basic
principles of management include detection of treatable causes, relief
of symptoms, prevention of malnutrition, and psychosocial support. In up
to 60% of cases, no cause can be identified, partly because of
inadequate investigative facilities. Symptomatic treatment is the
mainstay of management particularly when no cause can be identified.
Unfortunately this can be extremely difficult when the patient is
severely immune-suppressed. There is poor response to motility control
drugs, such as loperamide, and others, such as octreotide, are too
expensive. Fluid replacement should be started early to prevent
excessive dehydration. This should be combined with nutritional support
to prevent malnutrition. Psychosocial support, including counselling,
for both the patient and the caring relatives, is required to alleviate
anxiety, particularly when the diarrhea becomes intractable.
Murphy B, Taylor C, Crane R, Okong P, Bjarnason I. Comparison of
intestinal function in human immunodeficiency virus-seropositive
patients in Kampala and London. Scand J Gastroenterol. 1999
May;34(5):491-5.
BACKGROUND: White homosexual men with human
immunodeficiency virus (HIV) show progressive impairment of intestinal
function assessed in terms of intestinal permeability and absorptive
capacity. In this study we aimed to determine the effects of
heterosexually acquired HIV on small-intestinal function in native
Africans, among whom there is a high prevalence of tropical enteropathy.
METHODS: Intestinal absorptive capacity (using 3-O-methyl-D-glucose,
D-xylose, and L-rhamnose) and permeability (differential 5-h urinary
excretion of lactulose/L-rhamnose) were assessed in healthy white (n =
57) and black (n = 14) controls in London, apparently healthy black
Africans in Kampala, Uganda (n = 26), HIV-infected patients with (n = 9)
and without (n = 30) diarrhoea in Kampala, and 39 white homosexual men
with HIV in London who were stratified to resemble the African patient
group. RESULTS: Intestinal integrity and absorptive capacity were
significantly (P < 0.01) impaired in both black controls in London and
apparently healthy black Africans, compared with white controls.
HIV-infected white and black patients without diarrhoea did not differ
significantly from white and black African controls, respectively, with
the exception of increased intestinal permeability among the white
patients. White and black African patients with HIV/acquired
immunodeficiency syndrome (AIDS) and diarrhoea were found to have marked
malabsorption and increased intestinal permeability. Although the
relative increase in intestinal permeability was similar in the two
groups, by far the largest values for intestinal permeability were found
among black Africans with HIV/AIDS and diarrhoea. CONCLUSIONS: Whites
and blacks differ with regard to intestinal barrier function.
HIV-positive black Africans without gastrointestinal symptoms differ
insignificantly from white Londoners with homosexually acquired disease,
whereas those with gastrointestinal symptoms have markedly abnormal
indices of small-intestinal function with severely comprised intestinal
integrity.
WHO documents and publications
Edited by Giovanna Stancanelli and Aldo Campana,