In order to update global estimates of diarrhoeal morbidity and mortality in developing countries, we carried out a review of articles published from 1980 to the present and calculated median estimates for the incidence of diarrhoea and diarrhoeal mortality among under-5-year-olds The incidence of diarrhoea obtained (26 episodes per child per year) was virtually the same as that estimated by Snyder & Merson in 1982, while the global mortality estimate was lower (33 million deaths per year; range, 15-51 million) The mortality estimate is based on a small number of active surveillance and prospective studies, and thus associated with a large degree of uncertainty, reflecting the weakness of the global database However, many surveys reporting reductions in mortality in several locations are consistent with a decreased estimate for mortality More accurate execution of WHO survey methods, including population-based sampling in representative locations, and repeat surveys every 5 years, are needed to monitor the progress of diarrhoeal disease control programmes and trends in diarrhoeal morbidity and mortality over time

The magnitude of the global problem of diarrhoeal disease: a ten-year update.

OBJECTIVE: The major objective of this study is to provide estimates of diarrhoea mortality at country, regional and global level by employing the Child Health Epidemiology Reference Group (CHERG) standard. METHODS: A systematic and comprehensive literature review was undertaken of all studies published since 1980 reporting under-5 diarrhoea mortality. Information was collected on characteristics of each study and its population. A regression model was used to relate these characteristics to proportional mortality from diarrhoea and to predict its distribution in national populations. FINDINGS: Global deaths from diarrhoea of children aged less than 5 years were estimated at 1.87 million (95% confidence interval, CI: 1.56-2.19), approximately 19% of total child deaths. WHO African and South-East Asia Regions combined contain 78% (1.46 million) of all diarrhoea deaths occurring among children in the developing world; 73% of these deaths are concentrated in just 15 developing countries. CONCLUSION: Planning and evaluation of interventions to control diarrhoea deaths and to reduce under-5 mortality is obstructed by the lack of a system that regularly generates cause-of-death information. The methods used here provide country-level estimates that constitute alternative information for planning in settings without adequate data.

/pdf/estimating-child-mortality-due-to-diarrhoea-in-developing-2grufk5e33.pdf

Estimating child mortality due to diarrhoea in developing countries

In recent years significant progress has been made in understanding the ecology, epidemiology and related morbidity and development of new tools for the control of soil-transmitted helminths. Such knowledge has recognized the impact of helminth infections on the health of infected groups and has created a rational basis for their control. Schoolchildren harbour some of the most intense helminthic infections, which produce adverse effects on health, growth and scholastic performance. However, although great effort has been put into targeting school-age children, women of child-bearing age and pre-school children are two other groups at high risk of morbidity due to intestinal nematode infections. Highly effective and safety-tested, single-dose anthelminthic drugs are now available, permitting periodical deworming of schoolchildren and other high-risk groups at affordable prices. Four anthelminthics against all intestinal nematodes are included in the WHO Essential Drug List (albendazole, levamisole, mebendazole and pyrantel). Recently ivermectin has also been registered for use against Strongyloides stercoralis in humans. Several well-monitored country experiences have shown that chemotherapy-based control of morbidity due to soil-transmitted helminths is possible and highly cost-effective.

Control strategies for human intestinal nematode infections

The dynamics of drug resistance in Plasmodium falciparum

Ivermectin is highly effective against animal intestinal nematodes and is used in the treatment of onchocerciasis in humans. A study was undertaken to compare the efficacy of the drug with that of albendazole in the treatment of uncomplicated strongyloidiasis. Sixty patients with confirmed Strongyloides stercoralis infection were enrolled in an open randomized study and given either albendazole, 400 mg/d for 3 d or ivermectin, 150-200 micrograms/kg in a single dose. Efficacy and tolerance were evaluated on days 7, 30 and 90. Each visit included a parasitological examination of 3 stool specimens, using saline and Kato smears and formalin-ether and Baermann concentrations. Fifty-three patients were eligible for evaluation. Parasitological cure was obtained in 24 of the 29 patients treated with ivermectin (83%) and in 9 of the 24 patients who were given albendazole (38%); ivermectin was significantly more effective than albendazole (P < 0.01). Clinical and biological adverse reactions were negligible in both treatment groups. The 20 patients who failed therapy were given a second treatment course with 150-200 micrograms/kg of ivermectin in a single dose or on 2 consecutive days. Sixteen patients were cured and the other 4 had only incomplete follow-up. Ivermectin therefore constitutes an acceptable therapeutic alternative for uncomplicated strongyloidiasis.

Treatment of Strongyloides stercoralis infection with ivermectin compared with albendazole: results of an open study of 60 cases

The prevalence and the principal epidemiological characteristics of pityriasis versicolor have been studied in a randomized population of 870 adult individuals (418 males and 452 females) in the Central African Republic. The general clinical prevalence was 16·6%. Males were affected more often than females (20·6% vs. 12·9%). For both sexes, the maximum prevalence was in the 15 to 25-year-old age groups (23·5%). Lesions commonly occurred over the face (49·3%) and upper trunk (48·6%). Different climatic areas within the country, type of urbanization, religion and general hygiene showed no relevance to the disease. The prevalence was higher among people living in rammed-earth houses than in people living in hard-built houses. The sebaceous activity of the skin, a feature which is racially and genetically determined, probably constitutes a primary factor for developing this mycosis, associated with the tropical climate as an additional environmental factor.

Pityriasis versicolor in the Central African Republic: a randomized study of 144 cases.

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.

Diarrheal morbidity and mortality in children in the Central African Republic.

To describe and evaluate the frequency of neurological and psychiatric manifestations in African patients with AIDS 93 inpatients at the National Hospital Center Bangui were chosen according to the WHO clinical definition of AIDS and were confirmed to be HIV-1 positive (92- 93) or HIV-2 positive (1/93) by Western blot. Patients were given both neurologic and psychiatric examinations. Corticospinal fluid (CSF) analysis was performed in cases where there were neuropsychiatric signs. 11 patients demonstrated neurologic symptoms: 5 had focal processes associated in 2 cases with deep coma 4 had cryptococcal meningitis 1 had peripheral facial paralysis and 1 had abnormal movements. 4 patients presented with clear psychiatric symptoms and CSF analysis was only helpful in the etiologic diagnosis of cryptococcal infection. The mortality rate in these 15 patients was 60% over the course of the 2- month study. In this series neurologic and/or psychiatric symptoms were detected in 16% (15 of 93) of African patients with AIDS. (authors modified) (summaries in FRE ENG)

Manifestations neurologiques et psychiatriques du SIDA en République Centrafricaine

In Bangui (Central African Republic) an epidemiological survey making use of cluster sampling has been performed. Prevalence rate is not very high in Bangui (3.4%). Boys are more infected than girls. Both in rural and urban area prevalence rates are decreasing with age. Microsporum langeronii has been identified in 98% of case.

Epidemiology of Tinea capitis in Bangui (Central African Republic)

Emergence of multiresistant Plasmodium falciparum malaria in Central African Republic

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