Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study
- PMID: 23680352
- DOI: 10.1016/S0140-6736(13)60844-2
Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study
Abstract
Background: Diarrhoeal diseases cause illness and death among children younger than 5 years in low-income countries. We designed the Global Enteric Multicenter Study (GEMS) to identify the aetiology and population-based burden of paediatric diarrhoeal disease in sub-Saharan Africa and south Asia.
Methods: The GEMS is a 3-year, prospective, age-stratified, matched case-control study of moderate-to-severe diarrhoea in children aged 0-59 months residing in censused populations at four sites in Africa and three in Asia. We recruited children with moderate-to-severe diarrhoea seeking care at health centres along with one to three randomly selected matched community control children without diarrhoea. From patients with moderate-to-severe diarrhoea and controls, we obtained clinical and epidemiological data, anthropometric measurements, and a faecal sample to identify enteropathogens at enrolment; one follow-up home visit was made about 60 days later to ascertain vital status, clinical outcome, and interval growth.
Findings: We enrolled 9439 children with moderate-to-severe diarrhoea and 13,129 control children without diarrhoea. By analysing adjusted population attributable fractions, most attributable cases of moderate-to-severe diarrhoea were due to four pathogens: rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli producing heat-stable toxin (ST-ETEC; with or without co-expression of heat-labile enterotoxin), and Shigella. Other pathogens were important in selected sites (eg, Aeromonas, Vibrio cholerae O1, Campylobacter jejuni). Odds of dying during follow-up were 8·5-fold higher in patients with moderate-to-severe diarrhoea than in controls (odd ratio 8·5, 95% CI 5·8-12·5, p<0·0001); most deaths (167 [87·9%]) occurred during the first 2 years of life. Pathogens associated with increased risk of case death were ST-ETEC (hazard ratio [HR] 1·9; 0·99-3·5) and typical enteropathogenic E coli (HR 2·6; 1·6-4·1) in infants aged 0-11 months, and Cryptosporidium (HR 2·3; 1·3-4·3) in toddlers aged 12-23 months.
Interpretation: Interventions targeting five pathogens (rotavirus, Shigella, ST-ETEC, Cryptosporidium, typical enteropathogenic E coli) can substantially reduce the burden of moderate-to-severe diarrhoea. New methods and accelerated implementation of existing interventions (rotavirus vaccine and zinc) are needed to prevent disease and improve outcomes.
Funding: The Bill & Melinda Gates Foundation.
Copyright © 2013 Elsevier Ltd. All rights reserved.
Comment in
-
Diarrhoea in children: identifying the cause and burden.Lancet. 2013 Jul 20;382(9888):184-6. doi: 10.1016/S0140-6736(13)60941-1. Epub 2013 May 14. Lancet. 2013. PMID: 23680351 No abstract available.
-
Diarrhoea: Tackling the problem of moderate-to-severe diarrhoea in developing countries.Nat Rev Gastroenterol Hepatol. 2013 Jul;10(7):384. doi: 10.1038/nrgastro.2013.98. Epub 2013 May 28. Nat Rev Gastroenterol Hepatol. 2013. PMID: 23712312 No abstract available.
Similar articles
-
The incidence, aetiology, and adverse clinical consequences of less severe diarrhoeal episodes among infants and children residing in low-income and middle-income countries: a 12-month case-control study as a follow-on to the Global Enteric Multicenter Study (GEMS).Lancet Glob Health. 2019 May;7(5):e568-e584. doi: 10.1016/S2214-109X(19)30076-2. Lancet Glob Health. 2019. PMID: 31000128 Free PMC article.
-
Diarrhoeal disease and subsequent risk of death in infants and children residing in low-income and middle-income countries: analysis of the GEMS case-control study and 12-month GEMS-1A follow-on study.Lancet Glob Health. 2020 Feb;8(2):e204-e214. doi: 10.1016/S2214-109X(19)30541-8. Epub 2019 Dec 18. Lancet Glob Health. 2020. PMID: 31864916 Free PMC article.
-
Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: a reanalysis of the GEMS case-control study.Lancet. 2016 Sep 24;388(10051):1291-301. doi: 10.1016/S0140-6736(16)31529-X. Lancet. 2016. PMID: 27673470 Free PMC article.
-
Global burden of diarrheal diseases among children in developing countries: Incidence, etiology, and insights from new molecular diagnostic techniques.Vaccine. 2017 Dec 14;35(49 Pt A):6783-6789. doi: 10.1016/j.vaccine.2017.07.036. Epub 2017 Jul 29. Vaccine. 2017. PMID: 28765005 Review.
-
Vaccines for viral and bacterial pathogens causing acute gastroenteritis: Part II: Vaccines for Shigella, Salmonella, enterotoxigenic E. coli (ETEC) enterohemorragic E. coli (EHEC) and Campylobacter jejuni.Hum Vaccin Immunother. 2015;11(3):601-19. doi: 10.1080/21645515.2015.1011578. Hum Vaccin Immunother. 2015. PMID: 25715096 Free PMC article. Review.
Cited by
-
A Multidisciplinary Approach in the Management of Infectious Diarrhea in the Emergency Department.Cureus. 2024 Aug 26;16(8):e67788. doi: 10.7759/cureus.67788. eCollection 2024 Aug. Cureus. 2024. PMID: 39323695 Free PMC article.
-
Harnessing non-standard nucleic acids for highly sensitive icosaplex (20-plex) detection of microbial threats.medRxiv [Preprint]. 2024 Sep 10:2024.09.09.24313328. doi: 10.1101/2024.09.09.24313328. medRxiv. 2024. PMID: 39314929 Free PMC article. Preprint.
-
Host-derived CEACAM-laden vesicles engage enterotoxigenic Escherichia coli for elimination and toxin neutralization.Proc Natl Acad Sci U S A. 2024 Sep 17;121(38):e2410679121. doi: 10.1073/pnas.2410679121. Epub 2024 Sep 12. Proc Natl Acad Sci U S A. 2024. PMID: 39264739 Free PMC article.
-
Factors associated with antibiotic use in children hospitalized for acute viral gastroenteritis and the relation to rotavirus vaccination.Hum Vaccin Immunother. 2024 Dec 31;20(1):2396707. doi: 10.1080/21645515.2024.2396707. Epub 2024 Sep 9. Hum Vaccin Immunother. 2024. PMID: 39248509 Free PMC article.
-
Gut microbiota patterns associated with duration of diarrhea in children under five years of age in Ethiopia.Nat Commun. 2024 Sep 2;15(1):7532. doi: 10.1038/s41467-024-51464-w. Nat Commun. 2024. PMID: 39223134 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical