Diarrhea remains a major health issue in developing countries, with high morbidity and mortality rates. Determining the incidence of acute diarrhea in children and its associated factors is crucial to the planning of preventive approaches. The objective of this study was to determine the incidence of diarrhea and to assess some relevant associated factors to it in children younger than 40 months living in two slums of Salvador, Brazil. This is the first prospective cohort, community-based study that was performed in two periurban slums of Salvador, Brazil. Eightyfour children younger than 40 months were randomly selected and visited every other day for one year. The chisquare test was used to evaluate the occurrence of diarrhea and its associated factors. During the surveillance period, 232 diarrhea episodes were identified, resulting in an incidence rate of 2.8 episodes/child/year. In average (mean value of 84 children),each child suffered 11.1 days of diarrhea per year, yielding an average duration of 3.9 days per episode. The highest incidence rates were found among children under one year old. Early weaning, male sex, malnutrition, having a mother younger than 25 years or who considered her child malnourished, missed immunizations and previous pneumonia were associated factors for suffering diarrheal episodes. The rates of incidence and duration of diarrhea that we found are in accordance to those reported by others. Additionally, our results reinforce the importance of environmental and health-related associated factors to the onset of diarrhea.
A PCR technique to differentiate pathogenic enteric Escherichia coli strains in a field setting was evaluated. Among 76 children with acute diarrhea, this technique identified 12 children (16%) with enterotoxigenic E. coli, 6 (8%) with enteropathogenic E. coli, and 1 (1%) with enteroinvasive E. coli infection. Compared with the conventional assays, the PCR method proved to be simpler, more rapid, and inexpensive and therefore suitable for application in a developing-country field setting. Diarrheal disease remains a major public health problem in developing countries (25). Escherichia coli strains are among the most important bacterial causes of childhood diarrhea. At least five categories of diarrheagenic E. coli strains are recognized on the basis of distinct epidemiological and clinical features, specific virulence determinants, and association with certain serotypes (12, 15). Because of the costly and laborintensive diagnostic procedures, the epidemiology of E. coli infections remains obscure in many parts of the world. This study was undertaken to evaluate the application of a PCRbased test to differentiate E. coli isolates and determine their distribution among children with and without diarrhea. The study was conducted at Hospital Infantil of the Federal University of Bahia in Salvador de Bahia, Brazil. From 1 June to 31 August 1993, all children under 5 years of age with acute diarrhea who were brought to the hospital ambulatory clinic in the afternoon, Monday through Friday, were enrolled in the study. Two rectal swabs were collected from each child, placed in Cary-Blair transport medium, and processed within 4 h. One swab was processed by routine microbiological and biochemical tests to identify E. coli, Salmonella spp., Shigella spp., and Campylobacter jejuni, while the second swab was stored in 2 ml of phosphate-buffered saline (pH 7.4) at 4ЊC until tested for rotavirus by enzyme immunoassay (EIA) (LMD Laboratories, Inc., Carlsbad, Calif.). Fecal samples and/or rectal swab specimens were obtained for detection of Cryptosporidium parvum by enzyme-linked immunosorbent assay (ELISA) (Alexon Inc., Sunnyvale, Calif., and LMD Laboratories, Inc.). Three to six lactose-fermenting colonies and up to three lactose-negative colonies from each child were selected from MacConkey plates to be tested by conventional and PCR procedures. A total of 239 isolates were obtained from the 76 children and stored on tryptic soy agar (Difco Laboratories, Detroit, Mich.) gridplates for later testing by reference virulence assays. In addition, 43 isolates from 16 children without diarrhea were tested as controls.
Several methodological issues may have an impact on the incidence rates of childhood acute diarrhea reported by community-based studies. This study was performed to assess the impact of parental recall ability and definition of diarrhea on the estimate of incidence of acute diarrhea. Eighty-four children younger than 40 months were randomly selected and visited every other day for four weeks and the occurrence of diarrhea was registered. On the last day of the study, another visit was performed and the informants were inquired about the occurrence of diarrhea during the previous four weeks. Data gathered during the four weeks were compared to those obtained on the last visit. Additionally, the informants' definition of diarrhea was investigated and compared to the one adopted by this study. During the observation period, 33 children suffered diarrhea, but only 10 (30.3%) informants reported the occurrence of diarrhea. Although 42.4% of those informants reported that their children had been ill over that period, they did not report diarrhea. Further, 60.6% children who had diarrhea suffered at least one episode in the two weeks prior to the visitation. The same definition of diarrhea used in this study was adopted by 52.1% of the informants inquired. Parental recall is an unreliable method to estimate the incidence of diarrhea and studies with a short interval between the visits should be necessary to correctly evaluate this important health problem. Moreover, assessing the informants' own definition of diarrhea is a significant contribution to the interpretation of the results.
Knowledge about hepatotropic viruses is crucial for pediatricians because of the high prevalence of viral hepatitis during childhood. The multiplicity of hepatotropic viruses, the spectrum of acute and chronic infections, and the sequels of viral hepatitis result in a need for physicians to better understand the clinical and epidemiological context of patients with viral hepatitis, as well as the importance of prevention measures for hepatitis. A descriptive cross-sectional study was made of pediatrician's knowledge about viral hepatitis, through questionnaires to 574 pediatricians, with no obligation of identification. The pediatricians were recruited among those who attended a national Congress of Pediatrics in Brasília, Brazil. Among these pediatricians, 50.1% frequently treated cases of hepatitis, and 74.7% indicated that they had knowledge of the existence of five hepatotropic viruses; 14.5% knew about at least four types of hepatitis complications, while only 7.7% and 4.3% were able to correctly diagnose viral hepatitis A and B, respectively. Many (28.4%) did not know how to treat the patients adequately. Only 37.5% had already recommended vaccination against hepatitis B. Only 50.2% of the pediatricians had been vaccinated against hepatitis B. We concluded that it is crucial to make pediatricians more knowledgeable about viral hepatitis, through continued education programs, especially emphasizing prevention procedures.
Hepatitis A is one of the most frequent infectious liver diseases affecting children worldwide. The disease is usually mild and self-limited, and complications are very rare. Nevertheless, hepatitis A can sometimes cause acute liver failure (ALF), a severe, life-threatening condition. Herein is reported a case of a child who presented ALF during a course of hepatitis A. The need for early identification of possible ALF cases among hepatitis A patients, and for effective ways of evaluating such a possibility, are discussed. We also emphasize the importance of prevention measures, especially vaccination.
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