Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study.
Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study.
复制标题
5岁以下儿童的腹泻感染与腹泻有关的发病率，死亡率和长期后果：一项荟萃分析研究。
DOI：
10.1016/s2214-109x(18)30283-3
复制
发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Mokdad AH
中科院分区：
文献类型：
--
作者：
Khalil IA;Troeger C;Rao PC;Blacker BF;Brown A;Brewer TG;Colombara DV;De Hostos EL;Engmann C;Guerrant RL;Haque R;Houpt ER;Kang G;Korpe PS;Kotloff KL;Lima AAM;Petri WA Jr;Platts-Mills JA;Shoultz DA;Forouzanfar MH;Hay SI;Reiner RC Jr;Mokdad AH
原生动物隐孢子虫是5岁以下儿童腹泻发病率和死亡率的主要原因。然而，在以前的量化中，5岁以下儿童隐孢子虫感染的真正全球负担可能被低估了，因为它只考虑了腹泻的急性影响。我们的目的是证明隐孢子虫和儿童生长之间是否存在因果关系，如果是，量化相关的额外负担。2016年全球疾病、伤害和风险因素负担研究（GBD）是一项系统和科学的努力，旨在量化与300多种死亡和残疾原因相关的发病率和死亡率，包括隐孢子虫感染引起的腹泻。我们对GBD 2016中隐孢子虫负担的估计进行了补充，并对已发表和未发表的队列研究进行了系统性综述，并对隐孢子虫感染引起的儿童腹泻对身体生长的影响进行了荟萃分析。2016年，隐孢子虫感染是5岁以下儿童的第五大主要病原学，急性感染导致超过48000例死亡（95%不确定性区间[UI] 24600 - 81900）和超过420万残疾调整生命年损失（95%UI 220万-720万）。 我们从科学文献中确定了7个数据源，并从6个个体层面确定了隐孢子虫与儿童生长之间的关系。隐孢子虫感染引起的每次腹泻与年龄别身高Z评分（0.049，95%CI 0.014 - 0.080）、年龄别体重Z评分（0.095，0.055 - 0.134）和身高别体重Z评分（0.126，0.057 - 0.194）的降低相关。我们估计，隐孢子虫感染引起的腹泻导致额外的7.85百万残疾调整生命年（95%UI 5.42百万-10.11百万），在我们考虑了其对生长迟缓的影响后-比仅从急性影响估计的多153%。我们的研究结果表明，隐孢子虫感染对儿童生长和健康造成的大量短期腹泻负担低估了真正的负担。旨在预防和有效治疗5岁以下儿童感染的干预措施将对公共卫生和社会发展产生巨大影响。比尔及梅琳达·盖茨基金会。
The protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden. The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth. In 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone. Our findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts. The Bill & Melinda Gates Foundation.