Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study
Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study
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DOI：
10.1371/journal.pntd.0005795
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发表时间：
2017-08-01
影响因子：
3.8
通讯作者：
Knobel, Darryn L.
中科院分区：
文献类型：
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作者：
Conan, Anne;O'Reilly, Ciara E.;Knobel, Darryn L.
腹泻病仍然是全球5岁以下儿童死亡的主要原因之一。接触家畜可能是腹泻疾病的一个危险因素。这项研究的目的是确定肯尼亚西部农村地区儿童中与中到重度腹泻(MSD)病例相关的动物暴露，并确定在病例和对照儿童的家园中居住的家畜中存在的主要人畜共患肠道病原体。方法/主要发现我们描述了在肯尼亚西部全球肠道多中心研究中，病例和对照儿童(n=73对在家中报告的动物存在)与动物相关暴露的特征(n=73对，在年龄、性别和地点上匹配)，并分析了这些与MSD的关联。我们从居住在儿童家园的家畜身上收集的粪便样本中鉴定出潜在的人畜共患肠道病原体。与降低MSD风险相关的变量是动物接触后洗手(匹配优势比[MOR]=0.2；95%可信区间0.08-0.7)，以及成年绵羊不被关在圈中过夜(MOR=0.1；0.02-0.5)。与MSD风险增加相关的变量是养羊的数量增加(MOR=1.2；1.0-1.5)，经常在屋外观察新鲜的啮齿动物排泄物(MOR=7.5；1.5-37.2)，以及儿童参与给鸡提供水(MOR=3.8；1.2-12.2)。在从2,174只家畜收集的691份混合样本中，159份(23%)对一种或多种潜在的人畜共患肠道病原体(空肠弯曲杆菌、大肠埃希菌、非伤寒沙门氏菌、致泻性大肠杆菌、贾第虫属、隐孢子虫或轮状病毒)检测呈阳性。我们没有发现家养动物中特定病原体的存在与儿童MSD之间的任何联系。结论和意义公共卫生机构应该继续提倡频繁洗手，包括在与动物接触后洗手，以降低MSD的风险。未来的研究应该解决MSD与绵羊和鸡的饲养实践以及啮齿动物的存在之间的具体因果关系。
BackgroundDiarrheal disease remains among the leading causes of global mortality in children younger than 5 years. Exposure to domestic animals may be a risk factor for diarrheal disease. The objectives of this study were to identify animal-related exposures associated with cases of moderate-to-severe diarrhea (MSD) in children in rural western Kenya, and to identify the major zoonotic enteric pathogens present in domestic animals residing in the homesteads of case and control children.Methodology/Principal findingsWe characterized animal-related exposures in a subset of case and control children (n = 73 pairs matched on age, sex and location) with reported animal presence at home enrolled in the Global Enteric Multicenter Study in western Kenya, and analysed these for an association with MSD. We identified potentially zoonotic enteric pathogens in pooled fecal specimens collected from domestic animals resident at children's homesteads. Variables that were associated with decreased risk of MSD were washing hands after animal contact (matched odds ratio [MOR] = 0.2; 95% CI 0.08 - 0.7), and presence of adult sheep that were not confined in a pen overnight (MOR = 0.1; 0.02 - 0.5). Variables that were associated with increased risk of MSD were increasing number of sheep owned (MOR = 1.2; 1.0 - 1.5), frequent observation of fresh rodent excreta (feces/urine) outside the house (MOR = 7.5; 1.5 - 37.2), and participation of the child in providing water to chickens (MOR = 3.8; 1.2 - 12.2). Of 691 pooled specimens collected from 2,174 domestic animals, 159 pools (23%) tested positive for one or more potentially zoonotic enteric pathogens (Campylobacter jejuni, C. coli, non-typhoidal Salmonella, diarrheagenic E.coli, Giardia, Cryptosporidium, or rotavirus). We did not find any association between the presence of particular pathogens in household animals, and MSD in children.Conclusions and significancePublic health agencies should continue to promote frequent hand washing, including after animal contact, to reduce the risk of MSD. Future studies should address specific causal relations of MSD with sheep and chicken husbandry practices, and with the presence of rodents.