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
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
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DOI：
10.1016/s0140-6736(13)60844-2
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发表时间：
2013-07-20
期刊：
影响因子：
168.9
通讯作者：
Levine, Myron M.
中科院分区：
文献类型：
--
作者：
Kotloff, Karen L.;Nataro, James P.;Levine, Myron M.
腹泻病是低收入国家5岁以下儿童的疾病和死亡原因。我们设计了全球肠道多中心研究（GEMS），以确定病因和人口为基础的负担，儿科腹泻病在撒哈拉以南非洲和南亚。方法的GEMS是一项为期3年的，前瞻性的，年龄分层，匹配的病例对照研究中重度腹泻的儿童年龄0-59个月居住在人口普查的人口在非洲的四个网站和三个在亚洲。我们招募了患有中度至重度腹泻的儿童，他们沿着在健康中心寻求治疗，同时随机选择1至3名匹配的社区对照儿童，他们没有腹泻。从中度至重度腹泻患者和对照组中，我们获得了临床和流行病学数据、人体测量数据和粪便样本，以在入组时鉴定肠道病原体;约60天后进行一次随访家访，以确定生命状态，临床结果，结果我们招募了9439名中度至重度腹泻儿童和13129名对照儿童没有腹泻。通过分析调整后的人群归因分数，大多数中度至重度腹泻病例归因于4种病原体：轮状病毒、隐孢子虫、产热稳定毒素的肠致病性大肠埃希菌（ST-ETEC;伴或不伴热不稳定肠毒素共表达）和志贺氏菌。其他病原体在选定部位也很重要（例如，气单胞菌、霍乱弧菌O 1、空肠弯曲菌）。随访期间，中重度腹泻患者的死亡几率是对照组的8.5倍（比值比8.5，95%CI 5.8-12.5，p <0.05）。
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 measure ments, 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