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Pathogens associated with persistent diarrhoea in children in low and middle income countries: systematic review

Abba, Katharine, Sinfield, Rebecca, Hart, C. Anthony and Garner, Paul ORCID: (2009) 'Pathogens associated with persistent diarrhoea in children in low and middle income countries: systematic review'. BMC Infectious Diseases, Vol 9, e88.

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Background: Persistent diarrhoea in children is a common problem in low and middle income countries. To help target appropriate treatment for specific pathogens in the absence of diagnostic tests, we systematically reviewed pathogens most commonly associated with persistent diarrhoea in children. Methods: We sought all descriptive studies of pathogens in the stool of children with diarrhoea of over 14 days duration in low and middle income countries with a comprehensive search of the MEDLINE, EMBASE, LILACS and WEB OF SCIENCE databases. We described the study designs and populations, assessed the quality of the laboratory tests, and extracted and summarised data on pathogens. For Escherichia coli, we calculated high and low prevalence estimates of all enteropathic types combined. Results across studies were compared for geographical patterns. Results: Nineteen studies were included. Some used episodes of diarrhoea as the unit of analysis, others used children. The quality of reporting of laboratory procedures varied, and pathogens (particularly E. coli types) were classified in different ways. As there were no apparent regional differences in pathogen prevalence, we aggregated data between studies to give a guide to overall prevalence. Enteropathic E. coli types were commonly found in children with persistent diarrhoea (up to 63%). Various other organisms, including viruses, bacteria and parasites, were detected but across all studies their prevalence was under 10%. However, these pathogens were also found in similar frequencies in children without diarrhoea. Conclusion: A number of pathogens are commonly associated with persistent diarrhoea in children, but in children without diarrhoea the pathogens are found with similar frequencies. New research with carefully selected controls and standardised laboratory investigations across countries will help map causes and help explore effective options for presumptive treatment.

Item Type: Article
Additional Information: The electronic version of this article is the complete one and can be found online at:
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 312 Diarrheal disorders
WI Digestive System > WI 100 General works
WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
QZ Pathology > Manifestations of Disease > QZ 140 General manifestations of disease
WI Digestive System > WI 140 Diseases (General)
WB Practice of Medicine > Medical Climatology > WB 710 Diseases of geographic areas
QZ Pathology > Pathogenesis. Etiology > QZ 40 Pathogenesis. Etiology
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 200 Bacterial infections (General or not elsewhere classified)
WI Digestive System > WI 20 Research (General)
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 310 Digestive system
Faculty: Department: Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):
Depositing User: Philomena Hinds
Date Deposited: 25 Mar 2010 15:33
Last Modified: 17 Aug 2022 08:55


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