The Global Enteric Multicenter Study (GEMS) of Diarrheal Disease in Infants and Young Children in Developing Countries: Epidemiologic and Clinical Methods of the Case/Control Study

Kotloff, K. L., Blackwelder, W. C., Nasrin, D., Nataro, J. P., Farag, T. H., vanEijk, Anna ORCID: https://orcid.org/0000-0003-1635-1289, Adegbola, R. A., Alonso, P. L., Breiman, R. F., Golam Faruque, A. S., Saha, D., Sow, S. O., Sur, D., Zaidi, A. K. M., Biswas, K., Panchalingam, S., Clemens, J. D., Cohen, D., Glass, R. I., Mintz, E. D., Sommerfelt, H. and Levine, M. M. (2012) 'The Global Enteric Multicenter Study (GEMS) of Diarrheal Disease in Infants and Young Children in Developing Countries: Epidemiologic and Clinical Methods of the Case/Control Study'. Clinical Infectious Diseases, Vol 55, Issue S4, S232-S245.

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Abstract

Background. 
Diarrhea is a leading cause of illness and death among children aged <5 years in developing countries. This paper describes the clinical and epidemiological methods used to conduct the Global Enteric Multicenter Study (GEMS), a 3-year, prospective, age-stratified, case/control study to estimate the population-based burden, microbiologic etiology, and adverse clinical consequences of acute moderate-to-severe diarrhea (MSD) among a censused population of children aged 0–59 months seeking care at health centers in sub-Saharan Africa and South Asia.

Methods. 
GEMS was conducted at 7 field sites, each serving a population whose demography and healthcare utilization practices for childhood diarrhea were documented. We aimed to enroll 220 MSD cases per year from selected health centers serving each site in each of 3 age strata (0–11, 12–23, and 24–59 months), along with 1–3 matched community controls. Cases and controls supplied clinical, epidemiologic, and anthropometric data at enrollment and again approximately 60 days later, and provided enrollment stool specimens for identification and characterization of potential diarrheal pathogens. Verbal autopsy was performed if a child died. Analytic strategies will calculate the fraction of MSD attributable to each pathogen and the incidence, financial costs, nutritional consequences, and case fatality overall and by pathogen.

Conclusions. 
When completed, GEMS will provide estimates of the incidence, etiology, and outcomes of MSD among infants and young children in sub-Saharan Africa and South Asia. This information can guide development and implementation of public health interventions to diminish morbidity and mortality from diarrheal diseases.

Item Type:	Article
Additional Information:	This article appears in:The Global Enteric Multicenter Study (GEMS)
Subjects:	WA Public Health > WA 105 Epidemiology WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WS Pediatrics > Diseases of Children and Adolescents > By System > WS 312 Diarrheal disorders WS Pediatrics > By Age Groups > WS 430 Infancy
Digital Object Identifer (DOI):	https://doi.org/10.1093/cid/cis753
Depositing User:	Lynn Roberts-Maloney
Date Deposited:	22 Jan 2015 12:23
Last Modified:	16 Aug 2019 13:40
URI:	https://archive.lstmed.ac.uk/id/eprint/4782

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