Nhampossa Tacilta, Mandomando Inacio, Acacio Sozinho, Quintó Llorenç, Vubil Delfino, Ruiz Joaquin, Nhalungo Delino, Sacoor Charfudin, Nhabanga Arnaldo, Nhacolo Ariel, Aide Pedro, Machevo Sónia, Sigaúque Betuel, Nhama Abel, Kotloff Karen, Farag Tamer, Nasrin Dilruba, Bassat Quique, Macete Eusebio, Levine Myron M, Alonso Pedro
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique.
Barcelona Center for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain.
PLoS One. 2015 May 14;10(5):e0119824. doi: 10.1371/journal.pone.0119824. eCollection 2015.
Diarrheal disease remains a leading cause of illness and death, particularly in low-income countries. Its burden, microbiological causes and risk factors were examined in children aged 0-59 months living in Manhiça, rural southern Mozambique.
Trends of diarrhea-related burden of disease were estimated during the period 2001-2012. A prospective, age-stratified and matched (by age, gender and geographical origin), case-control study was conducted during 2007-2011. Clinical, epidemiology, anthropometric measurement and fecal samples obtained from recruited children were used to estimate moderate-to-severe diarrhea (MSD) weighted attributable fractions.
Over the last decade the incidence of acute diarrhea has dropped by about 80%. Incidence of MSD per 100 child years at risk for the period 2007-2011 was 9.85, 7.73 and 2.10 for children aged 0-11, 12-23 and 24-59 months respectively. By adjusted population attributable fractions, most cases of MSD were due to rotavirus, Cryptosporidium, ETEC ST (ST only or ST/LT), Shigella and Adenovirus 40/41. Washing hands and having facilities to dispose child's stools were associated with a reduced risk of MSD, while giving stored water to the child was associated with an increased risk of MSD.
Despite the predominantly decreasing trends observed throughout the last decade, diarrheal diseases remain today a major cause of morbidity among children aged 0-59 months living in this rural Mozambican area. Rotavirus, cryptosporidium, Shigella, ETEC ST and Adenovirus 40/41 were the most important aetiologies of MSD. Thus, well-known preventive strategies such as washing hands, improving the treatment of stored water, having facilities to dispose children stools, and accelerating the introduction of the rotavirus vaccine should be promoted on a wider scale to reduce the current burden of diarrheal diseases.
腹泻病仍然是疾病和死亡的主要原因，尤其是在低收入国家。对生活在莫桑比克南部农村曼希卡的0至59个月大儿童的腹泻病负担、微生物病因及风险因素进行了研究。
对2001年至2012年期间腹泻相关疾病负担的趋势进行了估计。在2007年至2011年期间开展了一项前瞻性、按年龄分层且匹配（按年龄、性别和地理来源）的病例对照研究。从招募的儿童中获取临床、流行病学、人体测量数据及粪便样本，以估计中重度腹泻（MSD）的加权归因分数。
在过去十年中，急性腹泻的发病率下降了约80%。2007年至2011年期间，每100名处于危险中的儿童年，0至11个月、12至23个月和24至59个月儿童的MSD发病率分别为9.85、7.73和2.10。经调整的人群归因分数显示，大多数MSD病例是由轮状病毒、隐孢子虫、产肠毒素大肠杆菌ST（仅ST或ST/LT）、志贺氏菌和腺病毒40/41引起的。洗手和有处理儿童粪便的设施与MSD风险降低相关，而给儿童喂储存水与MSD风险增加相关。
尽管在过去十年中总体呈下降趋势，但腹泻病如今仍是生活在莫桑比克这个农村地区的0至59个月大儿童发病的主要原因。轮状病毒、隐孢子虫、志贺氏菌、产肠毒素大肠杆菌ST和腺病毒40/41是MSD的最重要病因。因此，应更广泛地推广洗手、改善储存水的处理、设置处理儿童粪便的设施以及加快引入轮状病毒疫苗等众所周知的预防策略，以减轻当前腹泻病的负担。
