Balew Mastewal, Kibret Mulugeta
College of Science, Department of Biology, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Nutr. 2023 Feb 24;9(1):35. doi: 10.1186/s40795-023-00678-0.
Diarrheal disease is one of the leading causes of child mortality in low and middle-income countries. Low nutritional status and bacterial infections contribute to growth deficiency and death in children. But there is a gap in identifying the bacterial etiology of diarrheal diseases and their association with the nutritional status of under-five children. This study aimed to determine the bacterial etiology of diarrheal diseases and their association with the nutritional status of diarrheic under-five children.
A cross-sectional study was carried out from February 2021 to March 2022 at seven Health Centers in Bahir Dar Zuria district, Ethiopia. A total of 196 diarrheic under-five children visiting the health centers were included in the study. Stool samples were collected from each child for the isolation of Salmonella, Shigella, and E.coli O157:H7. The demographic characteristics and symptoms of children were obtained from parents/guardians. The weight, height, and age of each child were recorded and anthropometric indices were determined by WHO Anthro version 3.2.2 software. The association between bacterial prevalence and the nutritional status of children was analyzed by SPSS version 26 software using Binary logistic regression. All analyses were conducted at a 95% confidence interval and significant association was determined using a p-value < 0.05.
Of the total children included in the study, 13.1% had either E.coli O157:H7, Shigella, or Salmonella. Watery diarrhea and fever were the most clinical characteristics observed in children who are positive for enteric bacteria. The prevalence of stunted, underweight, and wasted was 56.6%, 24.4%, and 13.2% respectively. Children with wasting were significantly associated with Salmonella detection (OR = 7.2, CI, 1.38-38.1, P = 0.02) whereas stunted and underweight were not associated with bacterial prevalence.
Overall, the prevalence of bacterial pathogens in the study area is high. Stunting, wasting, and being underweight are important nutritional deficits of diarrheic under-five children in the study site. Further studies targeting possible sources of bacteria and determinants of malnutrition in children are suggested. Health sectors found in the district should increase their effort to enhance good nutritional practice through health education and treatment of malnourished children by the provision of micronutrients.
腹泻病是低收入和中等收入国家儿童死亡的主要原因之一。低营养状况和细菌感染导致儿童生长发育迟缓及死亡。但在确定腹泻病的细菌病因及其与五岁以下儿童营养状况的关联方面存在差距。本研究旨在确定腹泻病的细菌病因及其与腹泻的五岁以下儿童营养状况的关联。
2021年2月至2022年3月在埃塞俄比亚巴赫达尔祖里亚区的七个卫生中心开展了一项横断面研究。共有196名到卫生中心就诊的腹泻五岁以下儿童纳入研究。从每个儿童采集粪便样本以分离沙门氏菌、志贺氏菌和大肠杆菌O157:H7。儿童的人口统计学特征和症状从父母/监护人处获取。记录每个儿童的体重、身高和年龄，并使用WHO Anthro 3.2.2版软件确定人体测量指标。使用SPSS 26版软件通过二元逻辑回归分析细菌感染率与儿童营养状况之间的关联。所有分析均在95%置信区间进行，使用p值<0.05确定显著关联。
在纳入研究的儿童中，13.1%感染了大肠杆菌O157:H7、志贺氏菌或沙门氏菌。水样腹泻和发热是肠道细菌检测呈阳性儿童中最常见的临床特征。发育迟缓、体重不足和消瘦的发生率分别为56.6%、24.4%和13.2%。消瘦儿童与沙门氏菌检测显著相关（比值比=7.2，置信区间，1.38 - 38.1，P = 0.02），而发育迟缓和体重不足与细菌感染率无关。
总体而言，研究地区细菌病原体的感染率较高。发育迟缓、消瘦和体重不足是研究地点腹泻五岁以下儿童重要的营养缺陷。建议针对儿童可能的细菌来源和营养不良的决定因素开展进一步研究。该地区的卫生部门应加大力度，通过健康教育和为营养不良儿童提供微量营养素进行治疗，以加强良好的营养实践。
