Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
J Glob Health. 2024 Nov 1;14:04168. doi: 10.7189/jogh.14.04168.
While diarrhoeal disease remains a leading cause of death in children aged <5 years in low- and middle-income countries (LMICs), it also poses significant health risks for older children, underscoring the importance of our study focusing on children aged <10 years. In this systematic review, we assessed common diarrhoea aetiologies in children aged <10 years in LMICs.
We identified relevant articles in PubMed, Embase, and Web of Science using pre-defined search criteria. We included case series and case-control studies of children aged <10 years with non-bloody, bloody, acute, persistent, and chronic diarrhoea. Articles that evaluated two or more diarrhoea pathogens in LMICs conducted between 1 January 1990 and 31 July 2020 were eligible for inclusion. We stratified combined data from case series and case-control studies by age and World Health Organization (WHO) regions.
76 studies published between 1990-2020 were eligible for inclusion. Among these, eight were case-control studies. 56 papers focused only on children aged <5 years, while 20 also included children aged ≥5 years. The most common viral pathogens among <5 years old children were rotavirus, norovirus, adenovirus, and astrovirus. Bacterial pathogens included Escherichia coli, Salmonella enterica, Shigella species, and Campylobacter species, while parasitic pathogens included Cryptosporidium, Giardia, and Entamoeba species. Rotavirus was the most common viral pathogen among children across all age groups and every WHO region. Escherichia coli was prevalent in all age groups and was responsible for most diarrhoea cases in the African Region. Among parasitic pathogens, Entamoeba species and Giardia were prevalent in children aged three to five years, with the former a major cause of diarrhoea in the Eastern Mediterranean Region. Similarly, in children aged six to 10 years, bacterial pathogens, including Escherichia coli, Salmonella, and Shigella, suggest a continued significance of these pathogens beyond the age of five. Common viral pathogens for this group were rotavirus, norovirus, and sapovirus, although the number of studies for this age group is limited.
Escherichia coli, rotavirus, and Entamoeba species were the most common pathogens responsible for diarrhoea in children aged <5 years in LMICs. Future research should focus on characterising the pathogens responsible for causing diarrhoea in children aged six to 10 years stratified by geographic area of residence, i.e. WHO region and urban vs rural. Case-control or cohort studies covering a full 12-month period to account for seasonality are needed for a more accurate picture of diarrhoea aetiology among children.
PROSPERO (CRD42020204005).
虽然腹泻病仍然是低收入和中等收入国家（LMICs）5 岁以下儿童死亡的主要原因，但它也对年龄较大的儿童构成重大健康风险，这突显了我们专注于 10 岁以下儿童研究的重要性。在这项系统评价中，我们评估了 LMICs 中年龄<10 岁儿童的常见腹泻病因。
我们使用预定义的搜索标准在 PubMed、Embase 和 Web of Science 中确定了相关文章。我们纳入了年龄<10 岁的非血性、血性、急性、持续性和慢性腹泻的病例系列和病例对照研究。纳入的文章为 1990 年 1 月 1 日至 2020 年 7 月 31 日期间在 LMICs 中评估两种或多种腹泻病原体的病例系列和病例对照研究。我们按年龄和世卫组织（WHO）区域对病例系列和病例对照研究的综合数据进行分层。
1990-2020 年期间发表的 76 项研究符合纳入标准。其中，8 项为病例对照研究。56 篇论文仅关注<5 岁儿童，而 20 篇论文也包括≥5 岁儿童。<5 岁儿童中最常见的病毒病原体是轮状病毒、诺如病毒、腺病毒和星状病毒。细菌病原体包括大肠杆菌、沙门氏菌、志贺氏菌和弯曲菌，而寄生虫病原体包括隐孢子虫、贾第虫和肠贾第虫。轮状病毒是所有年龄组和每个世卫组织区域最常见的病毒病原体。大肠杆菌在所有年龄组中均很常见，是非洲区域大多数腹泻病例的病因。在寄生虫病原体中，肠贾第虫和肠贾第虫在 3 至 5 岁儿童中很常见，前者是东地中海区域腹泻的主要病因。同样，在 6 至 10 岁儿童中，包括大肠杆菌、沙门氏菌和志贺氏菌在内的细菌病原体表明这些病原体的重要性在五岁以后仍在继续。该年龄组的常见病毒病原体是轮状病毒、诺如病毒和诺如病毒，但该年龄组的研究数量有限。
大肠杆菌、轮状病毒和肠贾第虫是 LMICs 中<5 岁儿童腹泻的最常见病原体。未来的研究应侧重于根据居住地理区域（即世卫组织区域和城市与农村），描述导致 6 至 10 岁儿童腹泻的病原体特征。需要涵盖整个 12 个月的病例对照或队列研究来更准确地描述儿童腹泻的病因。
PROSPERO（CRD42020204005）。
