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Etiology of Diarrhea in Children Younger Than 5 Years Attending the Bengo General Hospital in Angola

Gasparinho, Carolina MSc*; Mirante, Maria Clara MSc*; Centeno-Lima, Sónia PhD; Istrate, Claudia PhD; Mayer, António Carlos MD§; Tavira, Luis MD, PhD; Nery, Susana Vaz PhD; Brito, Miguel PhD**

The Pediatric Infectious Disease Journal: February 2016 - Volume 35 - Issue 2 - p e28–e34
doi: 10.1097/INF.0000000000000957
Original Studies

Background: Diarrheal disease is among the leading causes of death in children younger than 5 years, especially in developing countries. The aim of this study was to investigate the most frequent etiological agents of diarrhea and its associated factors in children younger than 5 years attending the Bengo General Hospital in Angola.

Methods: From September 2012 through December 2013, stool samples were collected from 344 children presenting with diarrhea to investigate the presence of viral, bacterial and parasitic agents. Relevant sociodemographic and clinical data were obtained from parents and caregivers.

Results: An enteric pathogen was detected in 66.6% of stool samples: Cryptosporidium spp. (30.0%), rotavirus (25.1%), Giardia lamblia (21.6%), diarrheagenic Escherichia coli (6.3%), Ascaris lumbricoides (4.1%), adenovirus (3.8%), Strongyloides stercoralis (3.5%), astrovirus (2.6%), Hymenolepis nana (1.7%), Entamoeba histolytica/dispar (0.9%), Taenia spp. (0.6%), Trichuris trichiura (0.3%) and Entamoeba histolytica (0.3%). Children younger than 12 months were more frequently infected with Cryptosporidium spp. compared with older children (age: 12–59 months), independently of sex, season, lethargy and wasting [odds ratio (OR): 3.5, 95% confidence interval (95% CI): 2.0–6.2]. Age (OR: 5.0, 95% CI: 2.6–9.3), vomiting (OR: 2.7, 95% CI: 1.5–4.8) and type of admission (inpatients, OR: 0.5, 95% CI: 0.3–0.9) were significantly associated with rotavirus infection.

Conclusions: This study demonstrates high rates of infection with an enteric pathogen, particularly in children younger than 12 months, emphasizing the need to address diarrheal disease in this age group.

From the *Centro de Investigação em Saúde de Angola (CISA), Caxito, Bengo, Angola; Global Health and Tropical Medicine (GHTM), Unidade de Clínica Tropical e Centro de Malária e outras Doenças Tropicais (CMDT), Instituto de Higiene e Medicina Tropical de Lisboa (IHMT), Universidade Nova de Lisboa (UNL), Lisboa, Portugal; Global Health and Tropical Medicine (GHTM), Unidade de Ensino e Investigação de Microbiologia Médica, Instituto de Higiene e Medicina Tropical de Lisboa (IHMT), Universidade Nova de Lisboa (UNL), Lisboa, Portugal; §Hospital Geral do Bengo, Caxito, Angola; HealthGest, Luanda, Angola, Africa; Research School of Population Health, The Australian National University, Canberra, Australia; and **Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal.

Accepted for publication October 9, 2015.

Susana Vaz Nery and Miguel Brito act as equivalent co-senior authors.

Supported by the promoters of CISA (Camões - Instituto da Cooperação e da Língua, I.P, Fundação Calouste Gulbenkian, Governo Provincial do Bengo and Ministério da Saúde de Angola), which played no role in either the design of the study or in interpreting the findings. The other authors have no conflicts of interest to disclose.

Address for correspondence: Miguel Brito, PhD, CISA, Rua Direita, Caxito, Angola, Africa. E-mail:

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