Several longitudinal studies have investigated factors associated with childhood diarrhea in developing countries. However most studies have neglected important dynamic features of the longitudinal design and hierarchical interrelationships among the potential risk factors. We conducted a longitudinal study of 902 children age 0 to 36 months at baseline in a large urban center in northeastern Brazil. Diarrhea data were collected by following children from October 2000 until January 2002 with biweekly home visits. We used a dynamic time-to-event analysis to account for several longitudinal features. We applied an effect- decomposition strategy to quantify direct and indirect effects of risk factors grouped in different blocks. Childs age and an autoregressive effect of past diarrhea episodes explained some of the decline of diarrhea incidence observed throughout the study (from more than 14 episodes to 2 episodes per child-year) a phenomenon already observed but not explained in other longitudinal diarrhea studies. We identified the following major diarrhea determinants: low socioeconomic status poor sanitation conditions presence of intestinal parasites and absence of prenatal examination. The effect of socioeconomic status was mediated mostly by living and sanitation conditions. Our study shows important advantages of applying a dynamic analysis approach to longitudinal observational studies of diarrhea or other acute diseases and highlights the complex interrelationships of diarrhea determinants. Our results confirm the importance of sanitation as a major determinant of child health in urban settings of developing countries. (authors)

Risk factors for childhood diarrhea incidence: dynamic analysis of a longitudinal study.

Between January and March 1998, a cross-sectional survey was carried out in four rural communities in Honduras, Central America. We examined the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections among 240 fecal specimens, and the association between selected socio-demographic variables and infection for 62 households. The overall prevalence of A. lumbricoides and T. trichiura was 45% (95% CI 39.0-51.9) and 38% (95% CI 31.8-44.4) respectively. The most intense infections for Ascaris and Trichuris were found in children aged 2-12 years old. By univariate analysis variables associated with infections of A. lumbricoides were: number of children 2-5 years old (p=0.001), level of formal education of respondents (p=0.01), reported site of defecation of children in households (p=0.02), households with children who had a recent history of diarrhea (p=0.002), and the location of households (p=0.03). Variables associated with both A. lumbricoides and T. trichiura infection included: number of children 6-14 years old (p=0.01, p=0.04, respectively), ownership of a latrine (p=0.04, p=0.03, respectively) and coinfection with either helminth (p=0.001, p=0.001, respectively). By multivariate analysis the number of children 2-5 years living in the household, (p=0.01, odds ratio (OR)=22.2), children with a recent history of diarrhea (p=0.0, OR=39.8), and infection of household members with T. trichiura (p=0.02, OR=16.0) were associated with A. lumbricoides infection. The number of children 6-14 years old in the household was associated with both A. lumbricoides and T. trichiura infection (p=0.04, p=0.01, OR=19.2, OR=5.2, respectively).

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Prevalence and intensity of infections of Ascaris lumbricoides and Trichuris trichiura and associated socio-demographic variables in four rural Honduran communities

Objective: To determine the frequency of antibodies against leptospira in asymptomatic persons in people working in commerce and agriculture in Coronel Portillo province in Ucayali department, Peru. We also aimed at determining the prevalence of leptospirosis in domestic animals. Material and Methods: In this analytic cross-sectional study, serum samples from 364 people in 4 sites were taken, and we measured serum total antibodies against leptospira using an ELISA test and a microagglutination assay. A statistical analysis was performed in order to determine the degree of association between the population general characteristics and the data collected in the survey with being positive for antibodies against leptospira. Simultaneously we took 374 serum samples from domestic animals (dogs), and we performed microagglutination test in these samples. Results: 364 persons were enrolled, and 227 (62.4%) female and 137 (37.6%) male. 114 (31.3%) persons had antibodies against leptospira, and most frequent serovars were Bratislava and Georgia. Factors likely to be associated with having positive antibodies against leptospira in the population studied were: to keep food at the household (OR= 2.221), being a farmer (OR= 3.418), being a manual workers and a farmer (OR= 2.088), and to throw rubbish in the field (OR= 2.348). Amongst dogs, 181 (52.2%) has positive serological tests for leptospira. Conclusions: There is a high prevalence of positive serological tests for leptospira in the general asymptomatic population, and there are favorable conditions for the development of Leptospira infections in the sites studied. We recommend to frequently perform educational and preventive activities, taking into account the results from our study.

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Leptospirosis: una enfermedad zoonótica hiperendémica en la provincia de coronel portillo. ucayali, perú

La leptospirosis es una enfermedad aguda y febril causada por una bacteria del genero Leptospira que comprende sobre todo a los animales salvajes y domesticos. El hombre se contamina en forma accidental por el contacto con orina o tejidos de animales infectados y presenta cuadros clinicos variables que van desde infecciones inaparentes, meningitis aseptica, hasta formas severas como el sindrome de Weil. La penicilina sigue siendo la droga de eleccion.

Leptospirosis . Revision de tema

Resumen Objetivos: Describir el comportamiento epidemiologico de la leptospirosis en el departamento del Atlantico (Colombia), de enero de 1999 a marzo del 2004. Metodologia: Estudio descriptivo. Se analizaron 970 muestras unicas de pacientes sospechosos de infecciones con Leptospira en el Laboratorio Departamental del Atlantico mediante Aglutinacion Microscopica (MAT), usando como antigenos los serovares Icterohemorragiae, Pomona, Canicola, Hardjo, Grippotyphosa y Hardjo-bovis de Leptospira interrogans. Informacion adicional sobre la clinica de pacientes a traves de fichas epidemiologicas y visitas a hospitales, ademas de datos de precipitacion anual, fue obtenida. Resultados: El 9,7% de los casos fueron positivos para Leptospira, siendo los serovares Icterohaemor- rhagiae (62%) y Hardjo (12,8%) los mas frecuentes. La mayoria de casos (61%), se presentaron en hombres entre 15 y 45 anos de edad y la clinica mas comun se asocio a fiebre (91,7%), mialgias (72,2%), vomito/nausea (70,8%), cefalea (68,1%) e ictericia (63,9%). El 8.6% de los casos asociados a infec- ciones con el serovar Ictherohemorragiae fueron severos; la sintomatologia coincidio con el sindrome de Weil, pero no se registraron fatalidades. En los anos 2003(23), 2001(21) y 2002(18) se registro la mayor incidencia de casos, en meses de alta precipitacion (Agosto-Noviembre). Los municipios con mayor numero de casos fueron Barranquilla (46), Soledad (25), Puerto Colombia (6) y Galapa (6). Conclusiones: La leptospirosis debe tenerse en cuenta dentro del diagnostico diferencial de otras entidades comunes en la region (fiebre de dengue). Un diligenciamiento completo de la ficha epidemio- logica permitira un estudio mas detallado de esta patologia, para desarrollar programas de vigilancia y prevencion eficaces. Palabras claves: Leptospira, serologia, Atlantico, Colombia. Abstract Objective: This study was performed to describe the epidemiological situation of Leptospira in the Departament of Atlantico (Colombia), from January 1999 to March 2004. Methods: A descriptive study was performed. A total of 970 single serum samples from patients with suspected Leptospira infections, were analyzed using the microscopic agglutination test (MAT). The serovars of Icterohaemorrhagiae, Pomona, Canicola, Hardjo, Grippotyphosa and Hardjo-bovis belonging to L. interrogans, were used as antigens. Information about clinical presentation based on epidemiological sheets, visits to patients and climatological data were obtained. Results: The 9,7% samples were IgM positive for Leptospira and the most prevalent was the serovar Icterohaemorrhagiae (62%), followed by Hardjo (12.8%). Most of the patients were male (61%) between 15 and 45 y.o. The most common presenting features in these patients were (91.7%), myalgia (72%), vomit/nausea (70.8%), headache (68.1%) and icterichia (63.9%). 8.6% of the cases were severe, associated to infections with the serovar Icterohemorragiae and their symptomathology was similar to the Weil s syndrome; no fatalities were registered. The highest incidences were recorded during the years 2003 (23), 2001(21) and 2002 (18) especially during the rainy season (August-November). Barranquilla reported the highest number of cases (46) followed by Soledad (25), Puerto Colombia (6) and Galapa (6). Conclusions: Since leptospirosis is an increasing public health problem in the Caribbean Region, dif- ferential diagnosis with other similar pathologies (dengue fever, dengue haemorrhagic fever) has to be performed and surveillance and preventive programmes must be implemented. Key words: Leptospirosis, serology, Atlantico, Colombia.

Comportamiento de la leptospirosis en el departamento del Atlántico (Colombia)Enero de 1999 a marzo del 2004

In a study of parasitological prevalence in El Salvador, stool specimens of 210 children with diarrhea were examined for intestinal parasites. In 104 cases (49%), intestinal helminths and protozoa were found. 53.4% of the specimens showed single infestation, 31.7% showed double. 3% triple and 1% quadruple infestation. Of the helminths, 31% were Trichuris trichiura, 18% Ascaris lumbricoides and 5% Hymenolepis nana. Of the pathogenic protozoa, 7% were identified as Giardia intestinalis, 6% Entamoeba histolytica, 4% Cryptosporidium sp. and 3% Blastocystis hominis.

Intestinal parasites in children with diarrhea in El Salvador.

The authors examined 984 human sera for leptospirosis with the serovars from 15 serogroups serologically in 15 localities of El Salvador. In 17.5% of the sera the following reactions were found with serovars of 13 serogroups: Australis 6.8%, Pomona 5.5%, Grippotyphosa 3.2%, Icterohaemorrhagiae and Tarassovi each 2.1%, Javanica, Canicola, Pyrogenes, Cynopteri, Autumnalis, Sejroe, Hebdomadis, Bataviae, Shermani, between 0.2%-1.4%. Men showed a 18.5% and women 17.0% positive reaction. Positivity increases with an increase in age, an increase was shown from 11.5% in the group of up to 10 years, to 40.4% in the group of 51 to 60 years, in the last age group of over 60 years a decrease was shown of 34.7%. In 8 localities we were able to compare the serological positivity of the population, the highest percentages were found in Fey Esperanza 35.1%, San Jose de la Montana 31.6% and Domus Maria 27.8%, the lowest in Credisa 6.4% and Ametepec 7.6%.

Linck G

Papers

Intestinal parasites in children with diarrhea in El Salvador.

Results of leptospirosis examinations of human sera from El Salvador.