Diarrhoea, enteric pathogen detection and nutritional indicators among controls in the Global Enteric Multicenter Study, Kenya site: an opportunity to understand reference populations in case-control studies of diarrhoea

• Type of Material: Article
• Authors: David Berendes, Emory University; C. E. O'Reilly, Centers for Disease Control and Prevention; S. Kim, Centers for Disease Control and Prevention; R. Omore, Center for Global Health Research; J. B. Ochieng, Center for Global Health Research; T. Ayers, Centers for Disease Control and Prevention; K. Fagerli, Centers for Disease Control and Prevention; TH Farag, University of Maryland; D. Nasrin, University of Maryland; S. Panchalingam, University of Maryland; J. P. Nataro, University of Maryland; K. L. Kotloff, University of Maryland; M. M. Levine, University of Maryland; J. Oundo, Center for Global Health Research; K. Laserson, Centers for Disease Control and Prevention; Robert F Breiman, Emory University; Eric Mintz, Emory University
• Language: English
• Date: 2019-01-01
• Publisher: Cambridge University Press (CUP): STM Journals
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1017/S0950268818002972
• Title of Journal or Parent Work: Epidemiology and Infection
• ISSN: 0950-2688
• Volume: 147
• Start Page: 1
• End Page: 9
• Grant/Funding Information: Additional salary support for technical assistance with this sub-study was provided by the US Agency for International Development through an Inter-Agency Agreement with the US Centers for Disease Control and Prevention.; This study was funded by the Bill and Melinda Gates Foundation through the University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD, USA.
• Keywords: YOUNG-CHILDREN; CHILDHOOD DIARRHEA; Science & Technology; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; ILLNESS; estimating disease prevalence; OPTIMAL RECALL PERIOD; BEHAVIOR; Diarrhoea; DEVELOPING-COUNTRIES; gastrointestinal infections; SANITATION; INTERVENTION; DISEASE; DISPOSAL; Infectious Diseases
• Research Categories: Environmental Sciences; Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Given the challenges in accurately identifying unexposed controls in case–control studies of diarrhoea, we examined diarrhoea incidence, subclinical enteric infections and growth stunting within a reference population in the Global Enteric Multicenter Study, Kenya site. Within ‘control’ children (0–59 months old without diarrhoea in the 7 days before enrolment, n = 2384), we examined surveys at enrolment and 60-day follow-up, stool at enrolment and a 14-day post-enrolment memory aid for diarrhoea incidence. At enrolment, 19% of controls had ⩾1 enteric pathogen associated with moderate-to-severe diarrhoea (‘MSD pathogens’) in stool; following enrolment, many reported diarrhoea (27% in 7 days, 39% in 14 days). Controls with and without reported diarrhoea had similar carriage of MSD pathogens at enrolment; however, controls reporting diarrhoea were more likely to report visiting a health facility for diarrhoea (27% vs. 7%) or fever (23% vs. 16%) at follow-up than controls without diarrhoea. Odds of stunting differed by both MSD and ‘any’ (including non-MSD pathogens) enteric pathogen carriage, but not diarrhoea, suggesting control classification may warrant modification when assessing long-term outcomes. High diarrhoea incidence following enrolment and prevalent carriage of enteric pathogens have implications for sequelae associated with subclinical enteric infections and for design and interpretation of case–control studies examining diarrhoea.