Made available in DSpace on 2015-12-10T14:23:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-27. Added 1 bitstream(s) on 2015-12-10T14:29:44Z : No. of bitstreams: 1 000851519.pdf: 1178190 bytes, checksum: 6da71571493874117e3f938393027381 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Escherichia coli diarreiogênica (ECD) representa uma das principais causas da diarreia infantil. Com base em seus mecanismos de virulência, podemos classificá-la em seis patotipos distintos: E. coli enteropatogênica (EPEC), E. coli enterotoxigênica (ETEC), E. coli enteroinvasora (EIEC), E. coli produtora da toxina Shiga (STEC), E. coli enteroagregativa (EAEC) e E. coli que adere difusamente (DAEC). O objetivo deste estudo foi investigar a prevalência de ECD, entre crianças diarreicas (Pacientes) e crianças saudáveis (Controles), menores de cinco anos de idade, na cidade de Botucatu/SP. Foram analisadas amostras de fezes de 200 crianças com diarreia, atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, entre os meses de Março de 2013 a Setembro de 2014, e 200 crianças saudáveis. Isolados de E. coli foram classificados nos distintos patotipos de ECD pela pesquisa de marcadores de virulência específicos através de PCR e, posteriormente, foram caracterizados quanto ao padrão de aderência em células HeLa e resistência à drogas antimicrobianas. Os isolados portadores do locus of enterocyte effacement (eae+) foram submetidos ao teste de FAS (Fluorescence Actin Staining), para avaliar a capacidade desses isolados em induzir a lesão attaching and effacing (AE). Ademais, os isolados de EPEC e STEC tiveram seu antígeno somático (O), e flagelar (H) determinados. ECD foi isolada de 18,0% das crianças diarreicas, e em 19,0% das crianças saudáveis, sendo que nenhum patotipo de ECD pode ser individualmente associado com a doença diarreica (P0,05). O patotipo EAEC foi o mais frequente, tendo sido detectado em igual proporção entre crianças diarreicas e saudáveis (10,0%). Dentre os isolados de EPEC, 16 provenientes das fezes de crianças com diarreia e 18 provenientes de crianças saudáveis, somente um foi capaz de aderir às células HeLa no padrão localizado (AL), sendo esse o único isolado classificado... / Diarrheagenic Escherichia coli (DEC) comprises a major cause of child hood diarrhea. Based on their virulence mechanisms, DEC can be classified into six distinct pathotypes: enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteroaggregative E. coli (EAEC), enterohemorrhagic E. coli (EHEC) and diffusely adherent E. coli (DAEC). This study aims to investigate the prevalence of DEC among diarrheal children (patients) and healthy children (controls), up to five years of age in Botucatu/SP. We analyzed stool samples from 200 children with diarrhea attended at Hospital das Clínicas da Faculdade de Medicina de Botucatu, between March/2013 and September/2014, and 200 healthy children. E. coli isolates were classified in different pathotypes by detection of virulence markers (by PCR) and then, characterized regarding its adherence pattern to HeLa cells and antimicrobial resistance drugs. Isolates carrying the locus of enterocyte effacement (eae+) were submitted to FAS test (Fluorescence Actin Staining), to evaluate the ability of these isolates to induce attaching and effacing lesion (AE). In addition, EPEC and STEC isolates, had their somatic (O) and flagellar (H) antigens determined. DEC was isolated from 18.0% of diarrheal children, and 19.0% of healthy children, and none of the DEC pathotypes could be individually associated with the diarrheal disease (P>0.05). EAEC was the most frequent DEC pathotype, being detected in equal proportion between patients and controls (10.0%). Among the EPEC isolates, 16 from patients and 18 from controls, only one was able to produce the localized adherence (LA) pattern to HeLa cells, being this isolate the only typical EPEC (tEPEC) identified in this study. The remains EPEC isolates were classified as aEPEC (atypical EPEC), and detected in 8.0 and 8.5% of the patients and controls, respectively. STEC and ETEC were detected in only one child from each studied ... / FAPESP: 2013/05170-1

The study conducted in the rural area of the province of Imbabura included a total of 518 families that when compared with the estimated sample of 96%, 42.7 % corresponding to the indigenous ethnic group, 28.15% to Black and 25% to mixed-race ethnic groups, these differences of involvement between ethnic groups is due to the fact that the indigenous population is greater than the two remaining populations. Of the 518 families studied they were able to obtain a total of 794 children younger than 5, in which 48.5% pertaining to the male sex and 51.4% to the female sex. In linking the number of participating families and the number of children studied we were able to find that mothers have 1 to 2 children younger than the age of 5 in every family. In evaluating the nutritional state of the 794 studied children, 47.09% were found to have global malnutrition (P/E), 67.26% presented a chronic malnutrition that is to say a lower height for their age, whereas 13.97% presented an acute malnutrition, a percentage that doesn’t attract attention due to what I have already noted previously with children presenting low height and weight for their age when using the indicated weight/height, the nutritional state of the children is appropriate. The nutritional state of children under the age of 5, by considering the indicators of weight/age and height/age, identified the indigenous ethnicity having major problems of malnutrition (54% and 80.97%) respectively, while the two remaining ethnic groups have presented similar percentages. The opposite occurs with the indicator of weight/height, which detected that the Black ethnic group presented a major nutritional deterioration (24%) unlike the other two ethnic groups, we believe that this difference is due to indigenous children presenting a diminished height, consequently when we use the indicator of weight/height, an adequate weight for height is presented. According to the magnitude of diarrheal processes we find that 28.34% of children presented EDA, the indigenous ethnicity being that with the highest percentage (12.84%) in relation to the other two ethnic groups. According to the severity of the diarrheal processes, light EDA presents the highest percentage with 62.67%, with the indigenous ethnicity being affected the most, moderate EDA presents a 34.22% similarly affecting the indigenous ethnicity and severe EDA presents a 3.11% with the mixed-race ethnicity being the most affected. Relating the nutritional state with acute diarrheal illnesses, considering the indicators of weight/age and height/age, we find that the indigenous population is mostly affected in nutritional state as well as in the presence of EDA. Malnourished children present a higher number of diarrheal processes. Considering the indicator of weight/height, diarrhea is more frequent in children with a normal nutritional state, with the Black ethnicity that which presents the greater percentage of EDA in normal and malnourished children. For this reason, it is urgent that national programs of health and alimentation are defined and implemented in order to combat the nutritional problem and ensure an adequate supply of food for the whole population, improving the conditions of health and environmental sanitation in order to reduce the high rates of malnutrition, diarrhea and acute respiratory infections.

A qualitative study was conducted to explore and describe the knowledge and perceptions of parents and caregivers on the causes of diarrhoea among children under five years living in the rural areas of the Eastern Cape Province, South Africa. The aim was to assist in correcting the negative perceptions of the causes of under five child diarrhoea through improved educational interventions. Data were collected through individual, semi-structured and face-to-face interviews from seven participants who were parents and caregivers of under-five children presenting with diarrhoea or admitted for the management of diarrhoea at a specific hospital and thematic analysis was done. The findings revealed that the participants had inadequate knowledge and lacked understanding of diarrhoea and its causes. Participants could not mention all the causes and risk factors associated with diarrhoea. Noteworthy is that the participants’ perceived diarrhoea as a serious condition. The study recommends that the implementation of policies regarding public education and health promotion programmes be targeted at educating parents and caregivers / Health Studies / M.A. (Public Health)

Abstract Objectives: Diarrheal disease is a global health challenge that assumes gigantic importance with regard to child health in developing countries like Pakistan. Prompt medical attention and proper use of Oral Re-hydration Therapy (ORT) by mothers helps prevent dehydration and secondary complications among affected children. However, ORT use among mothers in Pakistan is low. This study seeks to examine how various socio-demographic factors impact the use of ORT and dispensary treatment among mothers of children affected with diarrhea. Methods:Data from Pakistan Demographic Health Survey (2012-2013) was used for the study. The study sample consisted of women aged 15-49 years old resident in Punjab region (N= 505) with children under five years old who had diarrhea within two weeks of the survey. Chi-square tests and logistic regression analyses were used to determine relationships between maternal socio-demographic characteristics and use of ORT and dispensary care. P-values Results: After controlling for place of residence, educational level and frequency of watching television, caregivers whose children had fever with diarrheal episodes had nearly two-fold increased odds of using ORT treatment [OR= 1.9, (95% CI: 1.28-2.82)], compared to those whose children did not have fever. Similarly poor and middle class socioeconomic status (SES) participants had 3 times increased odds [OR= 2.76, [95% CI: 1.1 -6.89)] of using dispensary treatment when compared to upper class mothers. Place of residence was not a significant predictor of ORT or dispensary use. Discussion: These findings are consistent with other studies that show that mothers’ socioeconomic status are a good indicator of their knowledge about ORT use, and health care seeking behavior. On the other hand, maternal place of residence was not a significant predictor of ORT use, or consultation at a dispensary, even though other studies have found significant associations. Conclusion: Interventions aimed at improving low-income mothers’ knowledge about diarrhea management can include lay medical personnel, such as dispensers, who are often the easily accessible medical resource to this population. Therefore, dispensers should be provided with further training to increase their knowledge and skills in treating children with diarrhea. Future studies that are more rigorous should be conducted to examine this public health issue.

Dissertation (D.P.H.)--University of Michigan.

Dissertation (D.P.H.)--University of Michigan.

A qualitative study was conducted to explore and describe the knowledge and perceptions of parents and caregivers on the causes of diarrhoea among children under five years living in the rural areas of the Eastern Cape Province, South Africa. The aim was to assist in correcting the negative perceptions of the causes of under five child diarrhoea through improved educational interventions. Data were collected through individual, semi-structured and face-to-face interviews from seven participants who were parents and caregivers of under-five children presenting with diarrhoea or admitted for the management of diarrhoea at a specific hospital and thematic analysis was done. The findings revealed that the participants had inadequate knowledge and lacked understanding of diarrhoea and its causes. Participants could not mention all the causes and risk factors associated with diarrhoea. Noteworthy is that the participants’ perceived diarrhoea as a serious condition. The study recommends that the implementation of policies regarding public education and health promotion programmes be targeted at educating parents and caregivers / Health Studies / M.A. (Public Health)

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-03T17:40:16Z No. of bitstreams: 1 Tese Maria Yury Ichihara. 2014.pdf: 2248119 bytes, checksum: 821a02dd8be59ca78df05111c9fdd559 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-07T13:52:13Z (GMT) No. of bitstreams: 1 Tese Maria Yury Ichihara. 2014.pdf: 2248119 bytes, checksum: 821a02dd8be59ca78df05111c9fdd559 (MD5) / Made available in DSpace on 2014-10-07T13:52:13Z (GMT). No. of bitstreams: 1 Tese Maria Yury Ichihara. 2014.pdf: 2248119 bytes, checksum: 821a02dd8be59ca78df05111c9fdd559 (MD5) / A diarréia é uma das causas mais freqüentes de atendimentos ambulatoriais e de hospitalização em menores de 5 anos. Bactérias e o rotavírus são os principais agentes etiológicos envolvidos nas diarréias graves, sendo o rotavírus responsável por 22% a 38% das admissões hospitalares. Para abordar o tema sobre a internação de crianças brasileiras menores de 2 anos devido a diarréia foram realizados três estudos casos-controles com base hospitalar. Inicialmente, foi estimada a associação dos fatores de risco e a internação por diarréia aguda (exceto àquela causada por rotavírus) de acordo com as rotas de transmissão dos agentes etiológicos, as várias fontes de infecção e as condições de vida das populações. Foi demonstrado que os principais fatores de risco associados à internação por diarréia foram a falta de esgotamento sanitário e de água de boa qualidade e ter uma ou mais internações prévias devido à diarréia. Em relação à diarréia aguda causada por rotavírus, a OMS recomenda o uso de duas vacinas licenciadas no mundo (Rotarix® e RotaTeq®). A vacina oral monovalente contra rotavirus (G1P[8], Rotarix®) foi introduzida no Programa Nacional de Imunização do Brasil em 2006. A eficácia e efetividade da vacina variam entre países com renda alta e baixa, embora exista forte evidência de proteção cruzada para os genótipos G1-G4 e G9. Avaliamos a efetividade global e genótipo-específica da vacina oral monovalente na prevenção de internação de crianças brasileiras com diarréia causada por rotavirus. Além disso, estimamos a efetividade da vacina global e genótipo-específica por tempo de vacinação após a segunda dose da vacina (até dois anos) e EV para as Regiões brasileiras. Elevadas efetividades geral e genótipo-específica da vacina foram observadas, mesmo num contexto de grande diversidade genotípica e com predominância do genótipo G2P[4]. A duração da proteção global e genótipo-específica da vacina permaneceu até dois anos e foi maior para G1P[8] do que para G2P[4]. Por outro lado, consideramos plausível que a EV poderia variar em diferentes populações e em diferentes períodos de tempo, mediante a grande diversidade genotípica, a ocorrência de genótipos incomuns, de combinações mistas de G e P e de emergência de novas cepas advindas de combinações inter-espécies (homem e animal). Analisamos a EV estratificada por Regiões brasileiras e ficou demonstrado que a EV para a Região Norte foi similar à EV global. Porém a EV para as outras Regiões foi menor, talvez devido ao pequeno número de casos. Baseado nos resultados dos estudos nós recomendamos: 1) implementar ações voltadas para o domínio público (ambiente, saneamento, higiene na comunidade e acesso a serviços de saúde) para reduzir a morbidade por diarréia; 2) a continuidade do uso da vacina oral monovalente no Programa Nacional de Imunização; e 3) o monitoramento de genótipos para detecção precoce de cepas novas e incomuns. Além disso, novos estudos precisam ser conduzidos para avaliar variações da efetividade da vacina entre as Regiões, as sub-regiões e as áreas mais vulneráveis do Brasil. Será importante realizar estudos de custo-efetividade para subsidiar a política nacional de imunização. / Diarrhea has been a frequent reason of visits to the health services and hospitalization among children under five. Bacteria and rotavirus are the main agents involved in severe diarrhea, in which rotavirus is responsible from 22% to 38% of children hospital admissions. To address the issue of hospitalization of Brazilian children under 2 years due to diarrhea, we conducted three hospital based case-control study. Initially, we aimed to estimate the association of risk factors and acute diarrhea hospitalization (except those caused by rotavirus) according to the routes of transmission of etiologic agents, the various sources of infection and the living conditions of populations. It was demonstrated that the main risk factors were lack of sewage and water of good quality, and already having one or more hospitalizations due to diarrhea. In relation to the rotavirus acute diarrhea, the World Health Organization has been recommended the use of two licensed vaccines worldwide (Rotarix ® and RotaTeq ®). The oral monovalent rotavirus vaccine (G1[P8] strain, Rotarix®) was introduced in Brazilian National Immunization Program in 2006. The vaccine efficacy and effectiveness vary between high and low income countries, although there is strong evidence of cross-protection for G1-G4 and G9 genotypes. We evaluated overall and genotype-specific oral monovalent rotavirus VE in preventing RV-A diarrhea hospital admission of Brazilian children. Also, we estimated overall and genotype-specific VE by time since second dose vaccination (up to two years) and VE according to Brazilian Regions. High overall and genotype-specific VE were observed, even though there was a great diversity of rotavirus genotypes circulating in Brazil and a predominance of G2P[4] genotype. The overall and genotype-specific VE lasted for two years after second dose vaccination and it was higher for G1P[8] than G2P[4]. Besides, we considered that it was plausible that RV-A VE could vary in different populations (Regions) and in different periods of time, since there was a great genotype diversity, an occurrence of unusual genotypes, mixed combinations of G and P and emergence of new strains from combinations of inter-species (human and animal). We analyzed the VE for Brazilian Regions and we demonstrated that the VE for Northern Region was similar to the overall VE. However, the VE for other Regions was lower than VE for Northern Region, maybe because of the small number of the cases. Based on the findings of the studies we recommend: 1) to implement actions of the public domain (environment, sanitation, hygiene in the community and access to health services) to reduce the diarrhea morbidity; 2) the continued use of oral monovalent rotavirus vaccine in the National Immunization Program; and 3) the monitoring for early detection of unusual and novel rotavirus genotypes. In addition, new studies should be conducted to evaluate the variations of rotavirus VE in different Regions, sub-Regions and vulnerable areas in Brazil. It might be useful to conduct cost-effectiveness studies to inform national immunization policy.

Orientadores: Tomomasa Yano, Maria Celia S. Lanna / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-07T10:36:24Z (GMT). No. of bitstreams: 1 Ribeiro_DanielaAlves_M.pdf: 9526817 bytes, checksum: 451baed1219c35350316a70f67d5b336 (MD5) Previous issue date: 2006 / Resumo: Estudos de infecções causadas pela ingestão de águas contaminadas, em especial por Escherichia coli, são importantes para definir o papel dessas bactérias em casos de gastroenterites. Devido à ocorrência freqüente da diarréia infantil na cidade de Ouro Preto-MG, análises microbiológicas da sua água de consumo determinaram a presença de E. coli. No presente trabalho, propriedades fenotípicas e genotípicas de virulência foram estudadas em 97 amostras de E. coli isoladas da água de consumo desse município. Os resultados obtidos para padrões de adesão mostraram que 79 (81,4%) amostras aderiram a células HEp-2 em diferentes padrões de adesão, sendo que 49 (62%) amostras aderiram de forma agregativa, 16 (20,3%) apresentaram o padrão difuso, 12 (15,2%) aderiram de forma não característica e 2 (2,5%) apresentaram o perfil de adesão localizada ¿like¿. Por ensaios de hemaglutinação verificou-se que 70 (72%) amostras hemaglutinaram hemácias de cobaia, 64 (65,9%) aglutinaram hemácias eqüinas, 5 (5,2%) foram positivas com hemácias humanas do grupo A e 10 (10,3%) aglutinaram hemácias bovinas. Todas essas amostras evidenciaram um perfil de hemaglutinação manose sensível, o que está associado à presença da fímbria tipo 1. Outro fator de virulência detectado foi a produção de aerobactina em 11 (11,3%) isolados. Em relação à expressão de hemolisinas em meio sólido, 50 amostras de E. coli foram positivas em placas de ágar sangue contendo hemácias de cavalo, 37 lisaram hemácias de carneiro, 28 lisaram eritrócitos de cobaia, nove lisaram eritrócitos humanos e seis foram positivas com hemácias bovinas. Entretanto, os sobrenadantes de cultura de todas essas bactérias não apresentaram atividade hemolítica ¿in vitro¿. Em relação à atividade citotóxica dos sobrenadantes de cultura das amostras, verificou-se que 89 deles provocaram diferentes alterações morfológicas em células Vero, HeLa e CHO. Deste total, 39 apresentaram efeito citotóxico caracterísitico de desarranjo do citoesqueleto celular, foram estáveis ao aquecimento por 100ºC e demonstraram atividade enterotóxica em camundongos recém nascidos. Estudos genotípicos pela PCR, identificaram nove amostras eltIA+, uma amostra stI+, 14 stII+, seis _ hLy+, três sat+, três astA+, duas pic+, 10 kps+, 11 iucD+, 88 fimH+, seis eae+, três papC+ e uma papG1+. Nenhuma amostra foi positiva para os genes stx1, stx2, stx2v, eltIIA, cnfs, cdt, enhly, pet, bfp, inv, K88 e 987p, aggA, aafA e papGII/GIII. Baseado na aderência em células, na produção de toxinas e na presença de genes de virulência, classificou-se 24 amostras como ETEC, 6 como EPEC atípicas , 36 EAEC e 13 como DAEC. Nenhuma amostra foi classificada como EHEC e EIEC. Estes resultados sugerem um possível envolvimento destas amostras de E. coli como um dos agentes enteropatogênicos envolvidos nas infecções entéricas ocorridas na cidade de Ouro Preto / Abstract: Infections studies caused by the ingestion of contaminated water, especially by Escherichia coli, are important to define the pathogenic role of these bacteria in gastroenteritis. Due to frequent infantile diarrhea in the city of Ouro Preto-MG, this city's water microbiologic analysis displayed the presence of E. coli. In the present study, genotypic and phenotypic virulence properties were studied among 97 E. coli strains isolated from the drinking water provided for this city. The obtained results for adhesion patterns showed that 81,4% of the samples adhere to HEp-2 cells in different adhesion patterns, wherein 49 strains adhere in a aggregative pattern, 16 displayed the diffuse pattern, 12 adhered in a non-characteristic pattern and 2 showed the localized adhesion profile ¿like¿. By means of hemagglutination tests we verified that 72 % of the strains hemagglutinated guinea pig erythrocytes, 65,9% agglutinated horse erythrocytes, 5,2% were positives on group A human erythrocytes and 10,3% agglutinated bovine erythrocytes. All these strains made evident a manose sensible hemagglutination profile, which is associated with type 1 fimbriae. Another virulence factor detected was the production of aerobactin in 11,3% of the isolates. Regarding the hemolysin expression in solid medium, 50 E. coli strains were positive in blood agar plates containing horse erythrocytes, 37 lysated sheep erythrocytes, 28 lysated guinea pig erythrocytes, 9 lysated human erythrocytes and 6 were positives on bovine erythrocytes. However, the culture supernatants of all these bacterias didn't displayed any hemolytic activity ¿in vitro¿. This could be associated with a possible b-hemolysin production. In respect of the cytotoxic activity produced by the strains culture supernatants, we verified that 89 of them provoked different morphological alterations in Vero, HeLa and CHO cells. From these, 39 showed a characteristic cytotoxic effect of disarrangement of the cellular cytoskeleton, remained stable when heated by 100ºC and also showed enterotoxic activity in suckling mice. Genotipic studies performed by PCR identified nine eltIA+ strains, one stI+ strain, 14 stII+, six _ hLy+, three sat+, three astA+, two pic+, 10 kps+, 11 iucD+, 88 fimH+, six eae+, three papC+ and one papG1+. None of these results were positive for the following genes stx1, stx2, stx2v, eltIIA, cnfs, cdt, enhly, pet, bfp, inv, K88 e 987p, aggA, aafA e papGII/GIII. Based on the adherence to cells, toxin production and the presence of the virulence genes, 24 strains were classified as ETEC, 6 as atypical EPEC, 36 as EAEC and 13 as DAEC. Anyone strain were classified as EHEC and EIEC. These results suggest a possible involvement of these E.coli strains as one of the enterophatogenic agents related with the enteric infections occurred in the city of Ouro Preto / Mestrado / Microbiologia / Mestre em Genética e Biologia Molecular

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)