Background: Diarrhoea remains one of the leading causes of mortality in young children. After dehydration and malnutrition, electrolytes disturbances are an important complication of diarrhoea. In Cape Town, fluctuation of plasma sodium and potassium has been observed in childhood diarrhoea and were seasonal in their occurrence. A study conducted at Red Cross Children's Hospital found that seasonal fluctuations of plasma sodium and potassium were associated with specific enteropathogens but did not identify associations that suggested potential public health interventions that could target the electrolytes disturbances. It is possible that by identifying association with the enteropathogens directly, one could identify public health interventions to avoid seasonal electrolyte disturbances. Objectives: To identify clinical, nutritional, socio-economic, socio-demographic and seasonal associations with childhood diarrhoea caused by the enteropathogens Shigella, Salmonella, enterotoxigenic E. coli, enteropathogenic E.coli, Cryptosporidium, rotavirus or Campylobacter. Methods: This study was a secondary analysis of a cross-sectional study of infants less than 2 years old admitted to the Rehydration Unit of the Red Cross Children's Hospital with diarrhoea. Data were obtained through routine medical records and a questionnaire. Multiple logistic regression was performed to identify determinants of the diarrhoea-associated electrolytes disturbances. Results: Height for age was negatively associated with enteropathogenic E.coli (OR: 0.82, p-value: 0.039), Campylobacter (OR: 0.87, p-value: 0.082) and Salmonella (OR: 0.79, 0-value: 0.029) in the bi-variate analysis. Weight forheight and height for age were associated respectively to rotavirus (OR: 1.24, p-value: 0.011) and enterotoxigenic E.coli (OR: 1.16, p-value: 0.064 ). Water source was positively associated with Enteropathogenic E. coli, Campylobacter and inversely associated with rotavirus. Toilet was positively associated with enteropathogenic E. coli and Salmonella. Average temperature was positively associated with Enteropathogenic E. coli, Enterotoxigenic E. coli, Salmonella and Shiga/la. In the multivariate analysis breast feeding was negatively associated with Cryptosporidium infection (OR: 0.13; 95% Cl 0.20-0.62) while average humidity was positively associated with Cryptosporidium infection (OR: 1.1 O; 95% Cl 1.05-1.16). Enteropathogenic E. coli infection was positively associated with average ambient temperature (OR: 1.16, 95% Cl 1.03- 1.30).The child's age was a determinant of Campylobacter, (OR: 1.05; 95% Cl 1.00-1.11 ). Formula feeding, (OR: 0.45; 95% Cl 0.20-0.99) average temperature (OR: 0.87; 95% Cl 0.81-0.95) and humidity (OR: 0.91; 95% Cl 0.80-0.94) were all protective of rotavirus infection. None of the socioeconomic variables were associated with specific enteropathogens. Discussion: The only determinant associated with Enteropathogenic E coli identified in this study was average temperature. This concurs with its summer isolation. No significant determinant was identified for Enterotoxigenic E. coli in this analysis. For Cryptosporidium, in the multivariate analyses were duration of diarrhoea, breast-feeding and average humidity were identified as significant determinants. With the exception of breast-feeding, none of these determinants could be amended through public health intervention. For Campylobacter, age and adequacy of drinking were identified as significant determinants during the multivariate analysis. Adequacy of drinking was the only significant determinant associated with Salmonella. Formula feeding, plasma pH, average humidity and average temperature were associated with rotavirus while associations identified with Shiga/la were duration of vomiting, plasma pH and average temperature. As above, none of the identified determinants could be changed to modify the occurrence of these enteropathogenic diarrhoea. Conclusion: Although associations with specific enteropathogens were identified, none of the associations identified suggest public health interventions to avoid seasonal electrolyte disturbances.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/38233 |
| Date | 15 August 2023 |
| Creators | Moeng, Helimamy |
| Contributors | Swingler, George |
| Publisher | Faculty of Health Sciences, Division of Public Health |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MPH |
| Format | application/pdf |
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