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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in botswana, 2006
Journal of Acquired Immune Deficiency Syndromes, Volume 53, No. 1, Year 2010
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Description
BACKGROUND: In 2006, a pediatric diarrhea outbreak occurred in Botswana, coinciding with heavy rains. Surveillance recorded a 3 times increase in cases and a 25 fold increase in deaths between January and March. Botswana has high HIV prevalence among pregnant women (33.4% in 2005), and an estimated 35% of all infants under the age of 6 months are not breastfed. METHODS: We followed all children <5 years old with diarrhea in the country's second largest referral hospital at the peak of the outbreak by chart review, interviewed mothers, and conducted laboratory testing for HIV and enteric pathogens. RESULTS: Of 153 hospitalized children with diarrhea, 97% were <2 years old; 88% of these were not breastfeeding. HIV was diagnosed in 18% of children and 64% of mothers. Cryptosporidium and enteropathogenic Escherichia coli were common; many children had multiple pathogens. Severe acute malnutrition (kwashiorkor or marasmus) developed in 38 (25%) patients, and 33 (22%) died. Kwashiorkor increased risk for death (relative risk 2.0; P = 0.05); only one breastfeeding child died. Many children who died had been undersupplied with formula. CONCLUSIONS: Most of the severe morbidity and mortality in this outbreak occurred in children who were HIV negative and not breastfed. Feeding and nutritional factors were the most important determinants of severe illness and death. Breastfeeding is critical to infant survival in the developing world, and support for breastfeeding among HIV-negative women, and HIV-positive women who cannot formula feed safely, may prevent further high-mortality outbreaks. Copyright © 2009 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Creek, Tracy L.
Unknown Affiliation
Kim, Andrea A.
Unknown Affiliation
Lu, Lydia
Unknown Affiliation
Bowen, A.
Unknown Affiliation
Masunge, Japhter
Unknown Affiliation
Arvelo, Wences
Unknown Affiliation
Smit, Molly
Unknown Affiliation
MacH, Ondrej
Unknown Affiliation
Legwaila, Keitumetse
Unknown Affiliation
Motswere, Catherine
Unknown Affiliation
Zaks, Laurel
Unknown Affiliation
Finkbeiner, Thomas
Unknown Affiliation
Povinelli, Laura
Unknown Affiliation
Maruping, Maruping
Unknown Affiliation
Ngwaru, Gibson
Unknown Affiliation
Tebele, Goitebetswe
Unknown Affiliation
Bopp, Cheryl A.
Unknown Affiliation
Puhr, Nancy D.
Unknown Affiliation
Johnston, Stephanie P.
Unknown Affiliation
DaSilva, Alexandre J.
Unknown Affiliation
Bern, Caryn
Unknown Affiliation
Beard, Rachel S.
Unknown Affiliation
Davis, Margarett K.
Unknown Affiliation
Statistics
Citations: 134
Authors: 23
Affiliations: 5
Identifiers
Doi:
10.1097/QAI.0b013e3181bdf676
ISSN:
15254135
Research Areas
Food Security
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Botswana
Participants Gender
Female