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Infectious Diseases - Pediatrics and Child Health - Public Health and Epidemiology

Case-Control Study of the Etiology of Infant Diarrheal Disease in 14 Districts in Madagascar
Published: Monday, September 17, 2012
Author: Rindra Randremanana et al.

by Rindra Randremanana, Frédérique Randrianirina, Marie Gousseff, Natasha Dubois, Richter Razafindratsimandresy, Elisoa Ratsima Hariniana, Benoit Garin, Arthur Randriamanantena, Hanitra Clara Rakotonirina, Lovasoa Ramparany, Charles Emile Ramarokoto, Fanjasoa Rakotomanana, Maherisoa Ratsitorahina, Soatiana Rajatonirina, Antoine Talarmin, Vincent Richard


Acute diarrhea is a major cause of childhood morbidity and mortality worldwide. Its microbiological causes and clinico-epidemiological aspects were examined during the rainy seasons from 2008 to 2009 in 14 districts in Madagascar.


Stool specimens of 2196 children with acute diarrhea and 496 healthy children were collected in a community setting. Intestinal parasites were diagnosed by microscopy and bacteria by culturing methods. Rota-, astro and adenoviruses were identified using commercially available ELISA kits and rotaviruses were confirmed using reverse transcriptase polymerase chain reaction (RT-PCR).


Intestinal microorganisms were isolated from 54.6% of diarrheal patients and 45.9% of healthy subjects (p?=?<0.01). The most common pathogens in diarrheic patients were intestinal parasites (36.5%). Campylobacter spp. and Rotavirus were detected in 9.7% and 6.7% of diarrheic patients. The detection rates of Entamoeba histolytica, Trichomonas intestinalis and Giardia lamblia were much greater in diarrheal patients than in non diarrheal subjects (odds ratios of 5.1, 3.2, 1.7 respectively). The abundance of other enteropathogens among the non diarrheal group may indicate prolonged excretion or limited pathogenicity.


In developing countries, where the lack of laboratory capacities is great, cross sectional studies of enteropathogens and their spatial distribution, including diarrheal and non diarrheal subjects, are interesting tools in order to advise regional policies on treatment and diarrheic patient management.