Cargando…

Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya

HIV-exposed, uninfected (HEU) children are a growing population at particularly high risk of infection-related death in whom preventing diarrhea may significantly reduce under-5 morbidity and mortality in sub-Saharan Africa. A historic cohort (1999–2002) of Kenyan HEU infants followed from birth to...

Descripción completa

Detalles Bibliográficos
Autores principales: Deichsel, Emily L., Pavlinac, Patricia B., Mbori-Ngacha, Dorothy, Walson, Judd L., Maleche-Obimbo, Elizabeth, Farquhar, Carey, Bosire, Rose, John-Stewart, Grace C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The American Society of Tropical Medicine and Hygiene 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204572/
https://www.ncbi.nlm.nih.gov/pubmed/32100682
http://dx.doi.org/10.4269/ajtmh.19-0705
_version_ 1783530076474703872
author Deichsel, Emily L.
Pavlinac, Patricia B.
Mbori-Ngacha, Dorothy
Walson, Judd L.
Maleche-Obimbo, Elizabeth
Farquhar, Carey
Bosire, Rose
John-Stewart, Grace C.
author_facet Deichsel, Emily L.
Pavlinac, Patricia B.
Mbori-Ngacha, Dorothy
Walson, Judd L.
Maleche-Obimbo, Elizabeth
Farquhar, Carey
Bosire, Rose
John-Stewart, Grace C.
author_sort Deichsel, Emily L.
collection PubMed
description HIV-exposed, uninfected (HEU) children are a growing population at particularly high risk of infection-related death in whom preventing diarrhea may significantly reduce under-5 morbidity and mortality in sub-Saharan Africa. A historic cohort (1999–2002) of Kenyan HEU infants followed from birth to 12 months was used. Maternal and infant morbidity were ascertained at monthly clinic visits and unscheduled sick visits. The Andersen–Gill Cox model was used to assess maternal, environmental, and infant correlates of diarrhea, moderate-to-severe diarrhea (MSD; diarrhea with dehydration, dysentery, or related hospital admission), and prolonged/persistent diarrhea (> 7 days) in infants. HIV-exposed, uninfected infants (n = 373) experienced a mean 2.09 (95% CI: 1.93, 2.25) episodes of diarrhea, 0.47 (95% CI: 0.40, 0.55) episodes of MSD, and 0.34 (95% CI: 0.29, 0.42) episodes of prolonged/persistent diarrhea in their first year. Postpartum maternal diarrhea was associated with increased risk of infant diarrhea (Hazard ratio [HR]: 2.09; 95% CI: 1.43, 3.06) and MSD (HR: 2.89; 95% CI: 1.10, 7.59). Maternal antibiotic use was a risk factor for prolonged/persistent diarrhea (HR: 1.63; 95% CI: 1.04, 2.55). Infants living in households with a pit latrine were 1.44 (95% CI: 1.19, 1.74) and 1.49 (95% CI: 1.04, 2.14) times more likely to experience diarrhea and MSD, respectively, relative to those with a flush toilet. Current exclusive breastfeeding was protective against MSD (HR: 0.30; 95% CI: 0.15, 0.58) relative to infants receiving no breast milk. Reductions in maternal diarrhea may result in substantial reductions in diarrhea morbidity among HEU children, in addition to standard diarrhea prevention interventions.
format Online
Article
Text
id pubmed-7204572
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher The American Society of Tropical Medicine and Hygiene
record_format MEDLINE/PubMed
spelling pubmed-72045722020-05-07 Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya Deichsel, Emily L. Pavlinac, Patricia B. Mbori-Ngacha, Dorothy Walson, Judd L. Maleche-Obimbo, Elizabeth Farquhar, Carey Bosire, Rose John-Stewart, Grace C. Am J Trop Med Hyg Articles HIV-exposed, uninfected (HEU) children are a growing population at particularly high risk of infection-related death in whom preventing diarrhea may significantly reduce under-5 morbidity and mortality in sub-Saharan Africa. A historic cohort (1999–2002) of Kenyan HEU infants followed from birth to 12 months was used. Maternal and infant morbidity were ascertained at monthly clinic visits and unscheduled sick visits. The Andersen–Gill Cox model was used to assess maternal, environmental, and infant correlates of diarrhea, moderate-to-severe diarrhea (MSD; diarrhea with dehydration, dysentery, or related hospital admission), and prolonged/persistent diarrhea (> 7 days) in infants. HIV-exposed, uninfected infants (n = 373) experienced a mean 2.09 (95% CI: 1.93, 2.25) episodes of diarrhea, 0.47 (95% CI: 0.40, 0.55) episodes of MSD, and 0.34 (95% CI: 0.29, 0.42) episodes of prolonged/persistent diarrhea in their first year. Postpartum maternal diarrhea was associated with increased risk of infant diarrhea (Hazard ratio [HR]: 2.09; 95% CI: 1.43, 3.06) and MSD (HR: 2.89; 95% CI: 1.10, 7.59). Maternal antibiotic use was a risk factor for prolonged/persistent diarrhea (HR: 1.63; 95% CI: 1.04, 2.55). Infants living in households with a pit latrine were 1.44 (95% CI: 1.19, 1.74) and 1.49 (95% CI: 1.04, 2.14) times more likely to experience diarrhea and MSD, respectively, relative to those with a flush toilet. Current exclusive breastfeeding was protective against MSD (HR: 0.30; 95% CI: 0.15, 0.58) relative to infants receiving no breast milk. Reductions in maternal diarrhea may result in substantial reductions in diarrhea morbidity among HEU children, in addition to standard diarrhea prevention interventions. The American Society of Tropical Medicine and Hygiene 2020-05 2020-02-24 /pmc/articles/PMC7204572/ /pubmed/32100682 http://dx.doi.org/10.4269/ajtmh.19-0705 Text en © The American Society of Tropical Medicine and Hygiene This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Articles
Deichsel, Emily L.
Pavlinac, Patricia B.
Mbori-Ngacha, Dorothy
Walson, Judd L.
Maleche-Obimbo, Elizabeth
Farquhar, Carey
Bosire, Rose
John-Stewart, Grace C.
Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya
title Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya
title_full Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya
title_fullStr Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya
title_full_unstemmed Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya
title_short Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya
title_sort maternal diarrhea and antibiotic use are associated with increased risk of diarrhea among hiv-exposed, uninfected infants in kenya
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204572/
https://www.ncbi.nlm.nih.gov/pubmed/32100682
http://dx.doi.org/10.4269/ajtmh.19-0705
work_keys_str_mv AT deichselemilyl maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya
AT pavlinacpatriciab maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya
AT mboringachadorothy maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya
AT walsonjuddl maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya
AT malecheobimboelizabeth maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya
AT farquharcarey maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya
AT bosirerose maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya
AT johnstewartgracec maternaldiarrheaandantibioticuseareassociatedwithincreasedriskofdiarrheaamonghivexposeduninfectedinfantsinkenya