Interventions for High-Burden Infectious Diseases in Children and Adolescents: A Meta-analysis

Enteric bacterial agents associated with diarrhea and their antimicrobial sensitivity profiles in children under 5 years from mukuru informal settlement, Nairobi, Kenya

BACKGROUND

In Kenya, diarrhoeal disease is the third leading cause of child mortality after malaria and pneumonia, accounting for nearly 100 deaths daily. We conducted a cross-sectional study in Mukuru informal settlements to determine the bacteria associated with diarrhea and their ASTs to provide data essential for implementing appropriate intervention measures.

METHODS

Diarrheagenic children (≤ 5 years) were purposively recruited from outpatient clinics of Municipal City Council, Mukuru kwa Reuben, Medical Missionaries of Mary, and Mama Lucy Kibaki Hospital, Nairobi. A total of 219 stool samples were collected between May 2021 and August 2021. Stool culture was done on MacConkey and Salmonella Shigella agar, while the recovered bacteria were identified using VITEK®2GNID and polymerase chain reaction (PCR) used for E. coli pathotyping. Antibiotic Susceptibility Testing was done using VITEK®2AST-GN83.

RESULTS

At least one bacterial organism was recovered from each of the 213 (97%) participants, with 115 (56%) participants having only one bacterial type isolated, 90 (43%) with two types of bacteria, and 2 (1%) with three types of bacteria recovered. The most predominant bacteria recovered was 85% (93/109) non-pathogenic E.coli and 15% (16/109)of pathogenic E.coli, with 2 (1%) were Enterohemorrhagic E.coli (EHEC), 6 (3%) were Enteroaggregative E.coli (EAEC), and 8 (4%) were Enteropathogenic E.coli (EPEC). Other potentially pathogenic bacteria included Enterobacter sp (27.8%), Klebsiella sp 33(11%), and Citrobacter sp 15(4.7%). Pathogenic isolates such as Salmonella 7 (2%), Proteus mirabilis 16 (6%), Providencia alcalifaciens 1 (0.3%), and Shigella 16 (4.7%) were detected. Isolates such as Pantoea spp 2(0.67%), Raoultella planticola 1(0.33%), and Kluyvera 6(2%) rarely reported but implicated with opportunistic diarrhoeal disease were also recovered. Ampicillin, cefazolin, and sulfamethoxazole-trimethoprim were the least effective antimicrobials at 64%, 57%, and 55% resistance, respectively, while meropenem (99%), amikacin (99%), tazobactam piperacillin (96%), and cefepime (95%) were the most effective. Overall, 33(21%) of all enterics recovered were multidrug-resistant.

CONCLUSION

The study documented different bacteria potentially implicated with childhood diarrhea that were not limited to E. coli, Shigella, and Salmonella, as previously observed in Kenya. The strains were resistant to the commonly used antibiotics, thus narrowing the treatment options for diarrheal disease.

Water, sanitation, and hygiene global research: evolution, trends, and knowledge structure

Water, sanitation, and hygiene (WASH) services play a crucial role in promoting public and environmental health as well as social and economic development. At the global level, particularly in the developing world, WASH issues continue to present significant challenges. These challenges have been further intensified by factors such as the COVID-19 pandemic, escalating conflicts, climate change, water scarcity, and rising inequality. The scientific community has actively engaged in constructive discussions on these issues, as evidenced by the notable research findings. Therefore, the aim of this study was to comprehensively examine and evaluate global knowledge on WASH. To search for relevant publications, the Scopus database was utilized using specific terms associated with WASH. VOSviewer 1.6.18 software was employed to generate network visualization maps, which assessed collaborative patterns and research trends in the field of WASH. The research output of countries was adjusted considering their gross domestic product (GDP) and population size. The total number of WASH-related publications, including all types of documents, was 1805. By narrowing the search to articles and reviews, the overall global productivity yielded 1589 documents: 1367 (86.0%) original articles and 222 (14.0%) review articles. The USA had the highest number of WASH publications (n = 668; 42.0%), followed by the UK (n = 396; 24.9%), Switzerland (n = 151; 9.5%), and Australia (n = 141; 8.9%). Ethiopia emerged as the leading country in terms of GDP per capita and the number of publications, followed by Uganda, Malawi, India, and Bangladesh. The USA, the UK, and Switzerland exhibited the most extensive collaboration among countries. The main research areas encompassed the role of WASH in sustainable development, the impacts of inadequate access to WASH services on gender equality, children, infants, and the outbreak of COVID-19 and other diseases, as well as the significance of hygiene practices and community and school-based WASH interventions in reducing infections. This study provides a novel analysis of global WASH-related research and highlights the distribution of outcomes across nations. Continued and increased collaboration between developed and developing nations will facilitate the sharing of responsibility for WASH research outcomes and the implementation of effective policies.

Interventions for Health and Well-Being in School-Aged Children and Adolescents: A Way Forward

The health and well-being of school-aged children has received little attention compared with younger children aged < 5 years and adolescents. In this final article in a supplement of reviews that have assessed the effectiveness of interventions for school-aged children across a variety of health-related domains (including infectious diseases, noncommunicable diseases, healthy lifestyle, mental health, unintentional injuries, and sexual and reproductive health), we summarize the main findings and offer a way forward for future research, policy, and implementation. We complement this evidence base on interventions with a summary of the literature related to enabling policies and intersectoral actions supporting school-aged child health. The school represents an important platform for both the delivery of preventive interventions and the collection of data related to child health and academic achievement, and several frameworks exist that help to facilitate the creation of a health-promoting environment at school.