clove and Rotavirus-Infections

Following a recommendation by the World Health Organization, Madagascar introduced rotavirus vaccine in 2014. Though national rotavirus vaccine coverage has remained <80%, rotavirus hospitalizations declined by 78%. Gavi, the Vaccine Alliance, has provided financial support for rotavirus vaccine, however the Malagasy government has increasing responsibility for the financial cost.. In this evaluation, we describe the direct medical, direct non-medical, and indirect cost of illness due to diarrhea among children <5 years old at a public pediatric referral hospital. A 3-part structured questionnaire was administered during and following the hospitalization and the child's hospital record was reviewed.. In total, 96 children were included in this analysis. The median total cost of the illness was $156.00 (IQR: 104.00, 210.86) and the median direct medical cost was $107.22. Service delivery costs represented a median of 44% of the inpatient costs; medications and diagnostic tests represented a median of 28% and 20% of the total costs of the hospitalization, respectively. The median percentage of the total illness costs paid by the household was 67%. Among households with income of <$61/month, the median costs of the illness paid by the household were $78.55, representing a median of 168% of the household's monthly expenses. Among households earning >$303/month, the median costs paid by the household were $147.30, representing a median of 53% of the household's monthly expenses. Among all household income levels, caregivers commonly paid these bills from savings, borrowed money, and donations.. Our findings will be useful in assessing the cost-effectiveness of rotavirus vaccine by decisionmakers. These results may also help hospital administrators and healthcare providers better understand the financial constraints of families.

Topics: Child; Child, Preschool; Cost of Illness; Diarrhea; Hospitalization; Humans; Infant; Madagascar; Rotavirus; Rotavirus Infections; Rotavirus Vaccines

Topics: Community Health Centers; Humans; Infant Health; Infant, Newborn; Madagascar; Pediatrics; Poverty; Rotavirus Infections; Rural Health Services; Vulnerable Populations

Rotavirus vaccine was introduced into the Extended Program on Immunization in Madagascar in May 2014. We analyzed trends in prevalence of all cause diarrhea and rotavirus hospitalization in children <5years of age before and after vaccine introduction and assessed trend of circulating rotavirus genotypes at Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET).. From January 2010 to December 2016, we reviewed the admission logbook to observe the rate of hospitalization caused by gastroenteritis among 19619 children <5years of age admitted at the hospital. In June 2013-December 2016, active rotavirus surveillance was also conducted at CHUMET with support from WHO. Rotavirus antigen was detected by EIA from stool specimen of children who are eligible for rotavirus gastroenteritis surveillance at sentinel site laboratory and rotavirus positive specimens were further genotyped at Regional Reference Laboratory by RT-PCR.. Diarrhea hospitalizations decreased after rotavirus vaccine introduction. The median proportion of annual hospitalizations due to diarrhea was 26% (range: 31-22%) before vaccine introduction; the proportion was 25% the year of vaccine introduction, 17% in 2015 and 16% in 2016. Rotavirus positivity paralleled patterns observed in diarrhea. Before vaccine introduction, 56% of stool specimens tested positive for rotavirus; the percent positive was 13% in 2015, 12% in 2016. Diverse genotypes were detected in the pre-vaccine period; the most common were G3P[8] (n=53; 66%), G2P[4] (n=12; 15%), and G1P[8] (n=11; 14%). 6 distinct genotypes were found in 2015; the most common genotype was G2P[4] (n=10; 67%), the remaining, 5, G12[P8], G3[P8], G1G3[P4], G3G12[P4][P8] and G1G3[NT] had one positive specimen each.. Following rotavirus vaccine introduction all-cause diarrhea and rotavirus-specific hospitalizations declined dramatically. The most common genotypes detected in the pre-vaccine period were G3P[8] and G2P[4] in 2015, the post vaccine period.

Topics: Antigens, Viral; Child, Preschool; Diarrhea; Feces; Gastroenteritis; Genotype; Hospital Records; Hospitalization; Humans; Immunization Programs; Infant; Madagascar; Prevalence; Rotavirus; Rotavirus Infections; Rotavirus Vaccines; Sentinel Surveillance; Vaccination; Vaccines, Attenuated

Diarrheal disease remains a leading cause of death in children in low-income countries. We investigated the etiology, risk factors and effects on nutritional status of severe diarrhea in children from two districts in Madagascar.. We performed a matched case-control study in 2011 to 2014, on children under the age of five years from Moramanga and Antananarivo. The cases were children hospitalized for severe diarrhea and the controls were children without diarrhea selected at random from the community. Stool samples were collected from both groups. Anthropometric measurements were made during follow-up visits about one and two months after enrolment.. We enrolled 199 cases and 199 controls. Rotavirus infection was the most frequently detected cause of diarrhea. It was strongly associated with severe diarrhea (OR: 58.3; 95% CI: 7.7-439.9), accounting for 42.4% (95% CI: 37.6-43.1) of severe diarrhea cases. At the household level, possession of cattle (OR = 0.3; 95% CI: 0.1-0.6) and living in a house with electricity (OR = 0.4; 95% CI: 0.2-0.8) were protective factors. The presence of garbage around the house was a risk factor for severe diarrhea (OR = 3.2; 95% CI: 1.9-5.4). We found no significant association between severe diarrhea and the nutritional status of the children at follow-up visits, but evident wasting at enrolment was associated with a higher risk of severe diarrhea (OR = 9; 95% CI: 4.5-17.9).. Severe childhood diarrhea is mostly caused by rotavirus infection. An anti-rotavirus vaccine has already been introduced in Madagascar and should be promoted more widely. However, post-licensing surveillance is required. Interventions to improve the nutritional status of children, preventive measures focused on household and personal hygiene and nutritional rehabilitation during severe diarrheal disease should be reinforced.

Topics: Animals; Campylobacter; Campylobacter Infections; Case-Control Studies; Cattle; Child, Preschool; Diarrhea; Dysentery, Bacillary; Enteropathogenic Escherichia coli; Escherichia coli Infections; Female; Garbage; Humans; Infant; Madagascar; Male; Nutritional Status; Risk Factors; Rotavirus; Rotavirus Infections; Shigella

In the context of the possible introduction of a preventive vaccine against rotaviruses in Madagascar, the G and P genotypes distribution of the rotaviruses circulating in the children in Madagascar was studied, and the presence of emerging genotypes and unusual strains were assessed. From February 2008 to May 2009, 1,679 stools specimens were collected from children ≤5 years old with diarrhea. ELISA was used for antigen detection, and molecular amplification of VP7 and VP4 gene fragments was used for genotyping. Rotavirus antigen was detected in 104 samples (6.2%). Partial sequences of VP7 and VP4 genes were obtained from 81 and 80 antigen-positive stools, respectively. The most frequent G and P types combinations detected were G9P[8] (n = 51; 64.6%), followed by G1P[8] (n = 15; 18.9%), and G1P[6] (n = 8; 10.1%). A few unusual G-P combinations, such as G4P[6] (n = 3; 3.8%), G9P[6] (n = 1; 1.3%), and G3P[9] reassortant feline human virus (n = 1; 1.3%) were identified. Both VP4 and VP7 sequences in one of the three G4P[6] isolates were closely related to those in porcine strains, and one was a reassortant human porcine virus. These findings give an overview of the strains circulating in Madagascar and should help public health authorities to define a vaccine strategy.

Topics: Antigens, Viral; Capsid Proteins; Child, Preschool; Cluster Analysis; Diarrhea; Feces; Female; Genetic Variation; Genotype; Humans; Infant; Infant, Newborn; Madagascar; Male; Molecular Epidemiology; Molecular Sequence Data; Phylogeny; Prevalence; Rotavirus; Rotavirus Infections; Sequence Analysis, DNA

A survey was undertaken of the etiology of acute gastroenteritis in children <16 years of age in Antananarivo, Madagascar, from May 2004 through May 2005. With use of electron microscopy of fecal specimens, 104 (36%) of 285 children were found to be infected with rotavirus. Rotavirus strain characterization was undertaken using enzyme-linked immunosorbent assay, electropherotyping, reverse-transcription polymerase chain reaction genotyping, and nucleotide sequencing. The predominant group A rotavirus strain types identified were P[4]G2 (62%) and P[8]G9 (23%). Nucleotide sequence analysis of the VP7 genes of selected Malagasy G2 and G9 strains demonstrated similarity with those of other recently identified African rotavirus strains belonging to the same genotype.

Topics: Adolescent; Child; Child, Preschool; Feces; Gastroenteritis; Humans; Infant; Infant, Newborn; Madagascar; Phylogeny; Rotavirus; Rotavirus Infections

An epidemiological study of rotavirus infections was conducted in Tananrive, Madagascar, from November 1988 to October 1990. Rotavirus antigen was detected by ELISA in faecal specimens of 183 of 1,659 children with acute diarrhoea (11%) and in 11 of 631 specimens from children without diarrhoea (1.7%). Rotaviral diarrhoeas were most frequently found in infants aged 6 to 18 months and occurred throughout the year with a definite peak during the first winter months. Analysis of the viral RNA by polyacrylamide gel electrophoresis permitted the characterisation of 170 and 194 strains identified. Nine different electropherotypes (A-I) and one mixed infection were observed. The "short" electropherotypes (A-E) were predominant and represented 140 strains (82.4%), and the "long" electropherotypes (F-I and M) represented 30 strains (17.6%). The "short" electropherotype A (cafb) was the most frequent in our environment (45.3% of cases) and was predominant during the first 14 months of the study. The "long" electropherotype F (bbea) appeared in July 1990 and was predominant during the last three months. Among these children with diarrhoea, the presence of rotavirus was significantly associated with vomiting, fever, and moderate to severe dehydration. However, no significant differences in the occurrence of these symptoms were found between the "short" and "long" electropherotypes.

Topics: Adolescent; Child; Child, Preschool; Diarrhea; Humans; Infant; Infant, Newborn; Madagascar; Rotavirus; Rotavirus Infections; Seasons

Topics: Child, Preschool; Diarrhea; Diarrhea, Infantile; Female; Humans; Infant; Infant, Newborn; Madagascar; Male; Rotavirus Infections

Our study included a total of 318 diarrheic stools and 52 normal stools collected from out-patients with acute diarrhea at welfare Center and children admitted at Antananarivo City children's Hospital, or control free of infectious disease during 8 months period. Enzyme linked immunosorbant assay and tissue cultures revealed the presence of 152 viral particles (47%) from children with diarrhea and 29 viral particles (55%) from control children. Positive cases were distributed according age, sex, and season factors. The highest infection rate was found in 25-36 months old of the children with diarrhea (72%). The two sexes were equally infected. Enteroviruses were isolated from diarrheic stools with a high frequency (43%) during the rainy and warm season while Rotaviruses were the prevailing agent during the dry and cool season, and Adenoviruses came in second place (19%). In view of our results, the etiological role of these viruses in diarrhea is discussed.

Topics: Adenoviridae; Adenoviridae Infections; Child, Preschool; Diarrhea, Infantile; Enterovirus; Enterovirus Infections; Feces; Female; Humans; Infant; Infant, Newborn; Madagascar; Male; Rotavirus; Rotavirus Infections; Seasons; Virus Diseases

Rotavirus were detected by enzyme immuno assay method in 36 p. 100 of faecal specimens from 80 children with acute diarrhoea and in 8 p. 100 of 80 controls, over a period of three months in Majunga area. The incidence of rotavirus was studied according to age group, sex, nutritional status, and clinical aspects.

Topics: Child, Preschool; Diarrhea, Infantile; Feces; Female; Humans; Immunoenzyme Techniques; Infant; Infant, Newborn; Madagascar; Male; Rotavirus; Rotavirus Infections; Seasons