Rego, Ryan, Watson, Samuel I., Alam, Mohammad Atique Ul, Abdullah, Syed Asif, Yunus, Mohammad, Alam, Imam Taskin, Chowdhury, A.S.M.Homuan Kabir, Haider, S.M.Arefeen, Faruque, ASG, Khan, Azharul Islam, Hofer, Timothy, Gill, Paramjit, Islam, Mohammad Sirajul and Lilford, Richard (2021) A comparison of traditional diarrhoea measurement methods with microbiological and biochemical indicators : a cross-sectional observational study in the Cox's Bazar displaced persons camp. eClinicalMedicine, 42 . 101205. doi:10.1016/j.eclinm.2021.101205 ISSN 2589-5370.
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Abstract
Background
Water, Sanitation, and Hygiene (WASH) systems aim to reduce the spread of enteric pathogens, particularly amongst children under five years old. The most common primary outcome of WASH trials is carer-reported diarrhoea. We evaluate different diarrhoea survey instruments as proxy markers of enteric pathogen presence in stool.
Methods
We recruited 800 community-based participants from the Cox's Bazar Displaced Person's Camp in Bangladesh, split evenly between the rainy (July/August 2020) and dry (November/December 2020) periods. Participants were randomized evenly into either a standard survey asking carers if their child under five years old has had diarrhoea in the past fortnight, or a pictorial survey asking carers to pick from a pictorial chart which stools their child under five years old has had in the past fortnight. We collected stools from a random sub-sample of 120. Stools were examined visually, and tested for proteins associated with enteric infection and 16 enteric pathogens. We calculated sensitivities and specificities for each survey type, visual examination, and proteins with respect to enteric pathogen presence.
Findings
The sensitivity of the standard survey for enteric pathogen presence was 0.49[95%CI:0.32,0.66] and the specificity was 0.65[0.41,0.85]. Similar sensitivities and specificities were observed for pictorial survey, visual inspection, and proteins.
Interpretation
While diarrhoea is an important sign in clinical practice it appears that it is a poor proxy for enteric pathogen presence in stool in epidemiological surveys. When enteric infection is of interest, this should be measured directly.
| Item Type: | Journal Article |
|---|---|
| Subjects: | Q Science > QR Microbiology R Medicine > RC Internal medicine R Medicine > RJ Pediatrics |
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
| Library of Congress Subject Headings (LCSH): | Cox's Bāzār (Bangladesh), Diarrhea , Diarrhea in children -- Bangladesh, Diarrhea, Infantile , Enterobacteriaceae -- Diagnosis , Pathogenic microorganisms -- Detection |
| Journal or Publication Title: | eClinicalMedicine |
| Publisher: | Elsevier |
| ISSN: | 2589-5370 |
| Official Date: | December 2021 |
| Dates: | Date Event December 2021 Published 20 November 2021 Available 1 November 2021 Accepted |
| Volume: | 42 |
| Article Number: | 101205 |
| DOI: | 10.1016/j.eclinm.2021.101205 |
| Status: | Peer Reviewed |
| Publication Status: | Published |
| Access rights to Published version: | Open Access (Creative Commons open licence) |
| Date of first compliant deposit: | 22 November 2021 |
| Date of first compliant Open Access: | 22 November 2021 |
| RIOXX Funder/Project Grant: | Project/Grant ID RIOXX Funder Name Funder ID |
| URI: | https://wrap.warwick.ac.uk/160260/ |
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