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Pediatric Diarrhea in Southern Ghana: Etiology and Association with Intestinal Inflammation and Malnutrition

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  • Department of Microbiology, University of Ghana Medical School, Accra, Ghana; Princess Marie Louise Children's Hospital, Accra, Ghana; Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia; Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland, Baltimore, Maryland

Diarrhea is a major public health problem that affects the development of children. Anthropometric data were collected from 274 children with (N = 170) and without (N = 104) diarrhea. Stool specimens were analyzed by conventional culture, polymerase chain reaction for enteroaggregative Escherichia coli (EAEC), Shigella, Cryptosporidium, Entamoeba, and Giardia species, and by enzyme-linked immunosorbent assay for fecal lactoferrin levels. About 50% of the study population was mildly to severely malnourished. Fecal lactoferrin levels were higher in children with diarrhea (P = 0.019). Children who had EAEC infection, with or without diarrhea, had high mean lactoferrin levels regardless of nutritional status. The EAEC and Cryptosporidium were associated with diarrhea (P = 0.048 and 0.011, respectively), and malnourished children who had diarrhea were often co-infected with both Cryptosporidium and EAEC. In conclusion, the use of DNA-biomarkers revealed that EAEC and Cryptosporidium were common intestinal pathogens in Accra, and that elevated lactoferrin was associated with diarrhea in this group of children.

Author Notes

*Address correspondence to Japheth A. Opintan, Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, MR6, Carter-Harrison Bldg, Rm 2709, 345 Crispel Drive, Charlottesville, VA 22903. E-mails: japh_opintan@yahoo.com or jyo4g@virginia.edu

Financial support: This study was supported in part by the University of Ghana Medical School, College of Health Sciences, Accra, Ghana and Pfizer-supported funds to the Center for Global Health, University of Virginia, Charlottesville, VA.

Authors' addresses: Japheth A. Opintan, Mercy J. Newman, and Patrick F. Ayeh-Kumi, Department of Microbiology, University of Ghana Medical School, Korle-Bu, Accra, Ghana, E-mails: jyo4g@virginia.edu, newmerci@yahoo.co.uk, and payehkumi@yahoo.com. Raymond Affrim and Rosina Gepi-Attee, Princess Marie Louise Children's Hospital, Accra, Ghana, E-mails: raffrim@yahoo.com and rgepi_attee@yahoo.com. Jesus E. A. D. Sevilleja, James K. Roche, Cirle A. Warren, and Richard L. Guerrant, Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, E-mails: emsevilleja@yahoo.com, jkr7m@virginia.edu, ca6t@virginia.edu, and rlg9a@virginia.edu. James P. Nataro, Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland, Baltimore, MD, E-mail: jpn2r@virginia.edu.

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