- Related item:
- A cohort study to define the age-specific incidence and risk factors of Shigella diarrhoeal infections in Vietnamese children: a study protocol
- Description:
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Background: Shigella spp. are one of the most common causes of paediatric dysentery globally, responsible for a
substantial proportion of diarrhoeal disease morbidity and mortality, particularly in industrialising regions. Alarming
levels of antimicrobial resistance are now reported in S. flexneri and S. sonnei, hampering treatment options. Little is
known, however, about the burden of infection and disease due to Shigella spp. in the community.
Methods/Design: In order to estimate the incidence of this bacterial infection in the community in Ho Chi Minh
City, Vietnam we have designed a longitudinal cohort to follow up approximately 700 children aged 12–60 months
for two years with active and passive surveillance for diarrhoeal disease. Children will be seen at 6 month intervals
for health checks where blood and stool samples will be collected. Families will also be contacted every two weeks
for information on presence of diarrhoea in the child. Upon report of a diarrhoeal disease episode, study nurses will
either travel to the family home to perform an evaluation or the family will attend a study hospital at a reduced
cost, where a stool sample will also be collected. Case report forms collected at this time will detail information
regarding disease history, risk factors and presence of disease in the household.
Outcomes will include (i) age-specific incidence of Shigella spp. and other agents of diarrhoeal disease in the
community, (ii) risk factors for identified aetiologies, (iii) rates of seroconversion to a host of gastrointestinal
pathogens in the first few years of life. Further work regarding the longitudinal immune response to a variety of
Shigella antigens, host genetics and candidate vaccine/diagnostic proteins will also be conducted.
Discussion: This is the largest longitudinal cohort with active surveillance designed specifically to investigate
Shigella infection and disease. The study is strengthened by the active surveillance component, which will likely
capture a substantial proportion of episodes not normally identified through passive or hospital-based surveillance. It is
hoped that information from this study will aid in the design and implementation of Shigella vaccine trials in the future.
- Related item:
- Excess body weight and age associated with the carriage of fluoroquinolone and third-generation cephalosporin resistance genes in commensal Escherichia coli from a cohort of urban Vietnamese children
- Description:
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Purpose. Antimicrobial-resistant bacterial infections in low- and middle-income countries (LMICs) are a well-established
global health issue. We aimed to assess the prevalence of and epidemiological factors associated with the carriage of
ciprofloxacin- and ceftriaxone-resistant Escherichia coli and associated resistance genes in a cohort of 498 healthy children
residing in urban Vietnam.
Methodology. We cultured rectal swabs onto MacConkey agar supplemented with resistant concentrations of ciprofloxacin
and ceftriaxone. Additionally, we screened meta-E. coli populations by conventional PCR to detect plasmid-mediated
quinolone resistance (PMQR)- and extended-spectrum b-lactamase (ESBL)-encoding genes. We measured the associations
between phenotypic/genotypic resistance and demographic characteristics using logistic regression.
Results/Key findings. Ciprofloxacin- and ceftriaxone-resistant E. coli were cultured from the faecal samples of 67.7% (337/498)
and 80.3% (400/498) of children, respectively. The prevalence of any associated resistance marker in the individual samples
was 86.7% (432/498) for PMQR genes and 90.6% (451/498) for b-lactamase genes. Overweight children were significantly
more likely to carry qnr genes than children with lower weight-for-height z-scores [odds ratios (OR): 1.24; 95%confidence
interval (CI): 10.5–1.48 for each unit increase in weight for height; P=0.01]. Additionally, younger children were significantly
more likely to carry ESBL CTX-M genes than older children (OR: 0.97, 95%CI: 0.94–0.99 for each additional year, P=0.01).
Conclusion. The carriage of genotypic and phenotypic antimicrobial resistance is highly prevalent among E. coli in healthy
children in the community in Vietnam. Future investigations on the carriage of antimicrobial resistant organisms in LMICs
should focus on the progression of carriage from birth and structure of the microbiome in obesity.
- Related item:
- Quantifying antimicrobial access and usage for paediatric diarrhoeal disease in an urban community setting in Asia.
- Description:
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Objectives: Antimicrobial-resistant infections are a major global health issue. Ease of antimicrobial access in
developing countries is proposed to be a key driver of the antimicrobial resistance (AMR) epidemic despite a lack
of community antimicrobial usage data.
Methods: Using a mixed-methods approach (geospatial mapping, simulated clients, healthcare utilization, longitudinal
cohort) we assessed antimicrobial access in the community and quantified antimicrobial usage for
childhood diarrhoea in an urban Vietnamese setting.
Results: The study area had a pharmacy density of 15.7 pharmacies/km2 (a pharmacy for every 1316 people).
Using a simulated client method at pharmacies within the area, we found that 8% (3/37) and 22% (8/37) of outlets
sold antimicrobials for paediatric watery and mucoid diarrhoea, respectively. However, despite ease of pharmacy
access, the majority of caregivers would choose to take their child to a healthcare facility, with 81%
(319/396) and 88% (347/396) of responders selecting a specialized hospital as one of their top three preferences
when seeking treatment for watery and mucoid diarrhoea, respectively. We calculated that at least 19%
(2688/14427) of diarrhoea episodes in those aged 1 to ,5 years would receive an antimicrobial annually; however,
antimicrobial usage was almost 10 times greater in hospitals than in the community.
Conclusions: Our data question the impact of community antimicrobial usage on AMR and highlight the need
for better education and guidelines for all professionals with the authority to prescribe antimicrobials.
- Related item:
- Factors associated with a low prevalence of exclusive breastfeeding during hospital stay in urban and semi-rural areas of southern Vietnam
- Description:
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Background: There is a paucity of data regarding risk factors associated with suboptimal breastfeeding practices in
urbanized areas of low-middle income countries (LMICs).
Methods: Through a large prospective birth cohort, which enrolled 6706 infants in Vietnam between 2009 and
2013, we investigated the practice of exclusive breastfeeding during hospital stay in urban and semi-rural
populations and aimed to identify factors associated with suboptimal breastfeeding practices. Univariate and
multivariable logistic regression were performed to determine factors associated with not exclusive breastfeeding
during hospital stay.
Results: Of 6076 mothers, 33% (2187) breastfed their infant exclusively before hospital discharge; 9% (364/4248) in
urban and 74% (1823/2458) in semi-rural areas. Exclusive breastfeeding up to 4 months was recorded in 15% (959/
6210) of participants; this declined to < 1% (56/6093) at 6 months. Delivery by Caesarean section (Odds Ratio [OR] 0.
07; 95% Confidence Interval [CI] 0.04, 0.11 and OR 0.05; 95% CI 0.03, 0.08) and neonatal complications (OR 0.2; 95%
CI 0.07, 0.47 and OR 0.25; 95% CI 0.14, 0.46) were common and highly significant risk factors associated with a lack
of exclusive breastfeeding during hospital stay in urban and semi-rural settings, respectively.
Conclusions: To our knowledge, this is the first large-scale investigation aimed at identifying factors associated
with exclusive breastfeeding during hospital stay in Vietnam. Breastfeeding promotion strategies should prioritize
common risk factors in hospital, such as Caesarean section and neonatal complications, and other location specific
factors associated with socioeconomics.
