Sistema Gastrointestinal e Digestivo

Abstrato

Shigellosis among Breastfed Children: A Facility Based Observational Study in Rural Bangladesh

Shahnawaz Ahmed, Farzana Ferdous, Jui Das, Fahmida Dil Farzana, Mohammod Jobayer Chisti, Jonathan R Latham, Sumon Kumar Das, Abdullah A Mamun and Abu Syed GolamFaruque

Objective: Although breastfed children are less likely to suffer from infectious diarrhea, children under 2 years of age are often infected with Shigella. The study aimed to understand socio-demographic, clinical, and host characteristics of breastfed children under 2 years of age with shigellosis and compare these factors with breastfed children who presented with non-Shigella associated diarrhea in rural Mirzapur, Bangladesh. Methods: From January 2010 to December 2012, a total of 3,409 children under 5 years with diarrhea were admitted to a tertiary level hospital in rural Bangladesh with diarrhea. A total of 2,278 (67%) of these children were aged 0-23 months and had reported history of breastfeeding and were enrolled in the study. Nine percent (n=205, 9%) of the enrolled children were infected with Shigella and were thus considered to be cases and the remaining children (n=2,073, 91%) were not infected with Shigella and formed the comparison group. Results: Breastfed children with shigellosis were more likely to be underweight (<–2 weight-for-age z-score) [(31% vs. 18%; p<0.001)], stunted (<–2 height-for-age z-score) [(22% vs. 13%; p<0.001)] and wasted (<–2 weightfor- height z-score) [(22% vs. 13%; p<0.001)] compared to breastfed children without shigellosis. Rotavirus (14% vs. 29%, <0.001) was detected less commonly as a co-pathogen amongst children with shigellosis relative to their counterparts. In multivariate analysis, significant associations with shigellosis were observed with child age (12-23 months) [OR: 3.02 (95% CI-2.17-4.18)], blood in stool [OR: 6.44 (4.68-8.88)], fever [OR: 1.95 (1.41-2.68)], convulsion [OR: 2.80 (1.04-7.54)], stunting [OR: 1.53 (1.03-2.28)], and use of zinc at home [OR: 0.67 (0.46-0.98)] after controlling for other covariates. Conclusion: Breastfed children with shigellosis were more likely to be malnourished than those who were also breastfed but not infected with Shigella among rural Bangladeshi children under 2 years of age.