A new international study published today in The Lancet provides the clearest picture yet of the impact and most common causes of diarrheal diseases, the second leading killer of young children globally, after pneumonia. The Global Enteric Multicenter Study (GEMS) is the largest study ever conducted on diarrheal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia and Africa.
GEMS, coordinated by the University of Maryland School of Medicine's Center for Vaccine Development, confirmed rotavirus for which a vaccine already exists as the leading cause of diarrheal diseases among infants and identified other top causes for which additional research is urgently needed. GEMS found that approximately 1 in 5 children under the age of 2 suffer from moderate-to-severe diarrhea (MSD) each year, which increased children's risk of death 8.5-fold and led to stunted growth over a two-month follow-up period.
"Until now, comprehensive data on the burden of diarrheal diseases in Asia and sub-Saharan Africa has been limited," says Dr. Myron M. Levine, GEMS principal investigator and professor at the University of Maryland School of Medicine. "By filling critical gaps in knowledge, we hope GEMS will help countries across these two highest-burden regions focus their efforts to improve child health."
Despite many causes, GEMS found that targeting just four pathogens could prevent the majority of MSD cases. Expanding access to vaccines for rotavirus, the leading cause of MSD among infants at every site, could save hundreds of thousands of lives. Likewise, GEMS data suggests that accelerating research on vaccines, treatments and diagnostics for the three other leading pathogens Shigella, Cryptosporidium and ST-ETEC, a type of E. coli could have a similar impact. Prior to GEMS, Cryptosporidium was not considered a major cause of diarrheal disease and as a result there is currently little research on this pathogen underway.
"The GEMS findings help set priorities for investments that could greatly reduce the burden of childhood diarrheal diseases," says Dr. Thomas Brewer, deputy director of the Enteric & Diarrheal Diseases team at the Bill & Melinda Gates Foundation, which funded the study. "Vaccines and treatments available today can save thousands of children right now but targeted research to develop new tools to combat severe diarrhea could save many more lives in the future."
The GEMS findings also suggest that longer-term monitoring and care of children with diarrheal diseases could reduce mortality and developmental delays. Children with MSD grew significantly less in height in the two months following the diarrheal episode when compared with control children without diarrhea, and were 8.5 times more likely to die over the course of the two-month follow-up period. Notably, 61 percent of deaths occurred more than a week after the initial diarrheal episode, with 56 percent of deaths happening after families had returned home from a healthcare facility.
"GEMS strongly indicates that follow-up care after the initial diarrheal episode is critical to protect the health and wellbeing of children," says professor George Griffin, senior co-chair of the GEMS International Strategic Advisory Committee and professor at St. George's, University of London. "By focusing only on the acute diarrhea that brings children to hospitals, we overlook a significant portion of diarrheal diseases' burden."
Expanding access to existing interventions that protect against or treat all diarrheal diseases, including oral rehydration solutions, zinc supplements, clean water and sanitation, can save lives and improve the health of children immediately.
"GEMS is a landmark study for the child health community," says professor Fred Binka, co-chair of the GEMS International Strategic Advisory Committee and Vice-Chancellor at the University of Health and Allied Sciences, Ghana. "By using consistent methods across countries, GEMS sites generated data that can guide evidence-based decision making at both the local and global levels."
Release of the GEMS findings follows last month's announcement by the World Health Organization and UNICEF of the first-ever Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD). The GEMS findings add to the scientific evidence cited in the GAPPD strategy for effectively controlling pneumonia and diarrhea, which together are the two leading causes of death among young children globally.
Â
Dear Helpdesk: Working in a Toxic Health Care Environment
March 28th 2024Dear Helpdesk is your steadfast companion, offering life coaching and workplace advice from 2 seasoned IPs for some of your most challenging real-life situations. Let us help you navigate the intersection between work and life, guiding you to navigate the dynamic world of infection prevention with confidence and grace. This article is on handling a toxic health care environment.
Product Locator: Spring and Early Mother's Day Gift Guide for Infection Prevention Personnel
March 27th 2024Whether it's a spring holiday, birthdays, or no reason at all, infection prevention personnel love to give and receive gifts that help at the end of a stressful day. Infection Control Today® offers some gift ideas for infection prevention personnel and their families.
Catching Up With Vangie Dennis, AORN 2022-2023 President at AORN 2024
March 26th 2024Infection Control Today (ICT) had the privilege of catching up with Vangie Dennis, MSN, RN, CNOR, CMLSO, at the Association of periOperative Registered Nurses' (AORN’s) International Surgical Conference & Expo 2024. As the former president of AORN and an esteemed figure in perioperative services, Vangie Dennis shared insights into her recent endeavors and the exciting new chapter she's embarked upon.
How To Optimize Your Time Management Strategies for the Busy Infection Preventionist
March 25th 2024Is your calendar resembling a chaotic masterpiece of overlapping tasks? Join the club of infection preventionists striving to balance responsibilities. Dive into proven strategies from a fellow infection preventionist to reclaim control of your time, streamline tasks, and boost productivity effectively. This is an IP Lifeline article.