DIADEN workshop. Diarrhea in Lao. Vientiane, Lao PDR 2-3 Feb 2010

Transcription

1 DIADEN workshop Diarrhea in Lao Vientiane, Lao PDR 2-3 Feb

2 Outline Diarrhea from national surveillance (NCLE) Incidence/death/year Diarrhea from previous studies: Etiological bacteria/virus etc Diarrhea outbreaks: Vibrio cholera Current study: Etiological study Chart review (In Mother and Child hospital) Conclusion and recommendation 2

3 Diarrhea in Lao PDR Context 3 rd leading cause of death in children under 5 years of age (after neonatal causes and pneumonia) Ranks 4 th in mortality among all age, accounting for 8% of deaths. (WHO, Mortality Country Fact Sheet in 2006) 3

4 Incidence Diarrhea in Lao PDR National surveillance at NCLE Incidence/ of AWD and ABD reported nationwide from the national routin surveillance (Lao-Ewarn program), Lao PDR, * 2009 * All age groups were included from the year of 2008 AWD ABD DEATH AWD: Acute watery diarrhea, ABD: Acute bloody diarrhea NCLE: National Center for Laboratory and Epidemiology 4

5 VIENTIANE CAP PHONGSALY LUANG NAMTHA OUDOMXAY BOKEO LUANGPHRABANG HUAPHANH XAYABURY XIENGKHUANG VIENTIANE BORIKHAMXAY KHAMMUANE SAVANNAKHET SARAVANE SEKONG CHAMPASACK ATTAPEU Number Diarrhea in Lao PDR National surveillance at NCLE Diarrhea by provinces reported nationwide in 3 years (07, 08 and 09) from LaoEwarn program, NCLE, Lao PDR AWD ABD Why this province Reported the highest Number of diarrhea In Lao? AWD: Acute watery diarrhea, ABD: Acute bloody diarrhea 5

6 Diarrhea in Lao PDR Previous studies (1994-5) Etiological study of diarrhea in Children at Mahosot hospital (No: 191) Main findings: Rotavirus (22%) E. coli (EPEC) (21.5%) Other: Shigella flexneri (4.7%)(high in rainy season) Campylobacter jejuni (2.9%) Shigella sonnei (2.1%) Giardia intestinalis et Entamoeba histolytica each: (0.5%) (No Vibrio cholerae and Shalmonella were observed) 6

7 Diarrhea in Lao PDR Previous studies (1996-7) Etiological study of diarrhea with all ages in health facilities of Vientiane (No:880) Main findings: E. coli (ETEC-ST): (17.2%) E. coli (EPEC): (11.0%) Shigella spp: (16.8%)(high in rainy season) Other: Rotavirus (6.1%) Campylobacter spp. (4.4%) Salmonella spp. (0.6%) (No Vibrio cholerae was observed) 7

8 Diarrhea in Lao PDR Cholera outbreaks The big Cholerae outbreaks have been reported in 1993 then extended in many parts of the country in The last Cholerae outbreak occurred in Sekong province (end of ). 400 cases and 3 deaths (Ogawa strain) 25% were children under five years of age Sensitive to Gentamycin, Ciprofloxacin and Nalidixic acid 8

9 December 28, 2007 Palai 24/12/07 Thonoi neua 24/12/07 Tok Saning 22/12/07 Palay 22/12/07 Kamkok 25/12/07 Huay lei 23/12/07 Nongsampanh 26/12/07 Tongai mai 21/12/07 Sateua tai 25/12/07 Affected village Chounluntai 19/12/07 Chounlunneua 24/12/07 9

10 January 29, 2008 Affected village 10

11 Current study (Sep 2009 to Feb 2010) Objectives: Etiological study (focus on bacteria only): E. coli O157 Shigella spp Salmonella spp Vibrio parahemolyticus Vibrio. cholerae O1 or O139 Create the network hospitals for diarrheal surveillance in Vientiane Mother an Child, 3 district hospitals and 1 Health Center Chart review ( ) Mother and Child hospital 11

12 Current study results (No 141) Etiological bacteria Using culture and PCR technic 17/141 cases (12%) were positive for: 7 Shigella spp 4 Shalmonella spp 3 Vibrio parahemolyticus 2 E-coli (ETEC)* 1 Staphylococcus aureus (No Vibrio cholera was observed) Most common causes are consistent with previous studies conducted in * Only some have been tested for pathogenic E-coli by using PCR 12

13 Percentage Current study results (No 141) Sources of drinking water Diarrhea by sources of drinking water and pathogenic bacteria in five network hospitals, Vientiane, Lao PDR Diarrhea Pathogenic bacteria Boiled water Unboiled water Bottled water Unknown 13

14 Current study results (No 141) Age groups/characteristics/symptoms 50% of the cases were children < 5 years Characteristics: 72% : watery diarrhea 7% : mucus or bloody diarrhea 21% : others Symptoms: 65% : abdominal pain 62% : nausea or vomiting 47% : fever 14

15 Current study results (No 141) Antibiograms for Salmonella and Shigella only More samples are needed to assess antibiotic resistance changes over time 15

16 Current study (Chart review: 1249 cases) (OPD) Acute diarrhea in Mother and Child (MCH) hospital ( ) 16

17 Number Chart review results (No: 1249) High age group: 0-5 years Distribution of age groups by gender of acute diarrhea in Mother and Child, Lao PDR, Male Female (2008) 0-5 (2009) (2008) (2009) Year of Chart review 17

18 January February March April May June July August September October November December Number Chart review results (No: 1249) Seasonal distribution of diarrhea Seasoning variation of acute diarrhea in Mother and Child, Lao PDR, Chart review in Acute diarrhea 0 No Rotavirus vaccine is available in the National Program of Vaccination Campaign 18

19 Chart review results (No: 1249) Common antibiotic using in MCH (about 18% each year) Kinds of antibiotic used in MCH hospital Chart review in % 4% 10% AMOXICILLINE BACTRIM ERYTHROMYCIN NALIDIXIC ACID 85% No Ciprofloxacin was observed in this review 19

20 Chart review results (No: 1249) Mapping of acute diarrhea in Vientiane Capital N W E S 20

21 Conclusions National surveillance shows there is a heavy burden of diarrhoeal disease in Lao: Especially: Children under five years of age Previous and current etiological studies in Vientiane Capital show: A range of causative pathogens includes: Rotavirus, E-coli and Shigella etc AWD is more common than ABD The current etiological study should be continued to gather further results on etiology and monitor emerging drug resistance 21

22 Water as a potential sources of diarrhea in Lao PDR: The promotion of good hygiene practice through using treated water sources is still a challenge in the remote area of Lao PDR More research into the relationship between diarrhea and household water contamination in Lao PDR is also needed 22

23 Recommendations More community awareness on causes of diarrhea and prevention Increate awareness of water and catering sector including restaurants and water companies More epidemiological studies to uncover the main sources of diarrhea disease in Laos are required 23

24 Thank you very much for your attention 24