Prevalence of rotavirus infection among children with acute diarrhoea after rotavirus Vaccine introduction in Kenya
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Date
2017Author
Muendo, Catherine N
Type
ThesisLanguage
enMetadata
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Background
Rotavirus is the commonest cause of severe and fatal diarrhoea among young children in
the world with mortality occurring more in Sub-Saharan Africa and Southern Asia.
Majority of these deaths are due to severe dehydration which is often not treated
adequately due to the unavailability of timely and optimal medical care. The prevalence
rates in Kenya are reported to be ranging from 30-40% among hospitalized children in
the pre-vaccination era. Rotavirus vaccine is considered the most successful public health
strategy in preventing infection and mitigating the severity of gastroenteritis. Rotavirus
vaccination was introduced in Kenya in 2014. There has not been a study post
introduction of the rotavirus vaccine in Kenyatta national hospital to determine whether
there is any change in the profile of children being treated with acute diarrhea.
Objectives
The primary aim of the study was to determine the prevalence of rotavirus infection
among children aged 3-24 months presenting with acute diarrhoea at Kenyatta National
Hospital after introduction of the rotavirus vaccine. The secondary objectives was to
determine the severity of the rotavirus associated diarrhoea using the Vesikari Clinical
Severity Scoring System and to determine the rotavirus vaccination status among the
children.
Methods
This was a short hospital-based longitudinal study at Kenyatta National Hospital among
children aged 3-24 months presenting with acute diarrhea. The patients who met the
inclusion criteria were enrolled sequentially. We acquired information on rotavirus
vaccination status, nutritional status (z-scores), feeding practices, sociodemographic
characteristics such as age, gender and caretaker characteristics such as age, level of
education and relationship with the child and entered into a pre- structured questionnaire
followed by a full clinical evaluation. The gastroenteritis severity was assessed using the
20 point Vesikari Clinical Severity Scoring System. The children who were admitted
were followed up for 7 days using hospital ward registers. Comorbid conditions were
established from patient’s physical examination and medical records. Stool specimen
from study participants was tested for rotavirus using enzyme linked immunosorbent
immunoassay (ELISA).
The data collected was entered and managed in Excel while data analysis was done with
STATA version 13 software package and presented in figures and tables as applicable.
Results
Three hundred and sixty five children aged 3-24 months presenting with acute diarrhoea
were recruited. Rotavirus was positive in 53/365 children, giving a prevalence of 14.5%
(95% CI 11.1 -18.6). Of the 53 children who tested rotavirus positive, 28.3% (n=15) had
severe rotavirus associated diarrhea, scored using the Vesikari Clinical Severity Scoring
System, 32.0% (n=17) had moderate rotavirus associated diarrhoea and 39.6% (n=21)
had mild rotavirus associated diarrhea. Three hundred and fifty six children (97.5%) were
fully vaccinated against rotavirus, with only 9 (2.5%) receiving partial or no vaccination.
Conclusion
The prevalence of rotavirus infection among children with acute diarrhea at Kenyatta
National Hospital is 14.5%. Twenty-eight percent of the children who tested rotavirus
positive had severe rotavirus associated diarrhea as scored by the Vesikari Clinical
Severity Scoring scale. The rotavirus vaccination status among the children was 97.5%,
having received 2 doses of rotarix vaccine.
Recommendation
Advocacy on use of the Rotavirus vaccine should continue due to the observed reduction
in the prevalence of rotavirus associated diarrhea.
Publisher
University of Nairobi
Subject
Rotavirus InfectionRights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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