Abstract Title:

Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006.

Abstract Source:

J Acquir Immune Defic Syndr. 2010 Jan 1;53(1):14-9. PMID: 19801943

Abstract Author(s):

Tracy L Creek, Andrea Kim, Lydia Lu, Anna Bowen, Japhter Masunge, Wences Arvelo, Molly Smit, Ondrej Mach, Keitumetse Legwaila, Catherine Motswere, Laurel Zaks, Thomas Finkbeiner, Laura Povinelli, Maruping Maruping, Gibson Ngwaru, Goitebetswe Tebele, Cheryl Bopp, Nancy Puhr, Stephanie P Johnston, Alexandre J Dasilva, Caryn Bern, R S Beard, Margarett K Davis

Article Affiliation:

Centers for Disease Control and Prevention, Global AIDS Program, 1600 Clifton Rd NE, Mailstop E-04, Atlanta, GA 30033, USA. [email protected]


BACKGROUND: In 2006, a pediatric diarrhea outbreak occurred in Botswana, coinciding with heavy rains. Surveillance recorded a 3 times increase in cases and a 25 fold increase in deaths between January and March. Botswana has high HIV prevalence among pregnant women (33.4% in 2005), and an estimated 35% of all infants under the age of 6 months are not breastfed. METHODS: We followed all children<5 years old with diarrhea in the country's second largest referral hospital at the peak of the outbreak by chart review, interviewed mothers, and conducted laboratory testing for HIV and enteric pathogens. RESULTS: Of 153 hospitalized children with diarrhea, 97% were<2 years old; 88% of these were not breastfeeding. HIV was diagnosed in 18% of children and 64% of mothers. Cryptosporidium and enteropathogenic Escherichia coli were common; many children had multiple pathogens. Severe acute malnutrition (kwashiorkor or marasmus) developed in 38 (25%) patients, and 33 (22%) died. Kwashiorkor increased risk for death (relative risk 2.0; P = 0.05); only one breastfeeding child died. Many children who died had been undersupplied with formula. CONCLUSIONS: Most of the severe morbidity and mortality in this outbreak occurred in children who were HIV negative and not breastfed. Feeding and nutritional factors were the most important determinants of severe illness and death. Breastfeeding is critical to infant survival in the developing world, and support for breastfeeding among HIV-negative women, and HIV-positive women who cannot formula feed safely, may prevent further high-mortality outbreaks.

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