Evidence map›Paper›PMID 26202075›Full record

ArticleThe Lancet. Global health2015

Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED).

James A Platts-Mills, Sudhir Babji, Ladaporn Bodhidatta, Jean Gratz, Rashidul Haque, Alexandre Havt, Benjamin Jj McCormick, Monica McGrath, Maribel Paredes Olortegui, Amidou Samie and 27 more

2 registry-linked trialsAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Global health, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 564 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
564citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06122870 phase1completednot on this mapstarted 2023, after this paper: background citation

Double-blind, Placebo-Controlled Trial Assessing the Efficacy and Safety of CampETEC Hyperimmune Bovine Colostrum (HBC) for the Prevention of Campylobacter-Mediated Diarrheal Diseases

TypeinterventionalSponsorJohns Hopkins Bloomberg School of Public HealthRan2023 to 2025Enrolled27ConditionsHealthy VolunteerArmsCampETEC HBC product, ProMilk 85, C. jejuni CG8421 Challenge strain
NCT06676215 nanot yet recruitingnot on this mapstarted 2025, after this paper: background citation

Efficacy of Amino Acid Supplementation on Gut Function and Nutritional Status in FIlipino Children Below Three Years Old

TypeinterventionalSponsorFood and Nutrition Research Institute, PhilippinesRan2025 to 2025Enrolled60ConditionsStunted GrowthArmsIAA mix supplement, Complementary food comprised of rice and legumes
3 · Its place in the literature

Who cites it

564 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  9. Interventions to improve sanitation for preventing diarrhoea.The Cochrane database of systematic reviews · 2023
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504 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

37 authors.

James A Platts-MillsDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Sudhir BabjiChristian Medical College, Vellore, India.
Ladaporn BodhidattaArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
Jean GratzDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA; Haydom Lutheran Hospital, Haydom, Tanzania.
Rashidul HaqueInternational Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Alexandre HavtClinical Research Unit and Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil.
Benjamin Jj McCormickFogarty International Center, National Institutes of Health, Bethesda, MD, USA.
Monica McGrathFogarty International Center, National Institutes of Health, Bethesda, MD, USA.
Maribel Paredes OlorteguiAsociación Benéfica PRISMA, Iquitos, Peru.
Amidou SamieUniversity of Venda, Thohoyandou, South Africa.
Sadia ShakoorAga Khan University, Karachi, Pakistan.
Dinesh MondalInternational Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Ila Fn LimaClinical Research Unit and Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil.
Dinesh HarirajuChristian Medical College, Vellore, India.
Bishnu B RayamajhiArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
Shahida QureshiAga Khan University, Karachi, Pakistan.
Furqan KabirAga Khan University, Karachi, Pakistan.
Pablo P YoriAsociación Benéfica PRISMA, Iquitos, Peru.
Brenda MufamadiUniversity of Venda, Thohoyandou, South Africa.
Caroline AmourHaydom Lutheran Hospital, Haydom, Tanzania.
J Daniel CarreonFogarty International Center, National Institutes of Health, Bethesda, MD, USA.
Stephanie A RichardFogarty International Center, National Institutes of Health, Bethesda, MD, USA.
Dennis LangFoundation for the National Institutes of Health, Bethesda, MD, USA.
Pascal BessongUniversity of Venda, Thohoyandou, South Africa.
Esto MdumaHaydom Lutheran Hospital, Haydom, Tanzania.
Tahmeed AhmedInternational Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Aldo Aam LimaClinical Research Unit and Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil.
Carl J MasonArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
Anita Km ZaidiAga Khan University, Karachi, Pakistan.
Zulfiqar A BhuttaAga Khan University, Karachi, Pakistan.
Margaret KosekBloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Asociación Benéfica PRISMA, Iquitos, Peru.
Richard L GuerrantDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Michael GottliebFoundation for the National Institutes of Health, Bethesda, MD, USA.
Mark MillerFogarty International Center, National Institutes of Health, Bethesda, MD, USA.
Gagandeep KangChristian Medical College, Vellore, India.
Eric R HouptDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA. Electronic address: erh6k@virginia.edu.
MAL-ED Network Investigators

Funding

INFECTIOUS DISEASES TRAINING PROGRAMT32AI007046 · NIAID · UNIVERSITY OF VIRGINIA CHARLOTTESVILLE · PI Alison K Criss, William A Petri · 1985 to 2026
$15.3M
Multi-disciplinary research training in enteric infectionsD43TW007392 · FIC · CHRISTIAN MEDICAL COLLEGE · PI KANG, GAGANDEEP · 2005 to 2020
$2.9M
Quantitative molecular diagnostics for diarrhea etiology and vaccine efficacyK23AI114888 · NIAID · UNIVERSITY OF VIRGINIA · PI PLATTS-MILLS, JAMES ALEXANDER · 2015 to 2019
$932k
FIC NIH HHS D43 TW007392NIAID NIH HHS K23 AI114888NIAID NIH HHS T32 AI007046
6 · The paper itself

Abstract

backgroundMost studies of the causes of diarrhoea in low-income and middle-income countries have looked at severe disease in people presenting for care, and there are few estimates of pathogen-specific diarrhoea burdens in the community.

methodsWe undertook a birth cohort study with not only intensive community surveillance for diarrhoea but also routine collection of non-diarrhoeal stools from eight sites in South America, Africa, and Asia. We enrolled children within 17 days of birth, and diarrhoeal episodes (defined as maternal report of three or more loose stools in 24 h, or one loose stool with visible blood) were identified through twice-weekly home visits by fieldworkers over a follow-up period of 24 months. Non-diarrhoeal stool specimens were also collected for surveillance for months 1-12, 15, 18, 21, and 24. Stools were analysed for a broad range of enteropathogens using culture, enzyme immunoassay, and PCR. We used the adjusted attributable fraction (AF) to estimate pathogen-specific burdens of diarrhoea.

findingsBetween November 26, 2009, and February 25, 2014, we tested 7318 diarrhoeal and 24 310 non-diarrhoeal stools collected from 2145 children aged 0-24 months. Pathogen detection was common in non-diarrhoeal stools but was higher with diarrhoea. Norovirus GII (AF 5·2%, 95% CI 3·0-7·1), rotavirus (4·8%, 4·5-5·0), Campylobacter spp (3·5%, 0·4-6·3), astrovirus (2·7%, 2·2-3·1), and Cryptosporidium spp (2·0%, 1·3-2·6) exhibited the highest attributable burdens of diarrhoea in the first year of life. The major pathogens associated with diarrhoea in the second year of life were Campylobacter spp (7·9%, 3·1-12·1), norovirus GII (5·4%, 2·1-7·8), rotavirus (4·9%, 4·4-5·2), astrovirus (4·2%, 3·5-4·7), and Shigella spp (4·0%, 3·6-4·3). Rotavirus had the highest AF for sites without rotavirus vaccination and the fifth highest AF for sites with the vaccination. There was substantial variation in pathogens according to geography, diarrhoea severity, and season. Bloody diarrhoea was primarily associated with Campylobacter spp and Shigella spp, fever and vomiting with rotavirus, and vomiting with norovirus GII.

interpretationThere was substantial heterogeneity in pathogen-specific burdens of diarrhoea, with important determinants including age, geography, season, rotavirus vaccine usage, and symptoms. These findings suggest that although single-pathogen strategies have an important role in the reduction of the burden of severe diarrhoeal disease, the effect of such interventions on total diarrhoeal incidence at the community level might be limited.

Indexed as

AfricaAsiaBacteriaBacterial InfectionsChild, PreschoolCohort StudiesDeveloping CountriesDiarrheaFecesFemaleHumansIncidenceInfantInfant, NewbornMalePolymerase Chain Reaction

Identifiers

PMID26202075
PMCPMC7328884

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.