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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 8192 - 8196 Received 25 April 2021; Accepted 08 May 2021.

Risk Factors for Bloody Diarrhea in Children Under Five Years of Age Residing in Hilla City

Abdulla L. Jiad1*, Salma N. Malik1

1Medical technical institute, Baghdad, Iraq.

*E-mail: [email protected]

Abstract:

Bloody diarrhea in young children is usually a sign of invasive enteric infections that carries the risk of serious morbidity and death .This study was conducted on children who are newborn to age five years and who complain of the cases of bloody diarrhea in the city of Hilla. In the period of 15 May 2010 to 15 August 2010,stool samples were collected for three of the primary health care centres in the city. This study was aimed to diagnose the spread and the causes that are related to bloody diarrhoea for children who are below five years old in HillaBabil. The number of samples were collected up to 226 samples. 124 samples were for male children (54, 86%) and 102 samples for females (45,13%). All stool samples were performed by microscopic examination in laboratory culture. Entamoebahistolytica are the highest cause of bloody diarrhea. They were the incidence of total samples 47.7% , followed by Shigella infection rate was 33.6%, while 13.3% of Entoemba coli and 1.7% Salmonella.

The low economic and social conditions of families may be the cause of the increase of infections in the children ofHilla.

Keywords: Entamoebahistolytica, Entoemba coli, diarrhea, Hilla city.

1.Introduction

Diarrhea is a common problem in children. This disease case of frequent stools with watery or loose stools more than three times within a period of less than 24 hours. Stool sometimes contains blood or mucus, so it becomes bloody diarrhea and causes deaths in children. This happens in developing countries for more than 11 million deaths under the age of five.

Diarrhea causes death in all countries of the world by 19% [1]. In 1992, the UNICEF outlined that 2.4 million child deaths occurred due to diarrhea which was the second cause of deaths globally [2]. In the world nearly 1 million deaths every year in children under five years of age are attributed to diarrhea [3]. The common infectious causes of bloody diarrhea are Entamoebahistolytica, Escherichia coli, Salmonella and Shigella spp. [4, 5]. Among important risk factors associated with bloody diarrhea are unhealthy drainage of the body and lack of hygienic conditions for disposing of human excrement. The use of river water and lack of concern for personal hygiene and artificial feeding [6] is one of the risks of causing this. Compared with watery diarrhea, hemorrhagic diarrhea generally lasts longer and causes intestinal damage and dehydration, sepsis, fever and abdominal cramps [7]. The present study is an attempt to shed light on the extent and risk factors of bloody diarrhea among children aged less than five years. There are three of the primary health care centres in Hilla city with following objectives:To determine the extent of bloody diarrhea among users of services in Hilla city.To identify certain risk factors associated with bloody diarrhea among less than five years old children. Determine the age –infected cases of diarrhea and bloody diarrhea in children and most important causes andeffect of breast –feeding when the infant on the prevalence of diarrhea and its complications and compared with children who use artificial feeding.

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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 8192 - 8196 Received 25 April 2021; Accepted 08 May 2021.

2.Materials and Methods

During the peak of the diarrheal season (May -August) 2010 , all children under five years old of age who were admitted with bloody diarrhea to three primary health care centres in Hilla city .Two hundred and twenty six child with bloody diarrhea were taken as samples from feces and sent to the laboratory for examination. Diagnosis was also taken with the installation of the required information from the mother directly, such as child's age, sex, place of residence and economic situation of the people of the child and type of feeding, natural or artificial.

2.1.Parasite detection

Smears of feces using 0.9% normal saline was examined microscopically for the presence of leucocytes and red blood cells and E. histolytica and Giardia lamblia cysts and trophozoits.

2.2.Bacteria detection

Stool specimens were collected following standard procedure [6]. Samples were then inoculated immediately on Mac Conkey and Salmonella –Shigella agar plates (oxoid). The inoculated plates were incubated at (37C) aerobically for 24 hours .The plates were then examined for the presence or absence of visible bacterial colonies.

3. Results

The total number of children which were collected fecal samples from 226 children with bloody diarrhea and sever other symptoms such as fever and abdominal pain and vomiting with these different symptoms and severity from child to another. This study included children reconstruction newborn to age five years and obtained this information from three centres for primary health care in the city of Hilla, dispersed to placed relatively far apart.Table (1) age, sex,shown percentage, which shows that the percentage of infected males (54.86%) was higher than the female, while females (45.13%) from total number. The prevalence of diarrhea in children less than 1 year was found to be significantly higher (p<

0.01).

Table 1.Samples distribution according to age &sex.

Total Female

Male Age

(years) No. % No. % No. %

38.9 88

40.9 36

59 52

Less than 1

33.6 76

44.7 34

55.2 42

1-3

27.4 62

51.6 32

48.3 3-5 30

100 226

45.13 102

54.86 124

Total

Shown in Table (2), types of pathogens for diarrhea and bloody diarrhea in children and age groups. The study showed that the most important causes of bloody diarrhea is parasitic and bacterial infection were the most important causes of Entamoebahistolytica, followed by Shigella and Entamoeba coli and Giardia lamblia and Salmonella, have been the cases were in children under one year of age, mostly caused by parasitic E. histolytica 66%, followed by bacterial infection (Shigella) 29.5% and (E.coli) 4.5%.Either confined between ages (1-3) years of cases were attributed, respectively, then E.histolytica 39% ,E coli 26.3%, Shigella 23% and Giardia 5.2%. As for ages (3-5) years was the cases to Shigella 51%, and Ehistolytica 25.8%, followed by E.coli 9.6%, followed by Giardia and Salmonella 6.4%.

Table 2.Distribution of diarrhea cases, bloody diarrhea according to causes.

Total Salmonell

Giardia E.coli

Shigella Entamoebahistolytic

Age

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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 8192 - 8196 Received 25 April 2021; Accepted 08 May 2021.

a a

(year

) No % No. % No. %

% . No

% . No

% . No.

38.

88 9 -

- 0 0 4.5 29. 4

26 5 66

58

<1

33.

76 6 -

5. 0 4 2 26.3 23. 29

18 6 39

34 1-3

27.

62 4 6.4 6. 4

4 4 9.6 51. 6

32 6 25.8

3-5 16

22 100 1.7 6

3. 4 8 5 13.2 30 7

33.

76 6 47.7

108 Total

Table (3) rates shows of cases that causes amoebic dysentery of acute diarrhea and for the same age groups for both sexes.

Table 3.Distribution of Amoebic dysentery according to age and sex.

Total Female

Male Age

(years) No. % No. % No. %

53.7 58

24.13 14

75.8 Less than 1 44

31.4 34

47 16

52.9 18

1-3

14.8 16

37.5 6

62.5 10

3-5

100 108

33.3 36

66.6 72

Total

Table (4) shows the impact of the type of breast feeding on incidence of diarrhea in children.

In which the study explained and through the table above, that cases of diarrhea in breast- feeding was much lower than the cases of artificial feeding (milk powder). Through the descent in Table (5), shows also that types of feeding are mixed (natural and on bottle) and infant formula are high rates of diarrhea, especially children under one year. We found that diarrheal disease was associated with early initiation and maintenance of breastfeeding [8, 9].

Table 4.Distribution of cases of diarrhea caused by Shigella dysentery according to sex and age.

Total Female

Male Age

(years) No. % No. % No. %

39.47 30

53.33 16

46.6 Less than 1 14

44.74 34

35.3 12

64.7 22

1-3

15.79 12

50 6

50 6

3-5

100 76

22.36 34

27.63 Total 42

Table 5.Distribution of cases of diarrhea by types of feeding.

Total Type of feeding

Age (year) Natural Mixed By bottle

%

% No.

% No.

% No.

No.

40.2 76

50 38

34.2 26

15.7 12

Less than 1

59.7 88

31.8 28

15.9 14

52.27 1-3 46

100 164

40.2 66

24.4 40

35.3 58

Total

4. Discussion

This study aimed to knowledge and identify the main factors causing severe diarrhea and bloody diarrhea in newborns and some factors that affected these cases. The importance of

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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 8192 - 8196 Received 25 April 2021; Accepted 08 May 2021.

this disease was when it is companion with acute respiratory infection and malnutrition, which lead to death of many children in developing countries [10, 11]. Bloody diarrhea was more frequent in the first category of children in this study (table1) which is under one year of age, as it amounted to 40% and this result is compatible with the findings of the other studies conducted on other Iraqi cities like Kirkuk and Tikrit [12]. By observing table (2) we find that cases of amoebic dysentery are the leading cause of bloody diarrhea of children under one year of age, with 66% of total cases for this age group due to Entamoebahistolytica as well as for second category (1-3) years, as the percentage of cases 39%. The third category (3-5) years, was the first cause of diarrhea which is the bacteria (Shigella) as 51% of all cases of this category. These bacteria are the cause of the second and important for bloody diarrhea in children [13]. Amoebic dysentery cases were more frequent among males than females (table3), this results is agreement with many studies. Bloody diarrhea occurs through many pathogens, including intestinal bacteria and parasitic protozoans such as E. histolytica, which causes diseases to more than 50 million people worldwide and over 100,000 deaths annually [14, 15]. Bloody diarrhea caused by bacterial infections of stomach and intestine, is caused mainly by Shigella , E coli ,have also been shown to play a role in epidemiology of diarrhea in certain areas of the world. Many studies and scientists have included that Shigella is the main cause of most cases of diarrhea [16]. In table (4) there is no significant differences in sex and age of cases of Shigella for infants under one year of age and age (3-5) years. The significant differences only in age (1-3) years of the study showed that the incidence was in males for the second category 64% and females 35.3% [17]. In table (5) we find that breast feeding has the greatest impact in protecting children below one years of age from diseases such as diarrhea, were there significant differences are clear between natural breast- feeding and children fed milk powder in the proportion of cases of diarrhea in two types ofbreast . This is confirmed by [18] of the presence of antibodies in breast milk increases the child immunity against disease. As in the case of mixed breast was a high incidence of diarrhea, but less than artificial feeding. Mother's milk contains antibodies (immunoglobulin's) and also contains mucins that attach themselves to bacteria and viruses and remove them from the body of the child completely without side effects. It also contains CD14 and sialic acid and L-fucose that increase the immunity of the child against diseases [19, 20]. As a result of the presence of such substances in breast milk and there were clear differences in the proportion of cases of diarrhea among children breast feeding and industrial.

5.References

[1] Pelletier DL, Frongillo EA Jr and Habicht JP 1993 Epidemiologic evidence for a potentiating effect of malnutrition on child mortality Am J Public Health83 1130.

[2] Biswas R, Leon EG and Nelson E A 1996Etiology of acute diarrhea in hospitalized children in Hong Kong Trop Med Int. Health2 679.

[3] Liu L, Johnson HL, Cousens S, PerinJ, Scott S, Lawn J, Rudan, EI, Campbell H,Cibulskis R,Li M,Mathers C and Black RE 2012 Global, Regional, and National Causes of Child Mortality: An Updated Systematic Analysis for 2010 with Time Trends since 2000Lancet3792151.

[4] Kadir M and Maki H 2000 A study on intestinal amoebiasis and it effect on nutritional status of primary school children in TozzcityIraqi J. Comm. Med.1397.

[5] Al-Janbi M 1994 Common health problems among primary school children in Sinnyia Diploma dissertation collage of medicine, University of Tikrit.

[6] WHO 1993 Preventivepriorities :Dialogue on diarrhea Issue 54 . WHO, Geneva1.

[7] Cheesbrough M 2006 District laboratory practice in tropical countries. In Escherichia coli. Part II. 2nd edition. UK: Cambridge university press 178.

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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 8192 - 8196 Received 25 April 2021; Accepted 08 May 2021.

[8] Gizaw Z and Woldu WBD 2017 Child feeding practices and diarrheal among children less than two years of age of the nomadic people in district,afar Region, Northeast Ethiopia Int. Breastfeed J . 12.

[9] Musher DM and Musher BL 2004 Contagious acute gastrointestinal infection N Engl.J.Med. 351 2417.

[10] Saeed A, Abd H and Sandstrom G 2015 Microbial etiology of acute diarrhea in children under five years of age in Khartoum, Sudan J Med. Microb. 64 432.

[11] WHO 1994 Sanitation solution : dialogue on diarrhea Issue 57 WHO Geneva, 1.

[12] Al-Jobouri HS 2001Etiology of diarrhea illness among children attending in Tikrit A diploma dissertation, Medical Collage, Tikrit university, 106.

[13] Bern TE, Petri WA and Behm JW 2007 Amebiccolitis : New insights into pathogenesis and treatment Curr. Gastroenterol.Rep. 9 429.

[14] Diniz DR 2005 Epidemiological and microbiological aspects of acute bacterial diarrhea in children from Salvodor, Bahia, BrazilBraz. J. Infect. Dis.29 77.

[15] Lori RH, Neil MA and Philip IT 2009 Acute bloody diarrhea: Medical emergency for patients of all ages Gastroenterology1361887-1898.

[16] Mota MI, Gadea MP,Gonzalez S, Gonzalez G, Pardol L and Sirok A2010 Bacterial pathogenesis associated with bloody diarrhea in Uruguayan childrenRevista Argentina de Microbiologia42 114.

[17] Shamoon AA Diarrheal disease among children under five years old in Al-Taameem province A diploma dissertation, Medical Collage, Tikrit university 23.

[18] Ebrahim GJ 1983 Breast milk a biological mediator. Med. Digest9 15.

[19] Ghalib AO and Salim TH 2011 Soluble SD14, Sialic acid and L-Fucose in breast milk and their role in increasing the immunity of breast –fed infants Am.J.

Biochem.Biotechnol.721.

[20] Field CJ 2005The immunological components of human milk and their effect on immune development in infants J. Nutr. 35.

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