Browsing by Autor "Robert Quick"

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Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: a promising new strategy
(Cambridge University Press, 1999) Robert Quick; Linda Venczel; Eric D. Mintz; Lorena Soleto; José Carlos Marchena Aparicio; M. GIRONAZ; Lori Hutwagner; K. D. Greene; Cheryl A. Bopp; Kathleen Maloney
A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed. Monthly water quality testing and weekly diarrhoea surveillance were conducted. Over a 5-month period, intervention households had 44% fewer diarrhoea episodes than control households (P = 0.002). Infants < 1 year old (P = 0.05) and children 5-14 years old (P = 0.01) in intervention households had significantly less diarrhoea than control children. Campylobacter was less commonly isolated from intervention than control patients (P = 0.02). Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households (P < 0.0001). Intervention households exhibited less E. coli contamination of stored water and less diarrhoea than control households. This promising new strategy may have broad applicability for waterborne disease prevention.
EPIDEMIOLOGY OF HELICOBACTER PYLORI INFECTION IN RURAL BOLIVIAN CHILDREN:98
(Lippincott Williams & Wilkins, 1997) C Friedman; Robert Quick; B Khanna; A Salcido; N lihoshi; M Gironaz; O Ganzales; Lori Hutwagner; Robert V. Tauxe; Eric Mintz
Introduction: Helicobacter pylori (Hp) is acquired in childhood, causes gastritis, duodenal ulcers, and is linked to MALT lymphoma and gastric cancer. Studies suggest that infection is the cause of iron deficiency anemia in Alaska Natives and in Bangladeshi children. Consumption of contaminated water has been reported as a risk factor for Hp infection in South America, although exact routes of transmission are not defined. Objectives: We determined the seroprevalence and risk factors for Hp infection acquisition in rural Bolivian children, and if an association between Hp and anemia existed in this population. Methods: The Hp serostatus and hemoglobin levels of 1,392 (70%) children between 6 months and 9 years living in 17 villages were determined. Information on dietary practices, hygeine, and water handling were performed. Drinking sources were tested for fecal coliforms. Results: Overall, 44% of children were Hp seropositive, 49% seronegative, and 7% had indeterminate serostatus. Of 1,293 children with defined serostatus, seroprevalence increased from 7% in children aged 6-12 months to 59% in 4-year olds. Controlling for age and family clustering, drinking contaminated water was associated with Hp infection (p<0.05). Univariate analysis demonstrated consumption of premasticated food was significantly associated with Hp infection in infants 6 months to 1 year (p<0.05). Overall, 38% of children were anemic. Anemia status decreased from 77% in < 2 years to 17% in 9-year olds. Multivariate analysis demonstrated no association between Hp infection and anemia. Conclusions: Hp seroprevalence is high in rural Bolivian children and most children are infected by 5 years of life. Contaminated drinking water may be a risk factor for Hp infection which suggests that intervention in drinking water purity may decrease seroconversion rates. Although anemia is significant in this population, an association between Hp infection and anemia was not confirmed.
EPIDEMIOLOGY OF HELICOBACTER PYLORI INFECTION IN RURAL BOLIVIAN CHILDREN
(Lippincott Williams & Wilkins, 1997) C Friedman; Robert Quick; B Khanna; A Salcido; N lihoshi; M Gironaz; O Ganzales; Lori Hutwagner; Robert V. Tauxe; Eric Mintz
Introduction: Helicobacter pylori (Hp) is acquired in childhood, causes gastritis, duodenal ulcers, and is linked to MALT lymphoma and gastric cancer. Studies suggest that infection is the cause of iron deficiency anemia in Alaska Natives and in Bangladeshi children. Consumption of contaminated water has been reported as a risk factor for Hp infection in South America, although exact routes of transmission are not defined. Objectives: We determined the seroprevalence and risk factors for Hp infection acquisition in rural Bolivian children, and if an association between Hp and anemia existed in this population. Methods: The Hp serostatus and hemoglobin levels of 1,392 (70%) children between 6 months and 9 years living in 17 villages were determined. Information on dietary practices, hygeine, and water handling were performed. Drinking sources were tested for fecal coliforms. Results: Overall, 44% of children were Hp seropositive, 49% seronegative, and 7% had indeterminate serostatus. Of 1,293 children with defined serostatus, seroprevalence increased from 7% in children aged 6-12 months to 59% in 4-year olds. Controlling for age and family clustering, drinking contaminated water was associated with Hp infection (p<0.05). Univariate analysis demonstrated consumption of premasticated food was significantly associated with Hp infection in infants 6 months to 1 year (p<0.05). Overall, 38% of children were anemic. Anemia status decreased from 77% in < 2 years to 17% in 9-year olds. Multivariate analysis demonstrated no association between Hp infection and anemia. Conclusions: Hp seroprevalence is high in rural Bolivian children and most children are infected by 5 years of life. Contaminated drinking water may be a risk factor for Hp infection which suggests that intervention in drinking water purity may decrease seroconversion rates. Although anemia is significant in this population, an association between Hp infection and anemia was not confirmed.
Etiology of Bloody Diarrhea in Bolivian Children: Implications for Empiric Therapy
(Oxford University Press, 1997) John M. Townes; Robert Quick; O. Gonzales; Manuel Linares; Esther Damiani; Cheryl A. Bopp; S P Wahlquist; Lori Hutwagner; Erica Hanover; Eric D. Mintz
In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.
HELICOBACTER PYLORI SERO-INCIDENCE IN A COHORT OF RURAL BOLIVIAN CHILDREN
(Lippincott Williams & Wilkins, 1998) C Friedman; Mike Glynn; Robert Quick; B Khanna; Naomi Iihoshi; Carmen Revollo; B. D. Gold
58 High seroprevalence rates for Helicobacter pylori (Hp) have been reported in developing countries; however, sero-incidence studies to determine age of initial acquisition and risk factors for seroconversion are lacking. We conducted two seroprevalence studies, 15 months apart, to determine the age-specific sero-incidence rate in a cohort of rural Bolivian children. In 8/96, we conducted a survey of 1,392 children between 6 months and 9 years old, living in 17 rural Bolivian villages, to determine Hp serostatus. In 11/97, we returned to the same villages to conduct a follow-up study. The 15 month age-specific sero-incidence was determined for a cohort of 333 children, 6 months and 6 years old, who either participated in both surveys and were seronegative in the first or were born during the follow-up period. Overall, 36% of 1040 children surveyed in the follow-up study were seropositive, 52% were seronegative, and 12% had indeterminate serostatus. Of 918 children with a definitive Hp serostatus, seroprevalence increased from 4% in children aged 6-11 months to 61% in 6-year olds. In the cohort of 333 children, 64 (19%) seroconverted during the 15 month follow-up period. 15-month sero-incidence rates are summarized in the table below: The largest increase in sero-incidence occurred in children between ages 2 and 3 years old. Further analysis of risk factors for Hp seroconversion (i.e., infection acquisition) focusing on this age group is ongoing.TABLE
HELICOBACTER PYLORI SERO‐INCIDENCE IN A COHORT OF RURAL BOLIVIAN CHILDREN
(Lippincott Williams & Wilkins, 1998) C Friedman; Mike Glynn; Robert Quick; B Khanna; Naomi Iihoshi; Carmen Revollo; B. D. Gold
Seroincidence ofHelicobacter pyloriInfection in a Cohort of Rural Bolivian Children: Acquisition and Analysis of Possible Risk Factors
(Oxford University Press, 2002) M. Kathleen Glynn; Cindy R. Friedman; Benjamin D. Gold; Bhawna Khanna; Lori Hutwagner; Naomi Iihoshi; Carmen Revollo; Robert Quick
High seroprevalence rates for Helicobacter pylori are reported in developing countries, yet few seroincidence studies exist that determine age of initial acquisition and risk factors for H. pylori seroconversion. Two H. pylori serosurveys were conducted in August 1996 and November 1997. Of 188 children aged 21 months to 6 years who were seronegative in the first survey, 44 (23%) had seroconverted at follow-up, yielding an 18% annual seroincidence. The largest increase in seroincidence occurred between children aged 2 years (10%) and children aged 3 years (32%). Use of a lidded, narrow-mouthed water vessel was protective against seroconversion (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.8), and the presence of another H. pylori-seropositive sibling in the household was a risk factor for seroconversion (OR, 3.1; 95% CI, 1.3-8.7). Although not a randomized intervention trial, this study suggests that the use of a narrow-mouthed water vessel may prevent the transmission of H. pylori in households in developing countries.