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ORIGINAL ARTICLE
Year : 2022  |  Volume : 21  |  Issue : 3  |  Page : 283-287  

Prevalence and characteristics of rotavirus acute gastroenteritis among under-five children in ahmadu bello university teaching hospital, Zaria, Nigeria


1 Department of Paediatrics, ABU/ABUTH, Zaria, Nigeria
2 Department of Medical Microbiology, ABU/ABUTH, Zaria, Nigeria
3 Department of Medical Laboratory Science, ABU/Medical Microbiology ABUTH, Zaria, Nigeria
4 WHO Africa Region Office for Africa, Brazzaville, Congo
5 WHO Country Office, Abuja, Nigeria
6 National Primary Health Care Development Agency, Abuja, Nigeria

Date of Submission07-Feb-2021
Date of Decision10-Jun-2021
Date of Acceptance14-Jun-2022
Date of Web Publication26-Sep-2022

Correspondence Address:
Sani Malam Mado
Department of Paediatrics, ABU/ABUTH, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_31_21

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   Abstract 


Background: Rotavirus infection is a significant cause of gastroenteritis in developing countries and, in severe cases even leads to death. The impact of rotavirus vaccine introduction in reducing the rotavirus disease burden in children was well known. The study was aimed to determine the prevalence and clinical characteristics of rotavirus gastroenteritis before the introduction of rotavirus vaccine into Nigeria's routine immunization program. Materials and Methods: We conducted a cross-sectional hospital-based study involving 735 children aged 0–59 months with acute gastroenteritis hospitalized at the Ahmadu Bello University Teaching Hospital Zaria from September 2017 to August 2020. Relevant sociodemographic and clinical data were obtained and entered into the World Health Organization standardized case investigation forms. Stool specimens were tested for rotavirus Group A antigen using the ProSpecT Rotavirus Microplate Assay by Thermoscientific Oxoid Microbiology UK. Results: One hundred and fifty-three stool samples tested positive for rotavirus giving a prevalence of 20.8%. One hundred and two (66.7%) children with rotavirus gastroenteritis were infants. There were 87 males and 66 females with M: F ratio of 1.3:1. Only 30 (19.6%) children with rotavirus-associated diarrhea presented with severe dehydration. The presence of vomiting was significantly associated with rotavirus diarrhea (P = 0.001). More cases of rotavirus diarrhea occurred in September through February. None of the studied children were vaccinated against rotavirus. Conclusion: The prevalence of rotavirus diarrhea remains high in this study. Infants were recognized as a high-risk group, and none of them were vaccinated against rotavirus and this underscores the urgent need for implementing the rotavirus vaccine in the national vaccination program to reduce the disease burden in the country.
Résumé
Contexte: L'infection à rotavirus est une cause importante de gastro-entérite dans les pays en développement et, dans les cas graves, entraîne même la mort. L'impact de l'introduction du vaccin antirotavirus pour réduire le fardeau de la maladie à rotavirus chez les enfants était bien connue. L'étude visait à déterminer la prévalence et les caractéristiques cliniques de la gastro-entérite à rotavirus avant l'introduction du vaccin antirotavirus dans le programme de vaccination systématique du Nigéria. Matériels et méthodes: Nous avons mené une étude hospitalière transversale portant sur 735 enfants âgés de 0 à 59 mois atteints de gastro-entérite aiguë. hospitalisé à l'hôpital universitaire Ahmadu Bello Zaria de septembre 2017 à août 2020. Données sociodémographiques et cliniques pertinentes les données ont été obtenues et saisies dans les formulaires normalisés d'investigation de cas de l'Organisation mondiale de la santé. Des échantillons de selles ont été testés pour le rotavirus Antigène du groupe A utilisant le test sur microplaque ProSpecT™ Rotavirus par Thermoscientific Oxoid Microbiology UK. Résultats: cent cinquante trois les échantillons de selles ont été testés positifs pour le rotavirus donnant une prévalence de 20,8 %. Cent deux (66,7 %) enfants atteints de gastro-entérite à rotavirus ont été nourrissons. Il y avait 87 hommes et 66 femmes avec un rapport M:F de 1,3:1. Seuls 30 (19,6 %) enfants atteints de diarrhée à rotavirus ont présenté déshydratation sévère. La présence de vomissements était significativement associée à la diarrhée à rotavirus (P = 0,001). Plus de cas de diarrhée à rotavirus se sont produits de septembre à février. Aucun des enfants étudiés n'a été vacciné contre le rotavirus. Conclusion: La prévalence de la diarrhée à rotavirus reste élevé dans cette étude. Les nourrissons ont été reconnus comme un groupe à haut risque et aucun d'entre eux n'a été vacciné contre le rotavirus, ce qui souligne la nécessité urgente de mettre en œuvre le vaccin antirotavirus dans le programme national de vaccination afin de réduire la charge de morbidité dans le pays.
Mots-clés: Gastro-entérite aiguë, diarrhée à rotavirus, vaccin à rotavirus, Zaria

Keywords: Acute gastroenteritis, rotavirus diarrhea, rotavirus vaccine, Zaria


How to cite this article:
Mado SM, Giwa FJ, Abdullahi SM, Alfa AM, Yaqub Y, Usman Y, Wammanda RD, Mwenda JM, Isiaka AH, Yusuf K, Lawali N. Prevalence and characteristics of rotavirus acute gastroenteritis among under-five children in ahmadu bello university teaching hospital, Zaria, Nigeria. Ann Afr Med 2022;21:283-7

How to cite this URL:
Mado SM, Giwa FJ, Abdullahi SM, Alfa AM, Yaqub Y, Usman Y, Wammanda RD, Mwenda JM, Isiaka AH, Yusuf K, Lawali N. Prevalence and characteristics of rotavirus acute gastroenteritis among under-five children in ahmadu bello university teaching hospital, Zaria, Nigeria. Ann Afr Med [serial online] 2022 [cited 2023 Feb 6];21:283-7. Available from: https://www.annalsafrmed.org/text.asp?2022/21/3/283/356827




   Introduction Top


Rotavirus is a major cause of severe acute gastroenteritis in children under the age of 5 years globally and remains a significant cause of death, especially in developing countries. According to the World Health Organization (WHO), about 215,000 children die each year from rotavirus-associated diarrheal diseases with most deaths (80%) being in low-income countries.[1] Rotavirus was responsible for about 258 million diarrheal episodes not requiring hospitalization and 1,537,000 hospitalizations among under-five children worldwide in 2016.[2] About 14% of the estimated 2013 global rotavirus gastroenteritis deaths in children occurred in Nigeria with a huge economic and health burden on the population and the country.[3] Furthermore, it was recently estimated that rotavirus diarrhea was responsible for 47,898 deaths annually in under-five children in Nigeria.[4] The prevalence of rotavirus diarrhea in Nigeria has been reported to be between 13.8% and 56%,[5],[6],[7],[8],[9],[10] with marked seasonal variability even in the same place. Rotavirus diarrhea is common in children below the age of 5 years with most infections occurring before the 2nd year of life. Contact with children with diarrhea, hospitalization, severity of symptoms, age <2 years, drinking of unboiled tap water, underweight, and low birth weight were some of the identified independent risk factors for rotavirus diarrhea.[10],[11] Although effective vaccines are available in many countries, they are yet to be incorporated into the Nigerian routine vaccination schedule. Ahmadu Bello University Teaching Hospital (ABUTH), where this study was conducted, is one of the national sentinel surveillance sites in the WHO Global Rotavirus Surveillance Network and the activities of this network are to establish among other things, the prevaccine burden of the disease and the prevailing viral serotypes as well as to monitor the impact of the vaccine following its introduction. The other rotavirus surveillance sites in Nigeria include the University of Nigeria Teaching Hospital Enugu, University of Ilorin Teaching Hospital, and Abubakar Tafawa Balewa Teaching Hospital, Bauchi. Activities of ABUTH, Zaria sentinel surveillance site include recruitment of eligible children and testing their stool samples for the presence of rotavirus antigen, sharing of data with the Ministry of Health and WHO; and sending stool samples to reference laboratory for genotyping. This study was conducted as part of the WHO rotavirus sentinel surveillance in Zaria to determine the prevalence and clinical characteristics of rotavirus diarrhea among under-five children.


   Materials and Methods Top


This was a cross-sectional hospital-based study involving 735 children aged 0–59 months with acute gastroenteritis of <14 days duration, hospitalized at the Emergency Pediatric Unit or Diarrhea Therapy Unit at the Institute of Child Health Banzazzau both of the ABUTH, Zaria from September 2017 to August 2020. Excluded from the study were children who presented with bloody stool or those who developed diarrhea while on admission for the treatment of other conditions at the sentinel site as well as those who were referred from other facilities with unknown diagnoses presenting with diarrhea. Relevant sociodemographic and clinical data were obtained and entered into the WHO standardized case investigation forms. Clinical details obtained were history of fever before presentation, frequency of diarrheal stool and vomiting in the preceding 24 h before admission, admitting axillary temperature and body weight, degree of dehydration, and history of rotavirus vaccination. Stool specimens of about 3–5 ml were collected from children 0–59 months with acute diarrhea within 48 h of presentation using labeled screw-capped leak-proof sterile universal containers. The labeled stool samples were kept in fridges at 2°C–8°C in the laboratories of the designated health centers and were transported in coolers with ice packs every 2 days to the Medical Microbiology Department ABUTH, Shika-Zaria. Each stool sample was made into three (1 ml) aliquots in cryovials with 2–3 drops of glycerol and stored at −20°C until assayed for the detection of rotavirus antigen using the enzyme immunoassay, ProSpecT Rotavirus Microplate Assay by Thermoscientific Oxoid Microbiology UK. Informed consent was obtained from the mothers and the rights of the subjects were safeguarded according to the Helsinki Declaration. Approval of ABUTH Health Research Ethics Committee was obtained before the commencement of the study.

Data analysis

Data were analyzed using the IBM SPSS Statistics for Windows, version 20.0. (Armonk, New York, USA). Frequencies and percentages were calculated and categorical variables were compared using Chi-square and P < 0.05 was considered statistically significant.


   Results Top


A total of 735 children were enrolled in this study; 153 (20.8%) stool samples were positive for rotavirus Group A antigen. The male-to-female ratio in both rotavirus and nonrotavirus diarrhea group were 1.3:1 and 1.5:1, respectively. Majority, 102 (66.7%) of children with rotavirus diarrhea were <12 months of age. Age <12 months was significantly associated with isolation of rotavirus in stool samples (P = 0.002), whereas the gender of the child was not statistically associated with rotavirus diarrhea [Table 1]. Ninety-four (61.4%) children with rotavirus diarrhea presented with vomiting and the presence of vomiting were significantly associated with rotavirus diarrhea (P = 0.001). Seventy-one (46.4%) children with rotavirus diarrhea had documented fever at presentation and fever was not significantly associated with rotavirus diarrhea [Table 2]. Only 30 (19.6%) children with rotavirus-associated diarrhea presented with severe dehydration on admission. All the cases with severe dehydration had no history of the use of oral rehydration solution (ORS) at the onset of illness and before presentation, whereas the rest had used ORS at home at the onset of diarrhea. The cluster of cases of rotavirus diarrhea occurred in September through February of the study period [Figure 1],[Figure 2], [Figure 3]. None of the enrolled children had ever received the rotavirus vaccine.
Table 1: Age and sex distribution among children 0-59 months with rotavirus diarrhea

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Table 2: Fever and vomiting among children 0-59 months with rotavirus diarrhea

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Figure 1: Monthly distribution of rotavirus diarrhea from September 2017 to August 2018

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Figure 2: Monthly distribution of rotavirus diarrhea from September 2018 to August 2019

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Figure 3: Monthly distribution of rotavirus diarrhea from September 2019 to August 2020

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   Discussion Top


Rotavirus is an important cause of acute gastroenteritis in under-five children in our environment as shown in our study where about one-fifth of acute diarrhea cases were due to human rotavirus. The prevalence obtained in this study is higher than the previous studies from Jos,[5] and Zaria,[6],[7] both from the Northern part of Nigeria, but lower than what was documented in previous studies,[8],[9],[10] in other centers in Nigeria. The prevalence of rotavirus diarrhea varies considerably among under-five children in different geographic areas as observed in studies in Nigeria,[5],[6],[7],[8],[9],[10] and elsewhere in Ghana,[11] (39%), Kenya,[12] (17%), Abidjan,[13] (28.9%), and Uganda,[14] (37%). Furthermore, the observed prevalence in this study is similar to that observed in other studies conducted in Ethiopia,[15] (21%) and Tanzania,[16] (21%). The observed differences in the prevalence of rotavirus diarrhea may be due to variations in climatic conditions from one area to another which may impact the survival of infective rotavirus agents. Although the higher prevalence of rotavirus diarrhea in males previously reported in studies from Abuja,[8] and Enugu,[10] was similarly observed in this study, there was no statistically significant gender association with rotavirus diarrhea. Our study demonstrated a higher vulnerability to rotavirus infection compared to the older child. A significant proportion of studied children were infants, and this buttresses the importance of the early introduction of the rotavirus vaccine during infancy to target those who bear the greatest disease burden.[17] Rotavirus vaccines were shown to be safe and very effective in preventing the occurrence of severe rotavirus disease in an extensive study,[18] by Breiman et al. in Africa and Asia. Similarly, a reduction in rotavirus diarrhea hospitalization following rotavirus vaccine introduction was shown in a study in Madagascar.[19] Documented evidence showed a substantial reduction in diarrhea mortality, especially in infancy in some studies from Latin America.[20],[21],[22],[23] Rotavirus gastroenteritis is commonly associated with other symptoms besides diarrhea, and some of such important symptoms include fever and vomiting.[24] Majority (61.4%) of children with rotavirus diarrhea presented with vomiting in this study, and children having rotavirus diarrhea were more likely to have vomiting (P = 0.001) compared to those without rotavirus diarrhea. Rotavirus is a known cause of severe dehydrating diarrhea worldwide, however, only a small proportion (19.6%) of children had severe dehydration in our study. The possible reason may not be unconnected with the fact that most subjects (80.4%) had appropriate use of ORS before presentation, and hence were unlikely to present with severe dehydration despite having rotavirus diarrhea which is known to cause severe dehydration due to severe loss of fluid and electrolytes in the watery stool. It was particularly noted that more cases of rotavirus diarrhea were seen during September through February during which 84% of cases occurred; with the highest peak recorded in December while few or no cases were seen from March to August depicting a seasonal pattern. The period from October to February which is relatively dry and very cold (harmattan season) has been postulated to favor the survival of infective rotavirus,[25] and may probably explain the observed increased incidence of rotavirus infection during the period. Similar distinct rotavirus seasonality was also documented in another study in Nigeria.[10] One of the limitations of this study was a failure to look at some of the risk factors that may affect rotavirus infections such as maternal level of education, exclusive breastfeeding in the first 6 months of life, and hand hygiene practices among others. Despite its limitation, the study provided prerotavirus vaccine data on the prevalence of rotavirus gastroenteritis from one of the national sentinel surveillance sites in the WHO Global Rotavirus Surveillance Network which may influence decision-making.


   Conclusion/Recommendation Top


The prevalence of rotavirus diarrhea remains high in our setting. Infants were recognized as a high-risk group, and none of them were vaccinated against rotavirus and this underscores the urgent need for implementing the rotavirus vaccine in the national vaccination program to reduce the disease burden in the country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Troeger C, Khalil IA, Rao PC, Cao S, Blacker BF, Ahmed T, et al. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatr 2018;172:958-65.  Back to cited text no. 2
    
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Fidhow AM, Samwel A, Ng'ang'a Z, Oundo J, Nyangao J, Wences A. Molecular epidemiology and associated risk factors of rotavirus infection among children<5 yrs hospitalized for acute gastroenteritis in North Eastern, Kenya, 2012. Pan Afr Med J 2017;28:3.  Back to cited text no. 12
    
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Temu A, Kamugisha E, Mwizamholya DL, Hokororo A, Seni J, Mshana SE. Prevalence and factors associated with Group A rotavirus infection among children with acute diarrhea in Mwanza, Tanzania. J Infect Dev Ctries 2012;6:508-15.  Back to cited text no. 16
    
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20.
Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, Esparza-Aguilar M, Johnson B, Gomez-Altamirano CM, et al. Effect of rotavirus vaccination on death from childhood diarrhea in Mexico. N Engl J Med 2010;362:299-305.  Back to cited text no. 20
    
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25.
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