A new study has identified rotavirus as the most common cause of diarrhoeal deaths among children around the world.

The Global Enteric Multicenter Study (GEMS), involving 20,000 children from across Asia and Africa was designed to identify the aetiology and population-based burden of paediatric diarrhoeal disease in developing countries.
It is a 3-year, prospective, age-stratified, matched case-control study of moderate-to-severe diarrhoea in children aged 0-59 months residing in censused populations at four sites in Africa and three in Asia.

The researchers said that recruited children with moderate-to-severe diarrhoea seeking care at health centres along with one to three randomly selected matched community control children without diarrhoea.

From patients with moderate-to-severe diarrhoea and controls, they said they obtained clinical and epidemiological data, anthropometric measurements, and a faecal sample to identify enteropathogens at enrolment.

One follow-up home visit was made about 60 days later to ascertain vital status, clinical outcome, and interval growth.

They enrolled 9439 children with moderate-to-severe diarrhoea and 13 129 control children without diarrhoea.

Analysing data from the study, researchers found that approximately one in five children under the age of two suffer from moderate-to-severe diarrhoea (MSD) each year, which increased children`s risk of death 8.5-fold and lead to stunted growth over a two-month follow-up period.

"Without a full picture of which pathogen causes the most harm, it had been difficult to make evidence-based decisions around diarrhoeal disease control," said Dipika Sur, principal investigator, National Institute of Cholera and Enteric Diseases, Kolkata.

By analysing adjusted population attributable fractions, they found that most attributable cases of moderate-to-severe diarrhoea were due to four pathogens: rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli producing heat-stable toxin (ST-ETEC; with or without co-expression of heat-labile enterotoxin), and Shigella.

Other pathogens were important in selected sites (eg, Aeromonas, Vibrio cholerae O1, Campylobacter jejuni).


Pathogens associated with increased risk of case death were ST-ETEC and typical enteropathogenic E coli in infants aged 0-11 months, and Cryptosporidium in toddlers aged 12-23 months.

The researchers noted that interventions targeting five pathogens (rotavirus, Shigella, ST-ETEC, Cryptosporidium, typical enteropathogenic E coli) could substantially reduce the burden of moderate-to-severe diarrhoea.

New methods and accelerated implementation of existing interventions (rotavirus vaccine and zinc) are needed to prevent disease and improve outcomes, they added.

More than 100,000 children die from diarrhoea in India every year, and approximately 4,57,000- 8,84,000 are hospitalised with the disease.

Nearly 800,000 deaths are caused by diarrhoea across the world.