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Article ; Online: Is there a real benefit to zinc and prebiotic fortified ORS in children under the age of 3 years?

Walker, Christa L Fischer

2011 Volume 14, Issue 4, Page(s) 113–114

Language	English
Publishing date	2011-10
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	1425988-6
ISSN	1468-9618 ; 1367-6539
ISSN (online)	1468-9618
ISSN	1367-6539
DOI	10.1136/ebn.2011-100084
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Article ; Online: A Systematic Review of the Effect of Rotavirus Vaccination on Diarrhea Outcomes Among Children Younger Than 5 Years.

Lamberti, Laura M / Ashraf, Sania / Walker, Christa L Fischer / Black, Robert E

The Pediatric infectious disease journal

2016 Volume 35, Issue 9, Page(s) 992–998

Abstract: Background: Rotavirus is the leading cause of vaccine-preventable diarrhea among children under 5 globally. Rotavirus vaccination has been shown to prevent severe rotavirus infections with varying efficacy and effectiveness by region.: Methods: We ... ...

Abstract	Background: Rotavirus is the leading cause of vaccine-preventable diarrhea among children under 5 globally. Rotavirus vaccination has been shown to prevent severe rotavirus infections with varying efficacy and effectiveness by region. Methods: We sought to generate updated region-specific estimates of rotavirus vaccine efficacy and effectiveness. We systematically reviewed published vaccine efficacy and effectiveness studies to assess the region-specific effect of rotavirus vaccination on select diarrheal morbidity and mortality outcomes in children under 5 years of age. We employed meta-analytic methods to generate pooled effect sizes by Millennium Development Goal region. Results: Rotavirus vaccination was both efficacious and effective in preventing rotavirus diarrhea, severe rotavirus diarrhea and rotavirus hospitalizations among children under 5 across all regions represented by the 48 included studies. Efficacy against severe rotavirus diarrhea ranged from 90.6% [95% confidence interval (CI): 82.3-95.0] in the developed region to 88.4% (95% CI: 67.1-95.9) in Eastern/Southeastern Asia, 79.6% (95% CI: 71.3-85.5) in Latin America and the Caribbean, 50.0% (95% CI: 34.4-61.9) in Southern Asia and 46.1% (95% CI: 29.1-59.1) in sub-Saharan Africa. Region-specific effectiveness followed a similar pattern. There was also evidence of vaccine efficacy against severe diarrhea and diarrheal hospitalizations. Conclusion: Our findings confirm the protective efficacy and effectiveness of rotavirus vaccination against rotavirus diarrheal outcomes among children under 5 globally.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Asia/epidemiology ; Child, Preschool ; Developing Countries ; Diarrhea/epidemiology ; Diarrhea/mortality ; Diarrhea/prevention & control ; Diarrhea/virology ; Humans ; Infant ; Infant, Newborn ; Latin America/epidemiology ; Rotavirus ; Rotavirus Infections/epidemiology ; Rotavirus Infections/mortality ; Rotavirus Infections/prevention & control ; Rotavirus Infections/virology ; Rotavirus Vaccines ; Vaccination/statistics & numerical data
Chemical Substances	Rotavirus Vaccines
Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000001232
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Zs.A 1852: Show issues

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Article ; Online: Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010.

Buckle, Geoffrey C / Walker, Christa L Fischer / Black, Robert E

Journal of global health

2012 Volume 2, Issue 1, Page(s) 10401

Abstract: Background: Typhoid and paratyphoid fever remain important causes of morbidity worldwide. Accurate disease burden estimates are needed to guide policy decisions and prevention and control strategies.: Methods: We conducted a systematic literature ... ...

Abstract	Background: Typhoid and paratyphoid fever remain important causes of morbidity worldwide. Accurate disease burden estimates are needed to guide policy decisions and prevention and control strategies. Methods: We conducted a systematic literature review of the PubMed and Scopus databases using pre-defined criteria to identify population-based studies with typhoid fever incidence data published between 1980 and 2009. We also abstracted data from annual reports of notifiable diseases in countries with advanced surveillance systems. Typhoid and paratyphoid fever input data were grouped into regions and regional incidence and mortality rates were estimated. Incidence data were extrapolated across regions for those lacking data. Age-specific incidence rates were derived for regions where age-specific data were available. Crude and adjusted estimates of the global typhoid fever burden were calculated. Results: Twenty-five studies were identified, all of which contained incidence data on typhoid fever and 12 on paratyphoid fever. Five advanced surveillance systems contributed data on typhoid fever; 2 on paratyphoid fever. Regional typhoid fever incidence rates ranged from <0.1/100 000 cases/y in Central and Eastern Europe and Central Asia to 724.6/100 000 cases/y in Sub-Saharan Africa. Regional paratyphoid incidence rates ranged from 0.8/100 000 cases/y in North Africa/Middle East to 77.4/100 000 cases/y in Sub-Saharan Africa and South Asia. The estimated total number of typhoid fever episodes in 2010 was 13.5 million (interquartile range 9.1-17.8 million). The adjusted estimate accounting for the low sensitivity of blood cultures for isolation of the bacteria was 26.9 million (interquartile range 18.3-35.7 million) episodes. These findings are comparable to the most recent analysis of global typhoid fever morbidity, which reported crude and adjusted estimates of 10.8 million and 21.7 million typhoid fever episodes globally in 2000. Conclusion: Typhoid fever remains a significant health burden, especially in low- and middle-income countries. Despite the availability of more recent data on both enteric fevers, additional research is needed in many regions, particularly Africa, Latin America and other developing countries.
Language	English
Publishing date	2012-11-29
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2741629-X
ISSN	2047-2986 ; 2047-2986
ISSN (online)	2047-2986
ISSN	2047-2986
DOI	10.7189/jogh.02.010401
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Article: Haemolytic-uraemic syndrome as a sequela of diarrhoeal disease.

Walker, Christa L Fischer / Applegate, Jennifer A / Black, Robert E

Journal of health, population, and nutrition

2012 Volume 30, Issue 3, Page(s) 257–261

Abstract: Haemolytic-uraemic syndrome (HUS) is a serious sequela of diarrhoea and results in a high mortality rate. This systematic review aimed at estimating the proportion of HUS cases that are linked to prior infection due to Shiga toxin-producing Escherichia ... ...

Abstract	Haemolytic-uraemic syndrome (HUS) is a serious sequela of diarrhoea and results in a high mortality rate. This systematic review aimed at estimating the proportion of HUS cases that are linked to prior infection due to Shiga toxin-producing Escherichia coli (STEC) or Shigella dysenteriae type 1. A systematic review of the existing literature was done to identify cohort and case-control studies that examined the relationship between STEC and S. dysenteriae type 1 and HUS. After screening 2,516 articles, 11 studies were found that met the inclusion/exclusion criteria. Findings of case-control studies suggest that 60.8% of the HUS cases may be attributable to a previous infection with STEC. In cohort studies, 7.8% of participants with STEC and 8% of participants with S. dysenteriae type 1 developed HUS during follow-up. HUS is linked to diarrhoea due to both STEC and S. dysenteriae type 1. Thus, preventing infections caused by both pathogens is critical for the prevention and control of HUS, especially in areas where timely and effective treatment is not available.
MeSH term(s)	Case-Control Studies ; Cohort Studies ; Diarrhea/complications ; Diarrhea/microbiology ; Diarrhea/physiopathology ; Dysentery/complications ; Dysentery/microbiology ; Dysentery/physiopathology ; Global Health ; Hemolytic-Uremic Syndrome/complications ; Hemolytic-Uremic Syndrome/etiology ; Humans ; Shiga-Toxigenic Escherichia coli/isolation & purification ; Shigella dysenteriae/isolation & purification
Language	English
Publishing date	2012-09-28
Publishing country	Bangladesh
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2025045-9
ISSN	2072-1315 ; 1606-0997
ISSN (online)	2072-1315
ISSN	1606-0997
DOI	10.3329/jhpn.v30i3.12288
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Article ; Online: Zinc treatment for serious infections in young infants.

Walker, Christa L Fischer / Black, Robert E

Lancet (London, England)

2012 Volume 379, Issue 9831, Page(s) 2031–2033

MeSH term(s)	Bacterial Infections/drug therapy ; Female ; Humans ; Male ; Zinc/therapeutic use
Chemical Substances	Zinc (J41CSQ7QDS)
Language	English
Publishing date	2012-06-02
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(12)60695-3
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Article: Zinc as an adjunct treatment for Shigella in low income settings

Walker, Christa L. Fischer

Journal of Pediatric Infectious Diseases

2008 Volume 03, Issue 03, Page(s) 155–157

Language	English
Publishing date	2008-09-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2236947-8
ISSN	1305-7693 ; 1305-7707 ; 1871-0336
ISSN (online)	1305-7693
ISSN	1305-7707 ; 1871-0336
DOI	10.1055/s-0035-1556992
Database	Thieme publisher's database

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Article: Public sector scale-up of zinc and ORS improves coverage in selected districts in Bihar, India.

Walker, Christa L Fischer / Taneja, Sunita / Lamberti, Laura M / Black, Robert E / Mazumder, Sarmila

Journal of global health

2015 Volume 5, Issue 2, Page(s) 20408

Abstract: Background: In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in ... ...

Abstract	Background: In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in intervention districts. Methods: We conducted baseline and endline household surveys among caregivers of children 2-59 months of age. We calculated summary statistics for household characteristics, knowledge, careseeking and treatments given to children with a diarrhea episode in the last 14 days and built logistic regression models to compare baseline and endline values. Results: Caregivers named a public health center as an appropriate source of care for childhood diarrhea more often at endline (71.3%) compared to baseline (38.4%) but did not report increased careseeking to public sector providers for the current diarrhea episode. In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline. Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector. Conclusion: Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.
Language	English
Publishing date	2015-12
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2741629-X
ISSN	2047-2986 ; 2047-2978
ISSN (online)	2047-2986
ISSN	2047-2978
DOI	10.7189/jogh.05.020408
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Article: Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under-five in Uttar Pradesh, India.

Lamberti, Laura M / Walker, Christa L Fischer / Taneja, Sunita / Mazumder, Sarmila / Black, Robert E

Journal of global health

2015 Volume 5, Issue 2, Page(s) 20410

Abstract: Background: There is limited evidence on adherence to the recommended dose and duration of zinc supplementation for diarrheal episodes in children under five years of age. In selected districts of Uttar Pradesh, India, we sought to assess adherence to ... ...

Abstract	Background: There is limited evidence on adherence to the recommended dose and duration of zinc supplementation for diarrheal episodes in children under five years of age. In selected districts of Uttar Pradesh, India, we sought to assess adherence to the nationally advised zinc treatment regimen (ie, 10 mg/day for ages 2-6 months and 20 mg/day for ages 7-59 months for 14 days) among caregivers of zinc-prescribed children. Methods: We identified and conducted follow-up visits to children advised zinc for the treatment of diarrhea. At the initial visit, we collected data on the treatment instructions received from providers. Caregivers were asked to record treatments administered on a pictorial tracking form and were asked to retain all packaging for collection at follow-up. We quantified the average dose and duration of zinc therapy and built logistic regression models to assess the factors associated with caregiver adherence to national guidelines. Results: Caregivers administered zinc for an average of 10.7 days (standard deviation (SD) = 3.9 days; median = 13 days), and 47.8% continued treatment for the complete 14 days. Among children receiving zinc syrups and tablets respectively, the age appropriate dose was received by 30.8% and 67.3%. Adherence to age appropriate dose and continuation of zinc for 14 days were highly associated with having received appropriate provider instructions. Conclusions: Our results indicate moderate-to-good adherence to national zinc treatment guidelines for diarrhea among caregivers in rural India. Our findings also highlight the importance of provider guidance in ensuring adherence to zinc dose and duration. Programs aiming to scale-up zinc treatment for childhood diarrhea should train providers to successfully communicate dosing instructions to caregivers, while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.
MeSH term(s)	Caregivers ; Child, Preschool ; Diarrhea/drug therapy ; Dietary Supplements ; Drug Administration Schedule ; Female ; Fluid Therapy/methods ; Guideline Adherence ; Humans ; India ; Infant ; Logistic Models ; Male ; Practice Guidelines as Topic ; Rural Population ; Zinc/administration & dosage
Chemical Substances	Zinc (J41CSQ7QDS)
Language	English
Publishing date	2015-12
Publishing country	Scotland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2741629-X
ISSN	2047-2986 ; 2047-2978
ISSN (online)	2047-2986
ISSN	2047-2978
DOI	10.7189/jogh.05.020410
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Article ; Online: Appropriate Management of Acute Diarrhea in Children Among Public and Private Providers in Gujarat, India: A Cross-Sectional Survey.

Walker, Christa L Fischer / Taneja, Sunita / LeFevre, Amnesty / Black, Robert E / Mazumder, Sarmila

Global health, science and practice

2015 Volume 3, Issue 2, Page(s) 230–241

Abstract: Diarrhea remains a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries. In 2006, the Indian government formally endorsed the World Health Organization guidelines that introduced zinc ... ...

Abstract	Diarrhea remains a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries. In 2006, the Indian government formally endorsed the World Health Organization guidelines that introduced zinc supplementation and low-osmolarity oral rehydration salts (ORS) for the treatment of diarrhea. Despite this, zinc is rarely prescribed and has not been available in the public sector in India until very recently. The Diarrhea Alleviation Through Zinc and ORS Treatment (DAZT) project was implemented in Gujarat between 2011 and 2013 to accelerate the uptake of zinc and ORS among public and private providers in 6 rural districts. As part of an external evaluation of DAZT, we interviewed 619 randomly selected facility- and community-based public and private providers 2-3 months after a 1-day training event had been completed (or, in the case of private providers, after at least 1 drug-detailing visit by a pharmaceutical representative had occurred) and supplies were in place. The purpose of the interviews was to assess providers' knowledge of appropriate treatment for diarrhea in children, reported treatment practices, and availability of drugs in stock. More than 80% of all providers interviewed reported they had received training or a drug-detailing visit on diarrheal treatment in the past 6 months. Most providers in all cadres (range, 68% to 100%) correctly described how to prepare ORS and nearly all (range, 90% to 100%) reported routinely prescribing it to treat diarrhea in children. Reported routine prescription of zinc was lower, ranging from 62% among private providers to 96% among auxiliary nurse-midwives. Among providers who reported ever not recommending zinc (n = 242), the 2 most frequently reported reasons for not doing so were not completely understanding zinc for diarrhea treatment and not having zinc in stock at the time of contact with the patient. In a multiple logistic regression analysis, recent training or drug-detailing visits and having zinc in stock were associated with reported zinc prescribing (P<.05). Recent training among public providers was significantly associated with having correct knowledge of zinc treatment duration and dosage, but the same was not true of drug-detailing visits among private providers. Treating diarrhea with zinc and low-osmolarity ORS is new for public and private providers in India and other low- and middle-income countries. Sufficient training and logistics support to ensure consistent supplies are critical if providers are to begin routinely treating all diarrhea episodes with zinc and ORS.
MeSH term(s)	Acute Disease ; Adult ; Child ; Clinical Competence ; Cross-Sectional Studies ; Diarrhea/drug therapy ; Diarrhea/therapy ; Disease Management ; Female ; Fluid Therapy ; Guideline Adherence ; Health Personnel/education ; Health Policy ; Humans ; India ; Male ; Middle Aged ; Practice Patterns, Physicians' ; Private Sector ; Program Evaluation ; Public Sector ; Rural Population ; Young Adult ; Zinc/supply & distribution ; Zinc/therapeutic use
Chemical Substances	Zinc (J41CSQ7QDS)
Language	English
Publishing date	2015-05-07
Publishing country	United States
Document type	Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2710875-2
ISSN	2169-575X ; 2169-575X
ISSN (online)	2169-575X
ISSN	2169-575X
DOI	10.9745/GHSP-D-14-00209
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Article ; Online: The effect of rotavirus vaccine on diarrhoea mortality.

Munos, Melinda K / Walker, Christa L Fischer / Black, Robert E

International journal of epidemiology

2010 Volume 39 Suppl 1, Page(s) i56–62

Abstract: Background: Approximately 39% of the global diarrhoea deaths in children aged 5 years may be attributable to rotavirus infection. Two rotavirus vaccines were recently introduced to the market, with evidence of efficacy in the USA, Europe and Latin ... ...

Abstract	Background: Approximately 39% of the global diarrhoea deaths in children aged 5 years may be attributable to rotavirus infection. Two rotavirus vaccines were recently introduced to the market, with evidence of efficacy in the USA, Europe and Latin America. We sought to estimate the effectiveness of these vaccines against rotavirus morbidity and mortality. Methods: We conducted a systematic review of published efficacy and effectiveness trials of rotavirus vaccines. Study descriptors and outcome measures were abstracted into standardized tables and the quality of each study was graded. We performed meta-analyses for any outcome with two or more data points, and used child health epidemiology reference group (CHERG) Rules for Evidence Review to estimate the effect of the vaccine on rotavirus mortality. Results: We identified six papers for abstraction, reporting results from four studies. No studies reported diarrhoea or rotavirus deaths, but all studies showed reductions in hospitalizations due to rotavirus or diarrhoea of any aetiology, severe and any rotavirus infections and diarrhoea episodes of any aetiology in children who received rotavirus vaccine compared with placebo. Effectiveness against very severe rotavirus infection best approximated effectiveness against the fraction of diarrhoea deaths attributable to rotavirus, and was estimated to be 74% (95% confidence interval: 35-90%). Conclusions: Rotavirus vaccines are efficacious against rotavirus morbidity and mortality and have the potential to substantially reduce child mortality in low-income countries if implemented appropriately.
MeSH term(s)	Child, Preschool ; Clinical Trials as Topic ; Diarrhea/epidemiology ; Diarrhea/mortality ; Diarrhea/prevention & control ; Diarrhea/virology ; Europe/epidemiology ; Female ; Humans ; Infant ; Latin America/epidemiology ; Male ; Rotavirus Infections/complications ; Rotavirus Infections/epidemiology ; Rotavirus Infections/mortality ; Rotavirus Infections/prevention & control ; Rotavirus Vaccines/administration & dosage ; Treatment Outcome ; United States/epidemiology
Chemical Substances	Rotavirus Vaccines
Language	English
Publishing date	2010-03-25
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyq022
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