Etiology of diarrhea among children under five years in Thai Binh, Vietnam: a prospective study

Abstract

Introduction: In developing countries like Vietnam, childhood diarrhea remains frequent and is often treated empirically without an etiological diagnosis.

Methodology: Patients aged under five years, hospitalized at a gastroenterology department with acute diarrhea, were recruited at one hospital. Enteric pathogens were tested by real-time PCR.

Results: 451 children with diarrhea were included, 65.2% were male. 56.3% were aged under 12 months. Upon inclusion, 49.7% (224/451) had nausea and vomiting, and 17.5% had bloody diarrhea. 27.1% of children had a fever, and 37.7% and 4.2% had moderate and severe dehydration, respectively. Almost all patients (437/451, 96.9%) received empirical antimicrobial treatment. 76.5% of children were positive for at least one pathogen, with 37.9% positive for two to four pathogens. Adenovirus, norovirus, and enterovirus were the most frequent viruses detected, with a proportion of 35.7%, 25.7%, and 20.6%, respectively, while Campylobacter jejuni was the most frequent bacterium detected (14.2%), followed by Salmonella spp. and Escherichia coli pathotypes. Male gender, patients positive for at least one virus, and rotavirus were associated with an increased risk of severe disease (OR = 1.55, p = 0.04, OR = 2.23, p < 0.001, and OR = 1.86, p = 0.03, respectively).

Conclusions: These findings underscore the complex interplay of viral and bacterial pathogens in pediatric diarrheal illness and highlight the need for targeted interventions focusing on appropriate diagnostic strategies, antimicrobial stewardship, and gender-specific considerations to mitigate the burden of childhood diarrhea in resource-limited settings like Vietnam.