Association of enteropathogen detection with diarrhoea by age and high versus low child mortality settings: a systematic review and meta-analysis.

BACKGROUND

The odds ratio (OR) comparing pathogen presence in diarrhoeal cases versus asymptomatic controls is a measure for diarrhoeal disease cause that has been integrated into burden of disease estimates across diverse populations. This study aimed to estimate the OR describing the association between pathogen detection in stool and diarrhoea for 15 common enteropathogens by age group and child mortality setting.

METHODS

We did a systematic review to identify case-control and cohort studies published from Jan 1, 1990, to July 9, 2019, which examined at least one enteropathogen of interest and the outcome diarrhoea. The analytical dataset included data extracted from published articles and supplemented with data from the Global Enteric Multicenter Study and the Malnutrition and Enteric Disease study. Random effects meta-analysis models were fit for each enteropathogen, stratified by age group and child mortality level, and adjusted for pathogen detection method and study design to produce summary ORs describing the association between pathogen detection in stool and diarrhoea.

FINDINGS

1964 records were screened and 130 studies (over 88 079 cases or diarrhoea samples and 135 755 controls or non-diarrhoea samples) were available for analysis. Heterogeneity (I

INTERPRETATION

Incorporating effect estimates from diverse data sources into diarrhoeal disease cause and burden of disease models is needed to produce more representative estimates.

FUNDING

WHO, Bill & Melinda Gates Foundation, and National Institutes of Health.

Informations de copyright

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Déclaration de conflit d'intérêts

Declaration of interests VEP has received reimbursement from Merck and Pfizer for travel expenses unrelated to the topic of this Article, and is a member of the WHO Immunization and Vaccine-related Implementation Research Advisory Committee. BAL reports grants and personal fees from Takeda Pharmaceuticals. All other authors declare no competing interests.