Rotavirus A infection in children under five years old with a double health problem: undernutrition and diarrhoea - a cross-sectional study in four provinces of Mozambique.
BACKGROUND
Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique.


METHODS
The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR).


RESULTS
Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed.


CONCLUSIONS
The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.
['Chissaque|Assucênio|A|http://orcid.org/0000-0002-9470-6068', 'Cassocera|Marta|M|', 'Gasparinho|Carolina|C|', 'Langa|Jéronimo Souzinho|JS|', 'Bauhofer|Adilson Fernando Loforte|AFL|', 'Chilaúle|Jorfélia José|JJ|', 'João|Eva Dora|ED|', 'Munlela|Benilde António|BA|', 'Sambo|Júlia Assiat Monteiro|JAM|', 'Boene|Simone Salvador|SS|', 'Djedje|Marlene Bernardo|MB|', 'Anapakala|Elda Muianga|EM|', 'Guimarães|Esperança Lourenço|EL|', 'Bero|Diocreciano Matias|DM|', 'Manhique-Coutinho|Lena Vânia|LV|', 'Cossa-Moiane|Idalécia|I|', 'Kellogg|Timothy A|TA|', 'Gonçalves|Luzia Augusta Pires|LAP|', 'de Deus|Nilsa|N|']
D000818:Animals D001942:Breast Feeding D015362:Child Nutrition Disorders D002675:Child, Preschool D015897:Comorbidity D003430:Cross-Sectional Studies D003967:Diarrhea D005191:Family Characteristics D005243:Feces D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D044342:Malnutrition D009073:Mozambique D015995:Prevalence D012307:Risk Factors D012401:Rotavirus D012400:Rotavirus Infections D022243:Rotavirus Vaccines
Rotavirus A Undernutrition Diarrhoea Mozambique Risk factors