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Content archived on 2024-04-19

Persistent Diarrhoea in early Childhood - A Prospective Community Study


The main objectives are to develop an algorithm for the management of persistent diarrhoea (pD) and to study immunity to major enteropathogens in order to suggest vaccine-based interventions against diarrhoea. The aim is: in addition, to explore the long-term impact of infection with specific agents on mortality and growth faltering. The study incorporates a substantial transfer of technology to the National public Health Laboratory in Bissau, and exchange and training of health Workers, technicians, and scientists.
A prospective community-based surveillance for diarrhoeal disease is proposed in which 150 children will be enroled at birth and followed by diarrhoea recall visits for two years. After this intensive phase the children will be followed up to the age of five years in order to collect data on growth, hospitalizations, and survival.
A protocol for the management of PD with appropriate guidelines for feeding and use of drugs will be elaborated, and all children with PD will be managed accordingly at the local health centre. An external control group will be followed to compare incidence and duration of diarrhoea and nutritional impact with that of the study group. Faecal samples will be collected each week and twice weekly in children with diarrhoea. The purpose is to study the etiology and pathogenesis of acute and PD, and to investigate immunity in terms of prevented disease and in terms of protection against colonization following infections with specific agents. The specimens will be analysed for rotavirus, enteric parasites, and pathogenic bacteria. The latter will, in Bissau, be achieved by hybridizations with non-radioactive DNA probes. Isolates of enterotoxigenic E.coli (ETEC) will be characterised by colony factor antigens (CFA) to describe the acquisition of CFA-specific immunitv following natural ETEC infection.The recent advancements in the development of a vaccine against Etec diarrhoea has been encouraaing hence this analysis has major implications for the design of immunization programmes. As a part of the immunological studies, specific antibodies in colostrum, breast-milk, and faeces will be measured. The antibody levels will be related to the risk of infection or disease with sdecific pathogens.


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