Abstract
Acute gastroenteritis is a major cause of pediatric morbidity and death worldwide, with high healthcare utili- zation, ongoing practice variation, and significant family burden, especially in developing countries, and young children under the age of five are the most vulnerable. me objectives of the study are to: To assess the factors associated with gastroenteritis in children 2-5 years of age and also to investigate if there is a correlation be- tween socio-demographic data with some of the factors of gastroenteritis A quantitative /descriptive study was conducted, with A non-probability /convenience sampling, me sample size was (111) children who had gastroenteritis and were admitted in Ranya maternity and pediatric teaching hospital and pediatric ward in Shahidan Qaladze Teaching Hospital. me data was collected by modifying the questionnaire that was asked from the patient’s parents by interview (face to face) method. me results of the study indicate that most of the cases were between the age (of 24-28) months 22%, (29-33) months 14%, (32-38) months14% and (59and more) months 28% with the (Mean =42) months. me male was more affected (58%) than the female (42%). Most of the patients were from urban areas (67%). According to the findings, there is a correlation between BMI (body mass index) with gastroenteritis because the P-value is less than 0.05, (P-value =0.04566), there is a significant correlation between Type of feeding and eating Type with Gastroenteritis because the p-value for both of these correlations is less than (0.05), the p-value of correlation between Feeding type and Gastroenteritis is (0.0374). mere is a correlation between making the water safer to drink with gastroenteritis because the P-value less than 0.05, and the P-value is (0.0423). Children under 5 years of age are vulnerable to suffering gastroenteritis, the factors, including BMI (body mass index) ،methods that are used to clean water safer, feeding type, and eating type; are those factors that make clients vulnerable to suffer gastroenteritis.
CHAPTER ONE
Introduction.
The main objective of this thesis was to investigate the etiology of outbreaks of viral gastroenteritis that remained without diagnosis after testing for common viral pathogens causing gastroenteritis, e.g. noroviruses, rotaviruses, sapoviruses, adenoviruses, and astroviruses. No causative pathogen could be detected in over 10% of these outbreaks. Viral gastroenteritis is about the most frequent disease in humans and this unexplained fraction concerns about 150000 cases in the Nigeria each year (41). Here, an overview of the state of the art of the literature on viral gastroenteritis is provided.
Gastroenteritis.
Gastroenteritis, which is also known as stomach flu, is an inflammation of the gastrointestinal tract that can be caused by a wide range of infectious and non-infectious causes. The infectious causes are a broad range of viruses, bacteria, and parasites. Gastroenteritis is defined by its clinical picture, which is mainly characterized by diarrhea and vomiting. Based on the clinical picture alone, it is not possible to distinguish between infectious and non-infectious causes. Here, we focus on the infectious causes only.
Epidemic and sporadic acute viral gastroenteritis (GE), is one of the most common diseases in humans in all age groups worldwide causing substantial morbidity and mortality (1, 23, 169). The estimated incidence is highest in children under the age of 5 years, and more than 700 million cases per year of acute diarrhea occur in this age group (23, 169). Annually, 3-5 million deaths occur as a result of diarrheal disease, placing these in the top five causes of death worldwide, with the majority again in children under age of 5 years in developing countries (1, 23, 37). The majority of these infections are of viral origin. In developed countries the mortality due to gastroenteritis is limited, as a result of better living conditions and improved hygiene and sanitation, which limits the spread of gastroenteritis viruses, and adequate and timely treatment. As a result, gastroenteritis episodes in these countries typically are considered mild and self-limiting. However, due to the high incidence, the morbidity of this disease remains high, and diarrheal disease remains an important reason for hospitalization, particularly in children (1, 23, 37, 169).
History of viral gastroenteritis.
Epidemic non-bacterial gastroenteritis or epidemic vomiting disease has been described first in 1929 and was named “winter vomiting disease” (177), describing the seasonality and one of the symptoms of the disease. It could not be attributed to known bacterial or parasitic pathogens, and the etiological agent was identified many years later. The breakthrough was the discovery of virus particles in human-passaged fecal material derived from an outbreak of acute gastroenteritis at an elementary school in 1968 in Norwalk, Ohio, USA
(79). Teachers and students had symptoms of acute gastroenteritis, both vomiting and diarrhea, and attempts to identify a pathogen failed. In 1972, Kapikian and co-workers observed viral particles in stool samples of volunteers that had been infected with purified stool samples from a patient from the Norwalk outbreak (4, 79, 147). Particles of 27 to 32 nm were measured and the agent was named Norwalk virus. These were the first viruses associated with gastroenteritis. Similarly, a year later, Bishop et al. identified rotaviruses in the duodenal mucosa of children with gastroenteritis (17), and these are now recognized as major pathogen in childhood diarrhea. In 1975 astroviruses (98) and enteric adenoviruses (115) were identified in the feces of children with acute diarrhea and were added to the list of viruses causing gastroenteritis (Figure 1).
Definitions of gastroenteritis.
Gastroenteritis is defined by its clinical picture, but there is no internationally accepted case definition. The WHO defines diarrhea as three or more loose stools in 24 hours, but this does not include vomiting, which is a common symptom of viral gastroenteritis. Persons with viral gastroenteritis may have fever, headache, abdominal pain, and cramps, along with vomiting and frequent and watery diarrhea. The condition is usually characterized by acute onset, and lasts 1 to 6 days. The disease is generally mild and self-limiting although dehydration may develop, especially with rotavirus infections.
For the diagnosis of viral gastroenteritis, and particularly noroviruses, a definition to recognize outbreaks has been proposed and successfully used with the following criteria (81) 1) absence of bacterial and parasitic pathogens in stool samples 2) vomiting in more than 50% of the affected cases; 3) mean (or median) duration of illness from 12 to 60 hours, and 4) mean (or median) incubation period of 24 to 48 hours.
1.2 Statement of the Problem
Gastroenteritis, an inflammation of the gastrointestinal tract involving both the stomach and the small intestine, remains one of the leading causes of morbidity and mortality across the globe, particularly in developing countries. The disease is often characterized by symptoms such as diarrhea, vomiting, abdominal cramps, and dehydration, and can be triggered by a range of pathogens including viruses (e.g., norovirus, rotavirus), bacteria (e.g., *Escherichia coli*, *Salmonella*), and parasites (e.g., *Giardia lamblia*). Despite the simplicity of its transmission pathways—often fecal-oral—the incidence of gastroenteritis continues to spike periodically, leading to epidemics with significant health, economic, and social consequences.
Numerous outbreaks have occurred in settings with compromised sanitation, unsafe water sources, poor hygiene practices, and inadequate health education. Yet, even in regions where such conditions are presumed to be under control, outbreaks still occur, suggesting the presence of multifactorial and possibly context-specific determinants that have not been thoroughly investigated or addressed. The challenge is further compounded by climate variability, population density, food contamination, limited public health surveillance, and resistance to antibiotics, all of which contribute to the complexity of gastroenteritis epidemiology.
This investigation is prompted by the recurrence of gastroenteritis outbreaks in both urban and rural environments, sometimes with significant fatalities, overwhelming health systems and disrupting social and economic activities. The failure to identify and understand the contextual and environmental factors that predispose populations to such outbreaks creates a gap in public health intervention strategies. While short-term measures such as rehydration therapy and antimicrobial treatment are often employed during outbreaks, there is a lack of long-term preventive strategies grounded in a sound understanding of the root causes.
Thus, this study seeks to systematically investigate the factors responsible for the outbreak of gastroenteritis within a specific population and locality, with a view to providing evidence-based recommendations that can aid in the prevention and control of future outbreaks. The problem is not merely the presence of the disease but the recurring nature of its outbreaks, the uncertainty surrounding the factors that sustain its transmission, and the inadequacy of existing public health responses to these determinants.
1.3 Objectives of the Study
The broad objective of this study is to investigate the factors responsible for the outbreak of gastroenteritis within a defined community or region, and to provide evidence-based strategies for its prevention and control.
The specific objectives are
1. To identify and analyze the environmental, socio-economic, and behavioral factors that contribute to the outbreak of gastroenteritis.
2. To examine the role of water quality, sanitation, and food hygiene in the transmission of gastroenteritis-causing pathogens.
3. To determine the level of awareness and knowledge of gastroenteritis among the affected population and their health-seeking behaviors during outbreaks.
1.4 Significance of the Study
The significance of this study lies in its potential to uncover the underlying drivers of gastroenteritis outbreaks and to contribute to the formulation of sustainable, context-specific public health interventions. The findings will be relevant not only for academic purposes but also for practical applications in policy, healthcare delivery, and community education.
Firstly, the study provides empirical insights into the environmental and socio-behavioral contexts that support the persistence and resurgence of gastroenteritis outbreaks. By identifying these factors, health authorities can tailor their interventions more effectively and allocate resources based on evidence rather than assumptions or generalized responses.
Secondly, the study highlights the role of water and food safety, hygiene practices, and public awareness in the transmission of gastroenteritis. In areas where safe water and sanitation infrastructure is lacking, findings from this study can inform infrastructure development priorities, promote behavioral change, and guide community-led sanitation initiatives. Furthermore, insights into food hygiene and handling can inform policies regulating food vendors, markets, and restaurants, especially in densely populated areas.
Thirdly, from a health system perspective, this study will expose the strengths and weaknesses in current outbreak response mechanisms. Understanding gaps in surveillance, diagnosis, and treatment will aid in strengthening institutional preparedness and response capacities. This is particularly important given the global call for increased resilience of health systems in the face of infectious disease threats.
Additionally, by examining community knowledge and practices regarding gastroenteritis, the study will guide the development of targeted health education and communication strategies. Educating communities about preventive measures—such as handwashing, safe food preparation, and timely health-seeking behavior—can significantly reduce the incidence and impact of the disease.
Importantly, the study also contributes to the body of literature on gastroenteritis, especially in developing regions where such studies are sparse. It provides a case-specific analysis that can be referenced by researchers, development agencies, and international organizations working on public health interventions in similar epidemiological contexts.
Finally, the outcomes of this study may be employed to develop a predictive model that integrates environmental, climatic, and behavioral indicators for early warning of potential outbreaks. This will enable a shift from reactive to proactive public health strategies, thereby reducing morbidity, mortality, and the socio-economic burden of the disease.
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