{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:56:14Z","timestamp":1792432574433,"version":"4.5.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T00:00:00Z","timestamp":1681862400000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1111236"],"award-info":[{"award-number":["OPP1111236"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1116751"],"award-info":[{"award-number":["OPP1116751"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Diarrheal disease is heterogeneous, including watery diarrhea (WD) and dysentery, some cases of which become persistent diarrhea (PD). Changes in risk over time necessitate updated knowledge of these syndromes in sub-Saharan Africa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The Vaccine Impact on Diarrhea in Africa (VIDA) study was an age-stratified, case-control study of moderate-to-severe diarrhea among children &amp;lt;5 years old in The Gambia, Mali, and Kenya (2015\u20132018). We analyzed cases with follow-up of about 60 days after enrollment to detect PD (lasting \u226514 days), examined the features of WD and dysentery, and examined determinants for progression to and sequelae from PD. Data were compared with those from the Global Enteric Multicenter Study (GEMS) to detect temporal changes. Etiology was assessed from stool samples using pathogen attributable fractions (AFs), and predictors were assessed using \u03c72 tests or multivariate regression, where appropriate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 4606 children with moderate-to-severe diarrhea, 3895 (84.6%) had WD and 711 (15.4%) had dysentery. PD was more frequent among infants (11.3%) than in children 12\u201323 months (9.9%) or 24\u201359 months (7.3%), P = .001 and higher in Kenya (15.5%) than in The Gambia (9.3%) or Mali (4.3%), P &amp;lt; .001; the frequencies were similar among children with WD (9.7%) and those with dysentery (9.4%). Compared to children not treated with antibiotics, those who received antibiotics had a lower frequency of PD overall (7.4% vs 10.1%, P = .01), and particularly among those with WD (6.3% vs 10.0%; P = .01) but not among children with dysentery (8.5% vs 11.0%; P = .27). For those with watery PD, Cryptosporidium and norovirus had the highest AFs among infants (0.16 and 0.12, respectively), while Shigella had the highest AF (0.25) in older children. The odds of PD decreased significantly over time in Mali and Kenya while increasing significantly in The Gambia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The burden of PD endures in sub-Saharan Africa, with nearly 10% of episodes of WD and dysentery becoming persistent.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad022","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T13:57:40Z","timestamp":1681912660000},"page":"S12-S22","source":"Crossref","is-referenced-by-count":39,"title":["Etiology, Presentation, and Risk Factors for Diarrheal Syndromes in 3 Sub-Saharan African Countries After the Introduction of Rotavirus Vaccines From the Vaccine Impact on Diarrhea in Africa (VIDA) Study"],"prefix":"10.1093","volume":"76","author":[{"given":"Andrea G","family":"Buchwald","sequence":"first","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Pediatrics, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer R","family":"Verani","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Centers for Disease Control and Prevention , Nairobi , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adama Mamby","family":"Keita","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins du Mali (CVD-Mali) , Bamako , Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Jahangir Hossain","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Roose","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Pediatrics, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samba O","family":"Sow","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins du Mali (CVD-Mali) , Bamako , Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Omore","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanogo","family":"Doh","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins du Mali (CVD-Mali) , Bamako , Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joquina Chiquita M","family":"Jones","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilruba","family":"Nasrin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed M A","family":"Zaman","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Okoi","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Antonio","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine , Banjul , The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B","family":"Ochieng","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Juma","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma","family":"Onwuchekwa","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins du Mali (CVD-Mali) , Bamako , Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Powell","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Pediatrics, University of Maryland School of Medicine , Baltimore, Maryland , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A","family":"Platts-Mills","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia , Charlottesville, Virginia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon M","family":"Tennant","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA"},{"name":"Department of Medicine, University of Maryland School of Medicine , 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