In study, new swab reveals one-third of babies with severe diarrhea had undiagnosed, treatable infection

With Canadian government funding, medical scientists have created and demonstrated a new tool that could dramatically lower the tragic annual toll of 760,000 infants and children killed, and millions more stunted, due to severe diarrhea.

Using an inexpensive innovation in specimen collection, the Canadian-led team diagnosed previously unrecognized pathogens that had caused the severe diarrhea of over one-third of children in a group of southern Africa hospitals.

With a grant from federally-funded Grand Challenges Canada, McMaster University researchers designed and tested in Botswana a specially-designed "flocked swab" for collecting samples from children admitted to hospitals with severe diarrheal disease - the second-leading cause of death of children under five in developing countries.

The flocked rectal swab eliminates the wait and biohazard involved in obtaining and transporting a bulk stool (feces) sample from an infant or child. This efficiency enabled implementation of a randomized clinical trial evaluating same-day diagnosis and treatment for a broad number of pathogens - the first study of its kind anywhere.

Published by the Journal of the Pediatric Infectious Disease Society, the study documented that over one-third of 671 babies hospitalized with severe diarrhea - including 17 of 26 (65%) who ultimately died - were infected with a treatable pathogen, infections that had gone unrecognized at the hospital and therefore generally went untreated.

Because so many of these severely ill children had treatable conditions, the researchers clinically tested whether same-day rapid diagnosis followed by timely, appropriate therapy would lead to improved outcomes.

Children randomly chosen for rapid testing using the flocked swab and appropriate treatment were 55% less likely to have diarrhoea recur, compared with children not chosen, and they had a clinically significant height gain after 60 days. This measure of growth is an important indicator of children's ability to reach their full developmental potential.

Led by David Goldfarb, MD (formerly of McMaster University, now at the University of British Columbia), along with Jeff Pernica, MD (McMaster) and collaborators Isaac Quaye, PhD (University of Namibia) and Margaret Mokomane (University of Botswana), the researchers witnessed dramatic health changes as a result of the rapid test-and-treat strategy.

And the 'treatment gap' revealed in their Botswana research uncovers a major opportunity to make a big long-term impact in child health worldwide, they say.

"The simple fact is: Diagnostics save lives," says Dr. Peter A. Singer, CEO of Grand Challenges Canada. "If health workers can quickly and accurately pinpoint the cause of a child's illness, timely help can be administered, preventing many deaths and improving many lives."