Poor water and sanitation infrastructure in countries such as Pakistan result in over 50,000 children dying from diarrhoea every year. All of these deaths are preventable. The disease is also a global problem since it is the second leading cause of death amongst children under the age of 5, according to the US Centres for Disease Control and Prevention (CDC).
Diarrhoea can be caused by a wide range of germs or pathogens with the rotavirus being the most common. In 2018, Pakistan introduced a rotavirus vaccine that has helped halve the number of rotavirus infections. But deaths from diarrhoeal infections continue to occur, with the healthcare system and research community lacking insights into which bacteria or pathogens account for the largest proportion of cases in the country.
During World Immunization Week 2021 (24-30 April), the Aga Khan University (AKU) announced that its Infectious Diseases Research Laboratory (IDRL) has been selected as a regional reference laboratory for the World Health Organization’s Regional Office for the Eastern Mediterranean (EMRO), and will generate evidence that will inform efforts to curb new cases of diarrhoea.
In the first phase of the project, AKU’s laboratory is scanning stool samples from sites in Sindh and Punjab. This will provide insights into the number of rotavirus cases after the vaccine’s introduction and determine how many diarrhoea cases are being caused by other pathogens such as the norovirus, ETEC and shigella. AKU’s laboratory is one of the few facilities in the country and in the region with TaqMan Array Card (TAC) technology which enables faster and more efficient analysis.
“Typical stool culture and other diagnostic tests for diarrhoea are slow since they take days and even weeks to complete and can only detect one or a few pathogens at a time,” said Mr Furqan Kabir, a manager in AKU’s IDRL who oversees laboratory operations. In 2011, Mr Furqan received training at the CDC on TAC technology and led efforts to introduce the advanced diagnostic tool in Pakistan at AKU.
“The major advantage of this technology is that you can detect up to 100 pathogens at a time from a single sample in just six hours,” Mr Furqan adds.
The sample analysis will help shed light on whether new vaccines are required to reduce the burden of diarrhoea in the country. In the long term, the laboratory will also analyse data from across the EMRO region, which include high-burden nations such as Afghanistan.
“Diarrhoea causes immense suffering in children leading to many days of missed school, hours spent in exhaustion, costly visits to the hospital and an enormous strain on caregivers,” explains Mr Kabir. He adds that since stool culture tests for diarrhoea take so long, doctors often promptly prescribe broad spectrum antibiotics to children without finding out which bug has caused the disease. Besides being an ineffective course of treatment, this approach can also worsen the global problem of antimicrobial resistance.
“Eventually we hope to develop tests that can enable better diagnosis in hospitals,” Mr Kabir says. “This will benefit thousands of children around Pakistan and be of benefit to society as a whole since antimicrobial resistance is a looming public health threat.”
AKU’s IDRL is one of over 30 surveillance sites around the world working under the World Health Organization’s Global Pediatrics Diarrheal Surveillance Network.
The global initiative aims to achieve targets under Goal 3 of the Sustainable Development Goals which seek to end preventable child deaths and to curb the prevalence of water-borne illnesses such as diarrhoea.
This text was adapted from an article published on the Aga Khan University website.