OBJECTIVE: To identify factors associated with diarrhoea occurrence in children in a city in a middle-income country, with high access to water and sanitation. METHODS: A case-control study in the city of Salvador, north-eastern Brazil was conducted from November 2002 to August 2004. The study population consisted of children presenting at a health facility. A total of 1688 cases of diarrhoea and 1676 controls were selected. Data collection was by a questionnaire and structured observation during home visits. The explanatory variables were grouped according to a conceptual model defined previously. Analysis was done using a hierarchical approach, to provide a more dynamic view of the transmission characteristics of childhood diarrhoea. Non-conditional logistic regression was used, and odds ratio and population-attributable fractions were estimated. RESULTS: Socioeconomic factors contributed most to determining diarrhoea occurrence, followed by interpersonal contact, while factors related to food preparation, the environment and water and sanitation made a smaller contribution. CONCLUSION: The findings indicate that the transmission of diarrhoea is influenced by factors from all hierarchical levels, with interpersonal transmission playing a relatively higher role than previously thought. This is compatible with a predominance of viruses and other agents spread by interpersonal routes including Shigella, Giardia and Cryptosporidium. Diarrhoea control strategies in similar settings (middle-income countries in which a large proportion of the population has access to water and sanitation) must give greater emphasis to policies geared towards reducing person-to-person transmission for the prevention of diarrhoea.
OBJECTIVE: To identify factors associated with diarrhoea occurrence in children in a city in a middle-income country, with high access to water and sanitation. METHODS: A case-control study in the city of Salvador, north-eastern Brazil was conducted from November 2002 to August 2004. The study population consisted of children presenting at a health facility. A total of 1688 cases of diarrhoea and 1676 controls were selected. Data collection was by a questionnaire and structured observation during home visits. The explanatory variables were grouped according to a conceptual model defined previously. Analysis was done using a hierarchical approach, to provide a more dynamic view of the transmission characteristics of childhood diarrhoea. Non-conditional logistic regression was used, and odds ratio and population-attributable fractions were estimated. RESULTS: Socioeconomic factors contributed most to determining diarrhoea occurrence, followed by interpersonal contact, while factors related to food preparation, the environment and water and sanitation made a smaller contribution. CONCLUSION: The findings indicate that the transmission of diarrhoea is influenced by factors from all hierarchical levels, with interpersonal transmission playing a relatively higher role than previously thought. This is compatible with a predominance of viruses and other agents spread by interpersonal routes including Shigella, Giardia and Cryptosporidium. Diarrhoea control strategies in similar settings (middle-income countries in which a large proportion of the population has access to water and sanitation) must give greater emphasis to policies geared towards reducing person-to-person transmission for the prevention of diarrhoea.
Authors: Kathleen E Fullerton; Elaine Scallan; Martyn D Kirk; Barbara E Mahon; Frederick J Angulo; Henriette de Valk; Wilfrid van Pelt; Charmaine Gauci; Anja M Hauri; Shannon Majowicz; Sarah J O'Brien Journal: Foodborne Pathog Dis Date: 2012-04 Impact factor: 3.171
Authors: B M Delfino; R G Campos; T M Pereira; S A S Mantovani; H Oliart-Guzmán; A C Martins; A M Braña; F L C C Branco; J A Filgueira-Júnior; A P Santos; T S Araújo; C S M Oliveira; A A Ramalho; P T Muniz; C T Codeço; M da Silva-Nunes Journal: Ecohealth Date: 2016-09-15 Impact factor: 3.184
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Authors: G Adamker; T Holzer; I Karakis; M Amitay; E Anis; S R Singer; Z Barnett-Itzhaki Journal: Epidemiol Infect Date: 2018-06-08 Impact factor: 4.434