A hierarchical model for studying risk factors for childhood diarrhoea: a case-control study in a middle-income country.


Ferrer, SR; Strina, A; Jesus, SR; Ribeiro, HC; Cairncross, S; Rodrigues, LC; Barreto, ML; (2008) A hierarchical model for studying risk factors for childhood diarrhoea: a case-control study in a middle-income country. International journal of epidemiology, 37 (4). pp. 805-15. ISSN 0300-5771 DOI: 10.1093/ije/dyn093

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Abstract

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.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Centre for Global Non-Communicable Diseases (NCDs)
Vaccine Centre
PubMed ID: 18515864
Web of Science ID: 257963500023
URI: http://researchonline.lshtm.ac.uk/id/eprint/7527

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