Risk factors for severe cholera among children under five in rural and urban Bangladesh, 2000-2008: a hospital-based surveillance study

• Published in: PloS one 2013-01, Vol.8 (1), p.e54395-e54395
• Main Authors: Colombara, Danny V, Cowgill, Karen D, Faruque, Abu S G
• Format: Article
• Language: English
• Subjects: Bangladesh; Biology; Breast feeding; Breastfeeding & lactation; Child; Child health; Child, Preschool; Children; Cholera; Cholera - epidemiology; Cholera - physiopathology; Confidence intervals; Consent; Diarrhea; Diarrhea - complications; Disease; Drinking water; Economics, Hospital; Education; Families & family life; Family Characteristics; Female; Hospitals; Households; Humans; Infant; Infections; Male; Medical research; Medicine; Pathogens; Patients; Poisson density functions; Public health; Risk analysis; Risk Factors; Risk reduction; Rural areas; Rural Health - economics; Socioeconomic Factors; Socioeconomics; Statistical analysis; Studies; Supplements; Surveillance; Systematic review; Urban areas; Urban Health - economics; Vibrio cholerae; Viruses; Vitamin A; Waterborne diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0054395

Children under five bear the largest cholera burden. We therefore sought to identify modifiable risk factors among Bangladeshi children. We used multivariate Poisson regression to assess risk factors for severe cholera among diarrheal patients presenting at hospitals in Matlab (rural) and Dhaka (urban), Bangladesh. Risk increased with age. Compared to those under one, rural and urban four-year-olds had adjusted risk ratios (aRR) of 4.17 (95% confidence interval (CI) 2.43-7.15) and 6.32 (95% CI: 4.63-8.63), respectively. Breastfeeding halved the risk in both rural (aRR = 0.49, 95% CI: 0.35-0.67) and urban (aRR = 0.51, 95% CI: 0.41-0.62) settings. Rural children's risk decreased with maternal education (P-trend: 84 USD/month. Increasing age, lower socioeconomic status, and lack of breastfeeding are key correlates of increased risk for cholera hospitalization among those under five in rural and urban Bangladesh. In addition, having a family member with diarrhea in the past week was associated with increased risk among rural children. Continued attention should be directed to the promotion of breastfeeding. Further research is needed to elucidate the relationship between maternal education and cholera risk. Renewed research regarding the use of chemoprophylaxis among family members of cholera cases may be warranted in rural endemic settings.