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Case–control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection
Summary Objectives Between January and March of 2006, over 35 000 diarrhea cases and 532 deaths were reported among children aged
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| Published in: | International journal of infectious diseases 2010-11, Vol.14 (11), p.e1002-e1007 |
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| container_end_page | e1007 |
| container_issue | 11 |
| container_start_page | e1002 |
| container_title | International journal of infectious diseases |
| container_volume | 14 |
| creator | Arvelo, Wences Kim, Andrea Creek, Tracy Legwaila, Ketumetse Puhr, Nancy Johnston, Stephanie Masunge, Japhter Davis, Margarett Mintz, Eric Bowen, Anna |
| description | Summary Objectives Between January and March of 2006, over 35 000 diarrhea cases and 532 deaths were reported among children aged |
| doi_str_mv | 10.1016/j.ijid.2010.06.014 |
| format | article |
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We conducted an investigation to characterize the outbreak, identify risk factors for diarrhea, and recommend control strategies. Methods We enrolled children <5 years of age presenting to the emergency department between March 2 and March 20, 2006. Cases had ≥3 loose stools per day and no antecedent diarrhea among household members. Controls had had no diarrhea since January 1, 2006. We conducted a multivariate logistic regression analysis controlling for socioeconomic status, age, and maternal HIV status. Results Forty-nine cases with median age of 12 months (range 0–45 months) and 61 controls with median age of 24 months (range 0–59 months) were enrolled; 33 (30%) were born to HIV-positive mothers. Case-parents were more likely to report storing household drinking water (adjusted odds ratios (AOR) 3.9, 95% confidence interval (CI) 1.2–15.7). Lack of hand washing after using the toilet or latrine (AOR 4.2, 95% CI 1.1–20.4) was more likely to be reported by case-parents. Case-children were less likely to be currently breastfeeding (AOR 30.3, 95% CI 2.0–1000.0). Five (10%) case-patients and no control-patients died. Multiple causal pathogens were identified. Conclusions During this diarrhea outbreak in a country with a national program to prevent mother-to-child transmission of HIV, ill children were less likely to be breastfed and more likely to have been exposed to environmental factors associated with fecal contamination. These findings underscore the importance of adequate access to safe water, sanitation, hygiene, and nutrition education among populations using breast milk substitutes.</description><identifier>ISSN: 1201-9712</identifier><identifier>EISSN: 1878-3511</identifier><identifier>DOI: 10.1016/j.ijid.2010.06.014</identifier><identifier>PMID: 20932791</identifier><language>eng</language><publisher>Canada: Elsevier Ltd</publisher><subject>Botswana ; Botswana - epidemiology ; Breast Feeding ; Breastfeeding ; Case-Control Studies ; Child, Preschool ; Confidence Intervals ; Diarrhea ; Diarrhea - complications ; Diarrhea - epidemiology ; Disease Outbreaks ; HIV ; HIV Infections - complications ; HIV Infections - epidemiology ; Humans ; Hygiene ; Infant ; Infant Formula ; Infant, Newborn ; Infectious Disease ; Logistic Models ; Odds Ratio ; Outbreak ; Prevalence ; Pulmonary/Respiratory ; Replacement feeding ; Risk Factors ; Sanitation ; Water Supply</subject><ispartof>International journal of infectious diseases, 2010-11, Vol.14 (11), p.e1002-e1007</ispartof><rights>2010</rights><rights>Copyright © 2010. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c454t-7c4c41ba882a83adb0b53cd215a34176e9fa901e4a718615f1bf9339543314e3</citedby><cites>FETCH-LOGICAL-c454t-7c4c41ba882a83adb0b53cd215a34176e9fa901e4a718615f1bf9339543314e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1201971210024574$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,778,782,3538,27911,27912,45767</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20932791$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arvelo, Wences</creatorcontrib><creatorcontrib>Kim, Andrea</creatorcontrib><creatorcontrib>Creek, Tracy</creatorcontrib><creatorcontrib>Legwaila, Ketumetse</creatorcontrib><creatorcontrib>Puhr, Nancy</creatorcontrib><creatorcontrib>Johnston, Stephanie</creatorcontrib><creatorcontrib>Masunge, Japhter</creatorcontrib><creatorcontrib>Davis, Margarett</creatorcontrib><creatorcontrib>Mintz, Eric</creatorcontrib><creatorcontrib>Bowen, Anna</creatorcontrib><title>Case–control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection</title><title>International journal of infectious diseases</title><addtitle>Int J Infect Dis</addtitle><description>Summary Objectives Between January and March of 2006, over 35 000 diarrhea cases and 532 deaths were reported among children aged <5 years in Botswana. We conducted an investigation to characterize the outbreak, identify risk factors for diarrhea, and recommend control strategies. Methods We enrolled children <5 years of age presenting to the emergency department between March 2 and March 20, 2006. Cases had ≥3 loose stools per day and no antecedent diarrhea among household members. Controls had had no diarrhea since January 1, 2006. We conducted a multivariate logistic regression analysis controlling for socioeconomic status, age, and maternal HIV status. Results Forty-nine cases with median age of 12 months (range 0–45 months) and 61 controls with median age of 24 months (range 0–59 months) were enrolled; 33 (30%) were born to HIV-positive mothers. Case-parents were more likely to report storing household drinking water (adjusted odds ratios (AOR) 3.9, 95% confidence interval (CI) 1.2–15.7). Lack of hand washing after using the toilet or latrine (AOR 4.2, 95% CI 1.1–20.4) was more likely to be reported by case-parents. Case-children were less likely to be currently breastfeeding (AOR 30.3, 95% CI 2.0–1000.0). Five (10%) case-patients and no control-patients died. Multiple causal pathogens were identified. Conclusions During this diarrhea outbreak in a country with a national program to prevent mother-to-child transmission of HIV, ill children were less likely to be breastfed and more likely to have been exposed to environmental factors associated with fecal contamination. These findings underscore the importance of adequate access to safe water, sanitation, hygiene, and nutrition education among populations using breast milk substitutes.</description><subject>Botswana</subject><subject>Botswana - epidemiology</subject><subject>Breast Feeding</subject><subject>Breastfeeding</subject><subject>Case-Control Studies</subject><subject>Child, Preschool</subject><subject>Confidence Intervals</subject><subject>Diarrhea</subject><subject>Diarrhea - complications</subject><subject>Diarrhea - epidemiology</subject><subject>Disease Outbreaks</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - epidemiology</subject><subject>Humans</subject><subject>Hygiene</subject><subject>Infant</subject><subject>Infant Formula</subject><subject>Infant, Newborn</subject><subject>Infectious Disease</subject><subject>Logistic Models</subject><subject>Odds Ratio</subject><subject>Outbreak</subject><subject>Prevalence</subject><subject>Pulmonary/Respiratory</subject><subject>Replacement feeding</subject><subject>Risk Factors</subject><subject>Sanitation</subject><subject>Water Supply</subject><issn>1201-9712</issn><issn>1878-3511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNp9Uk1v1DAQjRCIlsIf4IB845TFEztfEkJCK6CVKnGg4mo59mTjbGIvttNqb_wHDv1__SU42sKBAyd7xu-9kd-bLHsNdAMUqnfjxoxGbwqaGrTaUOBPsnNo6iZnJcDTdE9PeVtDcZa9CGGklPKqap5nZwVtWVG3cJ7db2XAh5-_lLPRu4mEuOgjiY5ojOhnY5F4E_aklyo6H0jvPNFGej-gJHJ2dkfUYCbt0RK9eJNqSSbpd0jcEjuPck-MTT3lljThSO5MHFI5mN1ADh5v5YRWJXBPLq--J2iPKhpnX2bPejkFfPV4XmQ3nz_dbC_z669frrYfr3PFSx7zWnHFoZNNU8iGSd3RrmRKF1BKxqGusO1lSwG5rKGpoOyh61vG2pIzBhzZRfb2JHvw7seCIYrZBIXTJC26JYi6qSkvG6gSsjghlXcheOzFwZtZ-qMAKtY4xCjWOMQah6CVSHEk0ptH-aWbUf-l_PE_Ad6fAJj-eGvQi6DMaog2PhkhtDP_1__wD11Nxholpz0eMYxu8Ta5J0CEQlDxbV2IdR-A0oKXNWe_AeV2sx4</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>Arvelo, Wences</creator><creator>Kim, Andrea</creator><creator>Creek, Tracy</creator><creator>Legwaila, Ketumetse</creator><creator>Puhr, Nancy</creator><creator>Johnston, Stephanie</creator><creator>Masunge, Japhter</creator><creator>Davis, Margarett</creator><creator>Mintz, Eric</creator><creator>Bowen, Anna</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101101</creationdate><title>Case–control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection</title><author>Arvelo, Wences ; Kim, Andrea ; Creek, Tracy ; Legwaila, Ketumetse ; Puhr, Nancy ; Johnston, Stephanie ; Masunge, Japhter ; Davis, Margarett ; Mintz, Eric ; Bowen, Anna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c454t-7c4c41ba882a83adb0b53cd215a34176e9fa901e4a718615f1bf9339543314e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Botswana</topic><topic>Botswana - epidemiology</topic><topic>Breast Feeding</topic><topic>Breastfeeding</topic><topic>Case-Control Studies</topic><topic>Child, Preschool</topic><topic>Confidence Intervals</topic><topic>Diarrhea</topic><topic>Diarrhea - complications</topic><topic>Diarrhea - epidemiology</topic><topic>Disease Outbreaks</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - epidemiology</topic><topic>Humans</topic><topic>Hygiene</topic><topic>Infant</topic><topic>Infant Formula</topic><topic>Infant, Newborn</topic><topic>Infectious Disease</topic><topic>Logistic Models</topic><topic>Odds Ratio</topic><topic>Outbreak</topic><topic>Prevalence</topic><topic>Pulmonary/Respiratory</topic><topic>Replacement feeding</topic><topic>Risk Factors</topic><topic>Sanitation</topic><topic>Water Supply</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arvelo, Wences</creatorcontrib><creatorcontrib>Kim, Andrea</creatorcontrib><creatorcontrib>Creek, Tracy</creatorcontrib><creatorcontrib>Legwaila, Ketumetse</creatorcontrib><creatorcontrib>Puhr, Nancy</creatorcontrib><creatorcontrib>Johnston, Stephanie</creatorcontrib><creatorcontrib>Masunge, Japhter</creatorcontrib><creatorcontrib>Davis, Margarett</creatorcontrib><creatorcontrib>Mintz, Eric</creatorcontrib><creatorcontrib>Bowen, Anna</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arvelo, Wences</au><au>Kim, Andrea</au><au>Creek, Tracy</au><au>Legwaila, Ketumetse</au><au>Puhr, Nancy</au><au>Johnston, Stephanie</au><au>Masunge, Japhter</au><au>Davis, Margarett</au><au>Mintz, Eric</au><au>Bowen, Anna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Case–control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection</atitle><jtitle>International journal of infectious diseases</jtitle><addtitle>Int J Infect Dis</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>14</volume><issue>11</issue><spage>e1002</spage><epage>e1007</epage><pages>e1002-e1007</pages><issn>1201-9712</issn><eissn>1878-3511</eissn><abstract>Summary Objectives Between January and March of 2006, over 35 000 diarrhea cases and 532 deaths were reported among children aged <5 years in Botswana. We conducted an investigation to characterize the outbreak, identify risk factors for diarrhea, and recommend control strategies. Methods We enrolled children <5 years of age presenting to the emergency department between March 2 and March 20, 2006. Cases had ≥3 loose stools per day and no antecedent diarrhea among household members. Controls had had no diarrhea since January 1, 2006. We conducted a multivariate logistic regression analysis controlling for socioeconomic status, age, and maternal HIV status. Results Forty-nine cases with median age of 12 months (range 0–45 months) and 61 controls with median age of 24 months (range 0–59 months) were enrolled; 33 (30%) were born to HIV-positive mothers. Case-parents were more likely to report storing household drinking water (adjusted odds ratios (AOR) 3.9, 95% confidence interval (CI) 1.2–15.7). Lack of hand washing after using the toilet or latrine (AOR 4.2, 95% CI 1.1–20.4) was more likely to be reported by case-parents. Case-children were less likely to be currently breastfeeding (AOR 30.3, 95% CI 2.0–1000.0). Five (10%) case-patients and no control-patients died. Multiple causal pathogens were identified. Conclusions During this diarrhea outbreak in a country with a national program to prevent mother-to-child transmission of HIV, ill children were less likely to be breastfed and more likely to have been exposed to environmental factors associated with fecal contamination. These findings underscore the importance of adequate access to safe water, sanitation, hygiene, and nutrition education among populations using breast milk substitutes.</abstract><cop>Canada</cop><pub>Elsevier Ltd</pub><pmid>20932791</pmid><doi>10.1016/j.ijid.2010.06.014</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal of infectious diseases, 2010-11, Vol.14 (11), p.e1002-e1007 |
| issn | 1201-9712 1878-3511 |
| language | eng |
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| source | BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS; ScienceDirect Journals |
| subjects | Botswana Botswana - epidemiology Breast Feeding Breastfeeding Case-Control Studies Child, Preschool Confidence Intervals Diarrhea Diarrhea - complications Diarrhea - epidemiology Disease Outbreaks HIV HIV Infections - complications HIV Infections - epidemiology Humans Hygiene Infant Infant Formula Infant, Newborn Infectious Disease Logistic Models Odds Ratio Outbreak Prevalence Pulmonary/Respiratory Replacement feeding Risk Factors Sanitation Water Supply |
| title | Case–control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection |
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